Falls πΆββοΈ
Clinical guide for assessing and managing patient falls. Head injury assessment, fracture evaluation, syncope workup, and falls prevention for on-call doctors.
π What to Ask on the Phone
- Was the fall witnessed or unwitnessed?
- Any headstrike, loss of consciousness or collapse?
- Is the patient anticoagulated?
- Can the patient mobilise now?
- Any signs of pain, bleeding, confusion or injury?
- Vitals at the time of the fall?
π Immediate Considerations
- Was this a mechanical trip/slip or a medical event (e.g. syncope, seizure)?
- Check for red flags: vomiting, confusion, GCS <15, abnormal vitals
- Look for signs of head injury, fracture, bleeding or sepsis
- Check medication chart for anticoagulants or sedatives
- Collateral history β always try to get this!
π§ͺ Initial Assessment
- ABCDE + full set of vitals including CRT
- GCS / neuro exam: lateralising signs? speech?
- CBG (hypoglycaemia can present as fall)
- ECG: if collapse/syncope suspected or rhythm unclear
- Lying/standing BP if ?orthostatic cause
- CT Brain only if LOC, headstrike, or neuro signs
- X-ray if fracture suspected
π©Ή Management
- Analgesia β start regular, not just PRN
- Neuro obs if head injury or uncertain neuro status
- Wounds: clean and dress lacerations, close if required
- Reassure patient and nursing team
- Consider need for close supervision or specialing
π Preventing Further Falls
- Review meds (e.g. sedatives, antihypertensives)
- Falls signage, assistive devices in reach
- Multidisciplinary team input (physio, OT)
- Check for delirium or sepsis as underlying cause
β Actions for Interns
- Document clear Hx and examination (incl. collateral)
- Include body chart if any injuries noted
- State your clinical impression (mechanical vs. medical)
- Propose care plan (e.g. analgesia, supervision, physio)
- Complete relevant section of clinical incident form
Note Template
Ready-to-use clinical note structure
π 26 / 05 / 2026 β 12:26 ATRP re: fall from bed / standing Patient: [age] [sex] Admission Dx: [reason for admission] PMHx: [esp. anticoagulation, dementia, mobility issues] π§Ύ Hx: β’ Witnessed? [yes/no] β’ Mechanism: [slip / trip / collapse / loss of consciousness] β’ Head strike / confusion / pain β’ Medications: [anticoagulants / sedatives] π©Ί Exam: β’ Vitals: HR __ BP __ Temp __ RR __ β’ GCS: __ Pupils: __ Neuro signs: [present / absent] β’ Head wound / limb injury / tenderness β’ Abdo / chest exam if indicated π Impression: Likely cause: [mechanical / syncope / ?injury] π Plan: β’ Neuro obs if head injury β’ CTB if LOC / anticoagulated / neuro Ξ β’ Wound care / pain relief β’ Body chart + incident form β’ Escalate if injuries / deterioration π€ [Your Name], [Role] IMC: _______