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I don’t think I want Dave investigating any crime scene where I am the accused! Jonathan Marrow’s comment that the Colles fracture suggests a fall works unless you have Parkinson’s Disease where they can’t reach out fast enough. People can slip backwards, particularly if they use a stick on the same side as the weak leg. They put themselves off balance and cannot break the fall because they are holding the stick. I read somewhere that an interesting sign of diminished brain function is the person who stops walking to say something – their brain can’t do two things simultaneously. These individuals realise they are falling but ht the ground before they realise can think through the action needed to break their fall.

 

Another cause of falls is podiatric problems, the painful foot, the pes planus causing plantar fasciitis, the untended onchogryphosis, the hard corns etc. all reduce stability. These people tend to fall backwards as they try to keep their weight off the forefoot.

 

I agree the history is the key to what went on, but you need to know what the paramedics and relatives found on scene and find the time to listen to the full story from the patient – who will delight at spinning it out – after all they like being the centre of attention and they really do have all day!

 

Vic Calland

 

-----Original Message-----
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 genuine 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./