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Now that is a useful clinical pearl....not exactly 100% discriminatory....but
part of ones gestault.
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of DAVID FLETCHER
Sent: 20 February 2008 11:13
To: [log in to unmask]
Subject: Re: A proper question.
One clue that I always use is to locate the appropriate head
injury. If you find the injury on the front of the head it's likely to be a
trip.
If the injury is to the back of the head its much much more
likely to be a collapse, vaso-vagal, hyotensive event, alcohol, Mobitz
type 2, cardiac arrest etc.
Not foolproof I know as I have known cardiac arrest victims
to go down flat on their face, but I never believe a patient who tells me
that 'they tripped' when they present with a scalp wound over the occiput. When
you quiz them these patients always have some part of the story missing.
Regards
Dave Fletcher
Rowley Cottingham <[log in to unmask]> wrote:
One of the most important questions that needs answering after a fall in
the elderly was whether it was a genuin! e trip and fall or a collapse. The
trip and fall is a relatively benign condition and you simply need to
deal with the consequences, but of course if someone collapses there may
be important pathology to deal with. Has anyone come up with a
satisfactory line of questioning to distinguish the two? I have thought
that the presence of antegrade and impact amnesia would be a useful
discriminator, but I recently saw an otherwise fit elderly man who is
certain he tripped over a piece of scaffolding that stuck out but has no
witnesses, and can't remember the incident. He can remember everything up
to that moment as he was preparing his car for a journey, but can't
remember falling or hitting the ground, just waking up on the ground. I
strongly suspect he blacked out and collapsed. Is there any evidence out
there?
/Rowley./
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