Browse categories and answer follow-up questions to refine your symptom profile.
History
Event context
Event context
Fall timing
Witnessed
Location
Height
Surface
Footwear
Lighting
Trip hazard
Mechanism and biomechanics
Mechanism and biomechanics
Mechanical fall
Possible syncope
Possible seizure
Intoxication related
Assault related
Sports related
Occupational injury
Axial load
Hyperextension
Rotational injury
Head and neck specifics
Head and neck specifics
Head strike
Loss of consciousness
Amnesia
Confusion
Vomiting episodes
Seizure activity
Neck pain
Midline tenderness history
Anticoagulant use
Injury symptoms OPQRST
Injury symptoms OPQRST
Onset
Immediate
Delayed
Provocation and palliation
Worse with weight bearing
Worse with motion
Relief with rest
Quality
Sharp
Dull
Pressure
Region and radiation
Maximal pain location
Radiation pattern
Severity
Pain score
Unable to ambulate
Timing
Constant
Intermittent
Progressive
Associated symptoms
Associated symptoms
Presyncope
Dizziness
Palpitations
Chest pain
Dyspnea
Headache
Vision change
Focal weakness
Numbness
New gait instability
Baseline and prior episodes
Baseline and prior episodes
Baseline mobility device
Baseline gait and balance
Prior falls frequency
Prior syncope episodes
Prior fractures
Osteoporosis diagnosis
Alarm Features
Immediate escalation triggers
Immediate escalation triggers
Airway compromise
Respiratory distress
Shock physiology
Rapidly declining mental status
Active major hemorrhage
Vital sign danger thresholds
Vital sign danger thresholds
Systolic blood pressure under 90 mmHg
Heart rate over 130
Respiratory rate over 30
Oxygen saturation under 90 percent
Temperature 38.0 C or higher with concerning source
High risk head injury features
High risk head injury features
GCS under 15 at 2 hours
Repeated vomiting
Severe worsening headache
New focal neurologic deficit
Suspected open skull fracture
Basilar skull fracture signs
Anticoagulated or bleeding disorder
High risk spine and neuro features
High risk spine and neuro features
Midline cervical tenderness
Neurologic deficit
Paresthesias
New bowel or bladder dysfunction
High energy mechanism
Intoxication with unreliable exam
High risk orthopedic and bleeding features
High risk orthopedic and bleeding features
Open fracture
Compartment syndrome concern
Hip pain with inability to bear weight
Pelvic instability
Anticoagulant associated hematoma expanding
Medications
Medication reconciliation
Medication reconciliation
Anticoagulants
Antiplatelets
Insulin and hypoglycemics
Antihypertensives
Diuretics
Opioids
Benzodiazepines
Antidepressants
Antipsychotics
Antiepileptics
Recent changes and adherence
Recent changes and adherence
New medication within 7 days
Dose increase within 7 days
Missed doses
Double dosing
High risk interaction and reversal considerations
High risk interaction and reversal considerations
Warfarin
Bleeding risk
INR guided management local protocol dependent
DOAC
Bleeding risk
Specific reversal agent availability local protocol dependent
Sedatives
Fall risk
Delirium risk
Diet
Intake and hydration
Intake and hydration
Poor oral intake
Vomiting
Diarrhea
Dehydration symptoms
Alcohol and substances
Alcohol and substances
Recent alcohol
Cannabis
Stimulants
Opioid use
Caffeine and energy drinks
Caffeine and energy drinks
Heavy caffeine use
Energy drinks
Review of Systems
Neurologic
Neurologic
Headache
Confusion
Seizure
Weakness
Numbness
Speech difficulty
Vision change
Gait change
Cardiopulmonary
Cardiopulmonary
Chest pain
Palpitations
Dyspnea
Orthopnea
Hemoptysis
Infectious and inflammatory
Infectious and inflammatory
Fever
Chills
Dysuria
Cough
New rash
Musculoskeletal
Musculoskeletal
Neck pain
Back pain
Hip pain
Knee pain
Ankle pain
Wrist pain
Shoulder pain
Collateral History and Family History
Collateral source and reliability
Collateral source and reliability
Witness account
EMS report
Family report
Video evidence
Family history relevant to fall and syncope
Family history relevant to fall and syncope
Sudden cardiac death
Inherited arrhythmia syndromes
Early coronary disease
Social support and supervision
Social support and supervision
Lives alone
Caregiver availability
Baseline cognitive impairment
Home safety concerns
Risk Factors
Falls risk and frailty
Falls risk and frailty
Age 65 or older
Prior falls
Mobility impairment
Visual impairment
Polypharmacy
Dementia
Bleeding and bone health risk
Bleeding and bone health risk
Anticoagulation
Antiplatelet therapy
Thrombocytopenia history
Osteoporosis
Chronic steroid use
Syncope and arrhythmia risk
Syncope and arrhythmia risk
Structural heart disease
Heart failure
Known arrhythmia
Family sudden death
Environmental and exposure risks
Environmental and exposure risks
Ice and slip hazard
Poor lighting
Workplace fall risk
Intoxication exposure
Differential Diagnosis
Life threatening
Life threatening
Intracranial hemorrhage
Anticoagulation increases risk
Worsening headache
Cervical spine fracture
Midline tenderness
Neurologic deficit
Hip fracture
Inability to bear weight
Shortened externally rotated leg
Pelvic fracture with hemorrhage
Hemodynamic instability
Pelvic pain
Cardiac syncope
Exertional syncope
Abnormal ECG
Aortic stenosis
Exertional syncope
Systolic murmur
Common
Common
Mechanical trip and fall
Clear environmental trigger
No prodrome
Vasovagal syncope
Prodrome
Triggered by pain or emotion
Orthostatic hypotension
Standing trigger
Volume depletion
Concussion
Headache
Photophobia
Soft tissue contusion
Localized tenderness
Preserved function
Less common
Less common
Seizure
Post event confusion
Tongue bite
Stroke or TIA
Focal deficits
Speech disturbance
Hypoglycemia
Diaphoresis
Altered mental status
Medication adverse effect
Sedatives
Antihypertensives
Pulmonary embolism
Dyspnea
Pleuritic chest pain
Past Medical History
Chronic conditions and baseline
Chronic conditions and baseline
Coronary artery disease (I25.10)
Heart failure (I50.9)
Atrial fibrillation (I48.91)
Seizure disorder (G40.909)
Diabetes mellitus type 2 (E11.9)
Chronic kidney disease (N18.9)
Osteoporosis (M81.0)
Dementia (F03.90)
Prior procedures and devices
Prior procedures and devices
Pacemaker
ICD
Valve replacement
Recent surgery within 30 days
Prior injuries and recovery
Prior injuries and recovery
Prior hip fracture
Prior intracranial bleed
Prior cervical spine injury
Physical Exam
Initial survey and general
Initial survey and general
Airway patency
Work of breathing
Perfusion
Mental status
Pain behaviors
Vital signs interpretation
Vital signs interpretation
Orthostatic vitals when safe
Fever pattern
Persistent tachycardia
Head and face
Head and face
Scalp hematoma
Lacerations
Periorbital ecchymosis
Hemotympanum
Septal hematoma
Neck and spine
Neck and spine
Midline cervical tenderness
Range of motion limitation
Thoracolumbar tenderness
Step offs
Neurologic
Neurologic
GCS components
Pupils size and reactivity
Cranial nerves gross screen
Motor strength symmetry
Sensation to light touch
Coordination
Gait if safe
Cardiopulmonary
Cardiopulmonary
Heart rate and rhythm
New murmurs
Lung sounds
Chest wall tenderness
Abdomen and pelvis
Abdomen and pelvis
Abdominal tenderness
Seatbelt sign
Pelvic stability
Extremities and skin
Extremities and skin
Deformity
Point tenderness
Range of motion
Neurovascular status distal
Compartment firmness
Skin tears
Pitfalls and subtle findings
Pitfalls and subtle findings
Occult hip fracture with normal x ray
Delayed intracranial hemorrhage risk in anticoagulated
Distracting injury masking spine pain
Lab Studies
Core screening based on presentation
Core screening based on presentation
Point of care glucose
CBC
Electrolytes
Creatinine
Bleeding and anticoagulation assessment
Bleeding and anticoagulation assessment
INR for warfarin
Platelets
Type and screen if major trauma concern
Cardiac and syncope workup when indicated
Cardiac and syncope workup when indicated
Troponin when ACS concern
BNP when heart failure concern
Magnesium for QT risk
Infection and metabolic triggers when indicated
Infection and metabolic triggers when indicated
Urinalysis when urinary symptoms or delirium
TSH when unexplained bradycardia or arrhythmia concern
Interpretation pitfalls
Interpretation pitfalls
Troponin elevation non ACS etiologies
Normal labs do not exclude intracranial hemorrhage
Imaging
Scoring Systems
Clinical decision tools for imaging
Canadian CT Head Rule
Use in minor head injury with GCS 13 to 15 and loss of consciousness or amnesia or disorientation
High risk factors include age over 65 and suspected open skull fracture and basilar skull fracture signs and vomiting more than 2 and GCS under 15 at 2 hours
Not validated in anticoagulated patients
New Orleans Criteria
Alternative minor head injury rule
Tends to increase CT utilization compared with Canadian CT Head Rule
Canadian C Spine Rule
Use in alert stable trauma patients
High risk factors include age 65 or older and dangerous mechanism and paresthesias
NEXUS C Spine
Imaging if any of midline tenderness or intoxication or altered alertness or focal neurologic deficit or distracting injury
Caution in older adults
Ottawa Ankle Rules
Ankle x ray criteria include malleolar zone pain plus bone tenderness or inability to bear weight
Foot x ray criteria include midfoot pain plus base of fifth metatarsal or navicular tenderness or inability to bear weight
Ottawa Knee Rule
Knee x ray criteria include age 55 or older or isolated patellar tenderness or fibular head tenderness or inability to flex to 90 or inability to bear weight
MRI
MRI indications after fall
Occult hip fracture suspected with negative x ray
Spinal cord injury concern with normal CT
Ligamentous cervical injury concern with persistent midline pain and negative CT local protocol dependent
Contraindications screening
Non compatible implanted device
Unstable patient
CT
CT indications after fall
CT head for high risk head injury features
CT cervical spine for high risk criteria or unreliable exam
CT chest abdomen pelvis for high energy trauma or concerning exam
Contrast considerations
Prior severe contrast reaction
Renal impairment risk assessment local protocol dependent
Ultrasound
Ultrasound applications after fall
eFAST in significant trauma
POCUS cardiac in syncope with shock
POCUS lung for pneumothorax
DVT ultrasound when leg swelling and PE concern
Pitfalls
FAST sensitivity lower in early small volume bleeding
Operator dependent findings
Special Tests
Bedside maneuvers and functional tests
Bedside maneuvers and functional tests
Orthostatic blood pressure and heart rate
Dix Hallpike when positional vertigo suspected
Romberg
Timed up and go when safe
Neuro and concussion screening
Neuro and concussion screening
Serial GCS
Symptom triggered neuro checks
Vestibulo ocular symptom triggers
Procedural diagnostics
Procedural diagnostics
Wound exploration for foreign body concern
Joint aspiration when septic arthritis concern after fall related trauma
ECG
When to obtain
When to obtain
Syncope or presyncope
Palpitations
Chest pain
Dyspnea
High risk patterns
High risk patterns
ST elevation or depression
New left bundle branch block
Brugada pattern
Pre excitation
QT prolongation
High grade AV block
Ventricular tachycardia
Rhythm interpretation pearls
Rhythm interpretation pearls
Atrial fibrillation with rapid ventricular response
Bradycardia with pauses
Frequent ectopy
Serial ECG logic
Serial ECG logic
Repeat if ongoing symptoms
Repeat with troponin pathway when ACS concern
Assessment
Problem representation
Problem representation
Mechanical fall with isolated injury pattern
Fall with possible syncope
Fall with altered mental status
Working diagnoses with codes when applicable
Working diagnoses with codes when applicable
Concussion without loss of consciousness (S06.0X0)
Traumatic intracranial hemorrhage suspected
Cervical strain (S16.1)
Hip fracture suspected (S72.00)
Syncope and collapse (R55)
Severity and risk stratification
Severity and risk stratification
Head injury risk high if anticoagulated or neuro deficit
Spine injury risk high if midline tenderness or neuro deficit
Hip fracture risk high if unable to bear weight
Complications to rule out
Complications to rule out
Delayed intracranial hemorrhage
Rhabdomyolysis after prolonged down time
Compartment syndrome
Uncertainty and alternatives
Uncertainty and alternatives
Mixed mechanism
Medication contribution
Occult infection contribution
Plan
Approach to the critical patient
Approach to the critical patient
First 5 minutes workflow
Continuous monitoring
Two large bore IV if shock concern
Point of care glucose within minutes if altered mental status
ECG within 10 minutes if syncope with concerning features
Immediate actions if unstable
If systolic blood pressure under 90 mmHg then resuscitation bay
If oxygen saturation under 90 percent then oxygen titration
If GCS under 13 then airway readiness and CT head trigger
Diagnostic sequencing
Diagnostic sequencing
Imaging guided by decision tools and red flags
Labs guided by syncope and bleeding risk
Reassessment loop
Repeat vitals within 30 to 60 minutes
Repeat neuro exam after analgesia and after imaging
Therapeutics and symptom control
Therapeutics and symptom control
Acetaminophen PO 1000 mg once
Ibuprofen PO 400 mg once
Avoid NSAIDs if significant bleeding risk or severe renal disease
Ondansetron ODT 4 mg once for nausea
Anticoagulation related management
Anticoagulation related management
Head strike on anticoagulation
Low threshold CT head local protocol dependent
Observation consideration local protocol dependent
Major bleeding concern
Reversal pathway local protocol dependent
Hematology consult threshold local protocol dependent
Consults
Consults
Trauma surgery for major mechanism or multi system injury
Neurosurgery for intracranial hemorrhage
Orthopedics for suspected hip fracture
Cardiology for high risk syncope features
Disposition
ICU criteria
ICU criteria
Need for airway or ventilatory support
Persistent shock despite initial resuscitation
Intracranial hemorrhage with declining exam
Inpatient admission criteria
Inpatient admission criteria
Intracranial hemorrhage on imaging
Unstable fracture requiring operative management
New neurologic deficit
High risk syncope features with abnormal ECG
Inability to ambulate safely
Observation pathway criteria
Observation pathway criteria
Concussion symptoms requiring serial neuro checks
Syncope evaluation with intermediate risk features
Pain control and mobility reassessment
Discharge criteria
Discharge criteria
Normal mental status at baseline
Stable vitals
No concerning imaging findings
Ambulation safe with baseline device
Reliable supervision and follow up
Time sensitive considerations
Time sensitive considerations
Older adults higher occult injury risk
Anticoagulated head strike delayed bleed risk local protocol dependent
Discharge Instructions
Copy discharge instructions
Copy discharge instructions
You were seen today after a fall
Your tests did not show an emergency injury that needs admission today
Pain control
Acetaminophen as directed on label
Avoid NSAIDs if you take blood thinners or have kidney disease unless told otherwise
Activity
Rest today
No driving if dizzy or drowsy from medications
Avoid alcohol for 24 hours
Head injury precautions
Return now for worsening headache
Return now for repeated vomiting
Return now for confusion
Return now for weakness or numbness
Return now for seizure
Bleeding precautions if on blood thinners
Return now for new severe headache
Return now for new vomiting
Return now for new confusion
Follow up
Primary care follow up within 2 to 7 days
Earlier follow up within 24 to 72 hours if dizziness or repeated falls
References
Guidelines and decision tools
Guidelines and decision tools
NICE Head injury assessment and early management NG232 2023
Stiell IG et al Canadian CT Head Rule derivation 2001
Stiell IG et al Canadian C Spine Rule derivation 2001
Hoffman JR et al NEXUS cervical spine rule 2000
Ottawa Ankle Rules validation studies 1990s
American College of Surgeons best practices guidelines spine injury
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.