Fall
A streamlined, differential-led presentation for rapid clinical review.
Twenty-second review
- A fall may be a mechanical injury or the visible result of syncope, stroke, seizure, infection, medication effect, or loss of mobility.
- Head strike, anticoagulation, new neurologic deficit, prolonged down time, or inability to weight-bear raises concern for occult serious injury.
- Keep syncope in the differential; overlapping or concurrent illness remains possible.
- For fall, trends and combinations of findings are more informative than one isolated vital sign.
Compare the clinical patterns
The repeated material is grouped inside each possibility. Open only the condition you need.
Intracranial hemorrhageTime-sensitive high-risk possibility
HPI
Clarify cause/mechanism; mechanical vs medical; head strike.
Signs & symptoms
Head strike, anticoagulant use, vomiting, focal deficit, or declining GCS.
Focused exam
Expose only as needed, inspect and palpate systematically, and document distal circulation, sensation, and movement; Reassess pain, swelling, perfusion, and neurologic status after movement or intervention.
Brief pathophysiology
Intracranial hemorrhage may cause fall through a time-sensitive process capable of rapid physiological deterioration.
What the trend may show
Hemorrhage is a trend diagnosis: tachycardia and narrowing pulse pressure may precede hypotension. Age, pregnancy, medications, and pacing can blunt expected responses.
Heart rate (bpm)
Often risesTachycardia is a common compensatory response but may be absent.
Pulse pressure (mmHg)
May narrowNarrowing pulse pressure can reflect reduced stroke volume.
Blood pressure (mmHg)
May fall lateA normal pressure does not exclude significant compensated hemorrhage.
MAP (mmHg)
May fallA falling trend supports worsening perfusion; interpret with mental status and skin signs.
Front-load in the triage report
- Intracranial hemorrhage: Head strike, anticoagulant use, vomiting, focal deficit, or declining GCS.
- Cause/mechanism?
- Mechanical vs medical?
Mechanical fallCommon presentation pattern
HPI
Clarify cause/mechanism; mechanical vs medical; head strike.
Signs & symptoms
Clear trip or slip with injuries matching the mechanism.
Focused exam
Expose only as needed, inspect and palpate systematically, and document distal circulation, sensation, and movement; Reassess pain, swelling, perfusion, and neurologic status after movement or intervention.
Brief pathophysiology
Mechanical fall may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.
What the trend may show
Isolated injury may have normal observations. Serial heart rate, pressure, respiratory status, and oxygenation help identify occult hemorrhage or thoracic injury.
Heart rate (bpm)
May risePain, distress, and hemorrhage can increase rate; medications can blunt it.
Blood pressure (mmHg)
May fall lateA normal pressure does not exclude compensated hemorrhage.
Respiratory rate (breaths/min)
Trend rate / effortTachypnea may reflect pain, thoracic injury, shock, or acidosis.
Oxygen saturation (SpO₂)
Usually preservedLow saturation suggests thoracic injury, hypoventilation, or concurrent disease.
Front-load in the triage report
- Clear trip or slip with injuries matching the mechanism.
- Cause/mechanism?
- Mechanical vs medical?
SyncopeImportant alternative presentation
HPI
Clarify cause/mechanism; mechanical vs medical; head strike.
Signs & symptoms
Transient cerebral hypoperfusion may precede the fall and changes the risk assessment.
Focused exam
Expose only as needed, inspect and palpate systematically, and document distal circulation, sensation, and movement; Reassess pain, swelling, perfusion, and neurologic status after movement or intervention.
Brief pathophysiology
Syncope can resemble fall through overlapping symptoms or referred physiology despite a different primary mechanism.
What the trend may show
Isolated injury may have normal observations. Serial heart rate, pressure, respiratory status, and oxygenation help identify occult hemorrhage or thoracic injury.
Heart rate (bpm)
May risePain, distress, and hemorrhage can increase rate; medications can blunt it.
Blood pressure (mmHg)
May fall lateA normal pressure does not exclude compensated hemorrhage.
Respiratory rate (breaths/min)
Trend rate / effortTachypnea may reflect pain, thoracic injury, shock, or acidosis.
Oxygen saturation (SpO₂)
Usually preservedLow saturation suggests thoracic injury, hypoventilation, or concurrent disease.
Front-load in the triage report
- Transient cerebral hypoperfusion may precede the fall and changes the risk assessment.
- Cause/mechanism?
- Mechanical vs medical?
Findings that should escalate concern
- Head strike or loss of consciousness
- Anticoagulant use
- New neurologic deficit
- Inability to weight-bear
- Head strike, anticoagulation, new neurologic deficit, prolonged down time, or inability to weight-bear raises concern for occult serious injury.
- Intracranial hemorrhage: Head strike, anticoagulant use, vomiting, focal deficit, or declining GCS.
Medication recognition
Continue the clinical pathway
Clinical and academic sources
Curated clinical guidance and peer-reviewed evidence supporting this presentation. Current BCEHS guidance, medical direction, and local policy remain authoritative for practice.
BCEHS Handbook — specific CPGs
- H01: Principles of Major TraumaBC Emergency Health Services Handbook
Official BCEHS clinical practice guidance for principles of major trauma.
- H03: Head TraumaBC Emergency Health Services Handbook
Official BCEHS clinical practice guidance for head trauma.
Supporting clinical and academic evidence
- CEDIS Presenting Complaint List updateCanadian Association of Emergency Physicians
Presenting-complaint terminology and categorization context. It does not establish a prehospital “top 100” ranking.
- Major trauma: assessment and initial managementNational Institute for Health and Care Excellence
Evidence-based initial assessment, hemorrhage control, imaging, and trauma-system guidance.
- World guidelines for falls prevention and management for older adults: a global initiativeAge and Ageing · 2022
Fall-risk assessment, injury review, multifactorial contributors, and prevention in older adults.