Investigations

Bedside assessment;

• Observations – Oxygen saturations, respiratory rate, level of blood pressure, heart rate, temperature, level of consciousness (?hypoxia, ?haemodynamic instability)
• Blood glucose (?hypoglycaemia)
• Cognitive assessment – eg. Abbreviated mental test (AMT) (?confusion)
• ECG  (?arrhhythmias, ?brady-/tachy-cardias)
• Urinalysis (?urinary tract infection)

Serum investigations;

Full Blood Count (FBC) – eg. Raised WCC (?infection)

Urea and Electrolytes (U+Es) (?acute kidney injury, ?electrolyte abnormalities)

Bone profile – forms part of the confusion screen and abnormalities present in malignancy (eg. hypercalcaemia)

Liver function tests / INR – alcoholic liver disease

Creatine kinase (CK) – rhabdomyolysis

Radiology;

Chest x-ray (?pneumonia)

CT head (?cerebrovascular accident, ?subdural/extradural hematoma) – remember that NICE (2014) guidance for CT scan following head injury includes any change in loss of consciousness of amnesia in addition to;

• Age 65 or older
• Any history of bleeding or clotting disorders
• Dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs).
• More than 30 minutes’ retrograde amnesia of events immediately before the head injury.

Consider FAST USS / CT scan in the context of significant trauma to the thorax, abdomen or pelvis

Learning Bite

It is important to establish the patients baseline cognition and mobility. Because elderly patients are more easily prone to delirium a range of bedside and serum screening investigations are very often appropriate to rule out organic pathologies, such as infection.