"Chief Complaints" I hate to see, Part 1: Fall from standing.

There's quite a few of these, so I thought I'd separate them into parts...

One of the "Chief Complaints" that really makes me cringe is when I see it on a chart is any patient over 80 years old with "Fall from standing."  If you're over 80, apparently, standing is a dangerous activity.  You wouldn't believe how many people over 80 years old fall from standing.  It's usually never a good thing, either.  It's usually at least a broken hip, broken ribs, intracranial bleed, or something else just as bad.

• Broken hips lead to deep vein thromboses that progress to pulmonary embolisms 
• Rib fractures or rib contusions rapidly progress to pneumonia; and full blown pneumonia in the elderly is never a good thing
• Intracranial bleeding is never a good thing in any patient, but in the elderly usually leads to permanent impairment

Even if these patients survive the initial injury; it's quite often the initiating event that leads to a rapid decomposition in this patient population.  I can't tell you how many elderly patients show up in the Emergency Room on death's doorstep that were "completely normal 3 months ago before he fell."

They tend to not do well...

I remember my first year out of residency.  It was the middle of January and I picked up a chart; "Fall from standing,"  "Hip pain,"  "87yo F."  And, of course, I thought, "this poor woman, her life is slowly beginning to end..."  Needless to say I was pleasantly shocked and surprised when I walked in the room... This very sweet woman was sitting in a chair in the room reading the newspaper.  As I walked into the room after knocking, she peered at me over the rim of her reading glasses and over the top edge of the newspaper...

She had been skiing in Colorado with her family 2 weeks prior to her emergency room visit, teaching her newest grandson how to ski...  She slipped and fell and hurt her right hip.  She came to the emergency room because it was still hurting after 2 weeks and wanted to get it checked out.  She was also more than a bit irritated at herself, because she didn't fall skiing down the hill; she fell while level skiing to the condo they were staying in after a full day of skiing when her ski hit a dry patch of dirt...