Found on the floor at 06:00

An 88-year-old found on her bedroom floor by her carer, unable to say how long she had been there. Nine regular medications. Admitted 'for a social sort-out'.

88-year-old womanAcute medical unit, bed 3Fictitious educational patient

HypertensionType 2 diabetesAtrial fibrillation on apixabanOsteoarthritisPrevious fall 4 months agoLives alone with a morning carer

Day 0 · 09:30

The clerking

She is bruised on the left hip and shoulder, cold, and embarrassed. She says she 'just went over' getting up to the toilet in the night. Her carer says she has fallen twice this month and did not tell anyone. The referral says 'mechanical fall, social admission'.

Vitals

HR58BP108/62RR18SpO295%T35.6

History

Before, during, after?: Got up in the dark; felt 'swimmy' on standing; next thing she was on the floor. No chest pain, no palpitations, no incontinence, no tongue biting. On the floor about four hours; could not get up.
Medications?: Amlodipine, bisoprolol, ramipril, doxazosin, gliclazide, metformin, apixaban, codeine at night for the knees, and a temazepam she has taken 'for years'.
Vision, feet, home?: Cataract on the right, awaiting surgery. Slippers with no backs. Rugs in the hall. No rails on the stairs.

What is wrong with the phrase 'mechanical fall', and what is the most important next step?

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