Could this be sepsis?
What paperwork can help guide detection of sepsis?
The Sepsis Pathway
Name three major injuries that could be sustained from a fall?
Head injury
Hip/lower limb fracture
Shoulder/upper limb fracture
Spinal injury
Provide a definition of a "fall"
“A fall is an event which results in a person coming to rest inadvertently on the ground or floor or other lower level”
- Clinical Excellence Commission 2026
What are potential neurological/cognitive causes of a fall?
- confusion leading to impulsivity (dementia, delirium)
- intracranial haemorrhage
- stroke
- seizure
What are the requirements for documenting and assessing risk of a fall?
- OMS falls risk screen within 8 hours of admission to ward/change in clinical condition
- Documented falls prevention strategies in place
Which patients are particularly at risk of sepsis?
- older patients
- patient with invasive devices
- patients with known infections
- neutropenic patients
How would you assess for upper limb injury?
- Ask the patient about pain at rest and on movement
- Compare left and right arms and shoulders for obvious difference - deformity, swelling, bruising
- Inspect both upper limbs for bruising/lacerations
- Compare both arms for strength difference - compare to baseline
What are the minimum requirements for post-falls observations?
General and Neurological observations
- Hourly for four hours
- 4th hourly for 24 hours
Increase frequency as indicated.
What are some cardiac causes of fall, and how could you detect these?
- ACS
- arrhythmias leading to syncopal event
- syncope caused by cardiac mechanism (e.g. heart failure)
- Detect via assessment for chest pain, dizziness, palpitations, pre-syncopal symptoms, ECG, use of cardiac medications
Who should have a FRAMP be completed?
- Patients with risk of falling
What are some signs someone who has fallen might have sepsis?
- fever
- new confusion or changed behaviour
- dizziness before falling/hypotension
- any sign of organ dysfunction
How would you assess lower limbs for injury (pelvis and legs)?
- Ask patient about pain in the pelvis, hips, legs on movement and at rest
- Inspect both limbs for bruising, bleeding, lacerations
- Assess strength of each limb
- Compare both limbs for change in appearance - deformity, rotation, shortening
There are three questions that our assessment data should aim to answer after a fall - what are they?
1) How/why did the fall happen?
2) What is the level of injury post-fall?
3) How do we prevent it from occurring again?
Perform a full set of neurological observations
Why is it crucial to perform these for every patient that falls, for at least 24 hours?
Correctly perform:
1) GCS
2) pupil assessment
3) limb strength assessment
Intracranial haemorrhage that caused or was sustained during the fall can change over time and symptoms can emerge several hours later.
What are the documentation requirements post-fall?
- OMS reattended
- FRAMP reattended
- Referral to appropriate allied health
- Thorough assessment documented
- Post Fall form
- IMS
How might sepsis cause a fall?
- confusion causing impulsivity
- hypotension
- hypoxia
- general weakness/fatigue/imbalance
- tripping on invasive devices
How would you assess for spinal injury (back & neck)?
- Gentle palpation of the spine
- ask the patient about pain in the neck/back
- log roll the patient and check for bruises/lacerations
- ask the patient about altered sensation in the limbs (numbness/tingling)
- Ask about new limb weakness
A) How could a stroke cause a fall?
B) How would you detect potential stroke?
A) causes:
- interrupted blood flow to the brain through wither bleeding or embolus
- sudden loss of balance, limb strength
- confusion
B) detection:
- Full neurological observations
- BE FAST assessment - unilateral numbness, weakness; facial asymetry; sudden mobility/balance changes; vision changes; speech changes; sudden confusion; sudden headache
Who should be communicated with after a patient falls?
- medical officer for clinical review/MERT
- team leader/NUM
- anyone required to assist gathering equipment/help perform transfer
- patient's family/carer
- nursing team at large
How will you mobilise someone with
A) suspected spinal injury
B) suspected upper limb injury
C) suspected lower limb injury
A) Apply neck brace if required, log roll onto spinal board, transfer via hoverjack and hovermat to bed until injury confirmed/ruled out and mobility restrictions documented
B) Transfer with required mobility aids - belt, hoist, hover mat/jack as required
C) Use hoverjack/may to return to bed, do not mobilise until injury confirmed/ruled out and mobility restrictions confirmed
What are signs and symptoms of an intracranial injury?
- Change in neurological status from baseline immediately/hours later
- Vomiting, nausea immediately/hours later
- Headache immediately/hours later
- Change in behaviour immediately/hours later