Assignment
Case Study - Emergency Medicine
An 83-year-old female with a history of Hypertension, Dyslipidemia, Paroxysmal Atrial Fibrillation, Osteoporosis, Parkinson Disease, Allergic Rhinitis, Osteoarthritis, and Insomnia presents to the ED via EMS with pain in her right leg. The patient's husband states she has been having more trouble walking lately and has been falling more, and states she fell in the house about an hour ago. No history of surgeries and no medication allergies. She does not smoke and does not use alcohol or other drugs. IV access was established in ambulance. Patient is alert and oriented x 3. She rates the pain in her right leg as a 10 out of 10. Physical exam shows tremor in bilateral hands; two green bruises on left upper arm, one purple bruise on right forearm, one greenish-yellow bruise left thigh, bilateral hip exams without abnormality; right lower leg with erythema and swelling starting mid-calf and extending to the right lateral malleolus with exquisite tenderness over right lateral malleolus; she is unable to bear weight on the right leg.
Current Medications:
Lisinopril 20 mg po every morning
Simvastatin 10 mg po every morning
Toprol XL 25 mg po every morning
Eliquis 5 mg po twice daily
Boniva 150 mg po monthly
Sinemet 25mg/100mg 1 tab po three times daily
Benadryl 25 mg po every morning
Ibuprofen 400 mg po twice daily
Ambien 10 mg po every night before bed
Vitals/Tests:
T 96.8, BP 103/62, P 110 and regular, R 20 and unlabored, SpO2 97% RA.
Blood sugar fingerstick 112.
ECG shows normal sinus rhythm.
Right LE venous ultrasound negative.
Right knee, ankle, and foot xrays negative for fractures.
CBC and CMP all within normal limits.
Task
a) What is contributing to falls?
b) What could be done to prevent falls?
c) What treatments would you order in the ED, if any, and why?
d) What medication changes would you make, if any, and why?
e) What referrals would you make?