Clinical Examination

A “head-to-toe” examination which incorporates all of the major body systems can ensure a comprehensive approach to examining a patient for pathologies that are causative or a consequence of the fall.

  Examination features
Head CNS:Level of consciousness – GCS, AVPUPupils equal and reactive? (PEARL)Facial weakness, slurred speech, posterior fossa signs (?CVA), evidence of head injury (eg. scalp laceration, Battle’s sign)ENT:Haemotympanum?
Neck  Suspicion of c-spine injury? (Kannus et al, 2019)
Chest Respiratory;Increased breathing effort?Dullness?Crepitations? (pneumonia?)Cardiovascular;Murmur? (eg. Aortic stenosis)Pulse? (arrhythmia?)Blood pressure? (eg. Septic shock, dehydration following fall)Musculoskeletal;Evidence of rib fractures? (eg. Increased mobility of ribs, crepitus)
Abdomen Gastrointestinal;Abdominal tenderness?Genitourinary;Distended bladder? (eg. urinary retention)
Hips Musculoskeletal;Fractured neck of femur? (eg. Reduced mobility of hip flexors, shortened and externally rotated leg)
Limbs (arms, legs) Neurological;Weakness? (eg. CVA)Increased tone? (eg. CVA)Hyper-reflexia? (upper motor neuron pathology)Poor coordination? (eg. Cerebellar pathology)Stable gait?Musculoskeletal;Limb pain or swelling? Reduced mobility? (have them walk for 3 metres if appropriate – assess walking with their usual walking aid)
Back Musculoskeletal;Spinal tenderness / bruising / swelling; ?vertebral fracture, ?spinal cord injury

Learning Bite

Following a falls episode a comprehensive examination should be performed which looks at the patient from head-to-toe with examination of the many potentially affected body systems.

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