When someone falls, a number of things must be determined at once. The answers to some of these questions will make a difference in how we should respond:
Why did the patient fall?
If the person fell because of a cardiac or neurological problem, such as a heart attack, blood pressure drop, or stroke, injuries from the fall may be the least of our concerns. It is more important to recognize that a medical problem has occurred and respond appropriately. Any time a patient falls and is unconscious or cannot say what caused the fall, consider cardiac, circulatory, or neurological disorders as potential causes. Any of these might require immediate medical care to prevent further damage from occurring to the brain or heart. This kind of fall requires an emergency response, since death or permanent disability might result without rapid intervention.
If the patient fell because of an environmental hazard, the most urgent concern is removing the person from further danger and examining the scene to prevent more falls. A quick survey of the environment might reveal water on the floor or something else in the area that caused the fall.
What injuries have occurred?
Falls are responsible for many fatal brain injuries. Even a seemingly minor bump on the head can cause dangerous bruising or bleeding in the brain. Find out whether the patient lost consciousness, even for a moment, either before or after the fall.
Loss of consciousness before a fall indicates a medical condition that must be investigated. Loss of consciousness as a result of hitting the head during a fall indicates the possibility of severe brain injury, even if no signs of head trauma are visible. Symptoms of a serious head injury can be delayed, which is why patients should be monitored every two to three hours for at least 24 hours after any trauma to the head, as well as checked periodically thereafter for several days.
Knowing what injuries may have occurred dictates the response to the fall. The possibility of head and neck injuries and fractures should be assumed whenever a fall occurs. Unless the patient must be removed from danger, he or she should not be moved until a comprehensive assessment has been performed. Hip fractures, so common in the elderly, may not present any visible signs to the unaided eye. Many people insist on standing up after a fall, only to collapse when they put weight on a fractured hip or leg, which can cause further injury.
Source: This excerpt was taken from the book Evidence-Based Falls Prevention: A study guide for nurses by Carole Eldridge, MSN, RN, CNAA, BC. For more information about our latest nursing resources, visit hcmarketplace.com.