Witnesses, prodrome, loss of consciousness, head strike, time on floor
Baseline mobility/cognition, medications including anticoagulants/sedatives
Chest pain, palpitations, focal symptoms, urinary/respiratory infection symptoms
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← All presentations
Falls & Geriatric Trauma
A fall may be injury, syncope, medication harm, infection, or a sentinel loss of function.
Your objective: explain the approach, recognize important warning signs, then test your recall.
Abbreviations explained
- ACS
- Acute coronary syndrome
- OMI
- Occlusion myocardial infarction
- ECG
- Electrocardiogram
- PE
- Pulmonary embolism
- POCUS
- Point-of-care ultrasound
- QTc
- QT interval corrected for heart rate
- LBBB
- Left bundle branch block
- RBBB
- Right bundle branch block
- hs-cTn
- High-sensitivity cardiac troponin
- CTA
- Computed tomography angiography
- ICU
- Intensive care unit
Filter
The jobA fall may be injury, syncope, medication harm, infection, or a sentinel loss of function.
- Treat injury and ask why the fall happened: trip, collapse, dizziness, seizure, stroke, medication effect, or infection.
- Lower the threshold for head, cervical-spine, pelvic, and hip evaluation when examination or history is unreliable.
- Assess mobility, cognition, supports, medications, and ability to return safely before discharge.
Older adults can have major injury and serious medical precipitants after low-energy mechanisms.
Pain and examination may be muted; anticoagulation, frailty, baseline cognition, and safe disposition matter as much as the initial radiograph.
Intracranial hemorrhage Critical
Key: Head strike, anticoagulation, altered baseline, vomiting, or new neurologic symptom warrants a low imaging threshold and local pathway.
Hip/pelvic fracture Critical
Key: Persistent hip/groin pain or inability to bear weight can be occult despite normal initial radiographs.
Syncope/arrhythmia/ACS/stroke as precipitant Critical
Key: An unexplained fall may be transient loss of consciousness or neurologic event.
Cervical-spine injury Emergent
Key: Neck pain, neurologic symptoms, distracting injury, or unreliable assessment needs imaging per local rule/pathway.
Delirium, infection, medication toxicity, dehydration Emergent
Key: Often the cause of the fall and a marker of unsafe discharge.
Tick what your patient has — the banner updates as you go.
Full trauma and neurologic examination; skin for pressure injury
Orthostatic context only after urgent causes are considered
Gait/transfer assessment and delirium screen when safe
Immediate
- ECG, glucose, targeted labs; CT head/c-spine per risk and local pathway
- X-ray hip/pelvis; CT/MRI for persistent suspicion with negative radiographs
Targeted
- Urinalysis/cultures only when symptoms or systemic concern support infection testing
- Medication review and collateral history
Safety
- PT/OT, social work, caregiver communication, mobility aids, and falls-prevention referral where available
Medication safety reminder
Use this as a first-pass prompt; verify all medications, doses, concentrations, contraindications, weight, pregnancy status, and local protocols before administration.
Check indication, allergy, route, renal/hepatic risk, interactions, monitoring, and local formulary.
Discharge
- No serious injury/medical cause, safe ambulation or support plan, and explicit return precautions.
Admit / observation
- Occult-injury concern, functional decline, delirium, medical precipitant, or unsafe disposition.
Trauma / neurology / cardiology pathway
- Hemorrhage, fracture, syncope/arrhythmia, stroke, or significant trauma.
Use objective reassessment and the local pathway.
Before the next decision · reassess and hand over
Use these learning prompts with the presentation’s pathway. They are not discharge criteria.
- Reassess: compare symptoms, observations and examination with the initial assessment and response to treatment.
- Warning signs for Falls & Geriatric Trauma:
- Anticoagulation with head impact or neurologic change
- Inability to bear weight, severe hip/groin or neck pain
- Unwitnessed collapse, exertional fall, or prodromal palpitations/chest pain
- New delirium, hypotension, fever, or prolonged time on floor
- Unsafe home environment or no reliable observation
- Reconsider: check unresolved findings and alternative explanations, including the pitfalls below.
- Escalate: communicate deterioration, uncertainty or needs beyond the current setting.
- Plan the transition: identify outstanding results, responsibility for follow-up, patient understanding and specific return advice.
Clinical Pearls
- A successful ED disposition restores safety, not only normal vital signs.
- Frailty and anticoagulation lower the threshold for imaging and observation.
Pitfalls
- Calling it a mechanical fall without asking about prodrome or collapse.
- Using a negative X-ray to dismiss persistent inability to bear weight.
PRACTICE REFRESHER
Rapid recall
Test your first action and the dangerous diagnoses before revealing the answer.
01 · First move
Before you scroll, what needs to happen first?
Treat injury and ask why the fall happened: trip, collapse, dizziness, seizure, stroke, medication effect, or infection.
02 · Immediate threats
Name at least two diagnoses that cannot wait.
Intracranial hemorrhage · Hip/pelvic fracture · Syncope/arrhythmia/ACS/stroke as precipitant
PRIVATE TO THIS DEVICE
Your learning note
Capture a weak point, a teaching pearl, or a question to take to your next shift.
Review schedule starts when marked reviewed
Selected guidance · source check 2026-09-07. These 1 source links support selected teaching points, not a complete review of this topic. Check population, setting and local protocol before applying a recommendation.
- Rosen’s Emergency Medicine, 10th ed. — geriatric emergency and trauma care
- ACEP geriatric emergency-department resources; local head-injury pathways