Responding to a Patient Fall with Possible Head Injury

Scenario

You hear a thud and find your elderly patient on the floor next to the bed.
They are awake but confused, with a small forehead laceration and BP 176/94 mmHg, HR 92, SpO₂ 95%.
They state they “felt dizzy” before getting up.

Question: What are your immediate actions and priorities in managing this fall?

Best Practice Answer

1. Ensure Immediate Safety and Initial Assessment:

   • Do not move the patient until you assess for injury or request help.
   • Check responsiveness, airway, breathing, and circulation (ABCs).
   • If the patient hit their head or takes anticoagulants, treat as potential head injury.
   • Call for assistance — do not attempt to lift alone.

2. Immediate Interventions:

   • Stay with the patient and keep them still.
   • Apply pressure to bleeding areas if needed, using sterile gauze.
   • Obtain vital signs and neuro assessment (Glasgow Coma Scale, pupil size, limb strength).
   • Check for pain, deformity, or limited movement (possible fracture).
   • Apply O₂ if SpO₂ < 94% or patient shows distress.

3. Notify and Escalate:

   • Call the provider and charge nurse immediately.
   • Anticipate orders for head CT or x-rays if trauma suspected.
   • If on anticoagulants (warfarin, heparin, DOAC), emphasize risk of intracranial bleed.
   • Notify family per policy once patient stabilized.

4. Documentation and Incident Reporting:

   • Record the exact time and location of fall, patient’s condition, and witnesses if any.
   • Document neuro checks, vital signs, and provider notifications.
   • Complete an incident report (separate from medical chart, per policy).
   • Do not assign blame — focus on factual, objective documentation.

5. Ongoing Monitoring:

   • Perform neurological checks every 15–30 minutes for the first 2 hours, then hourly per protocol.
   • Watch for vomiting, unequal pupils, new confusion, or declining LOC — report immediately.
   • Reassess orthostatic vitals and environmental hazards before ambulation.

6. Post-Event Prevention:

   • Re-educate on call light use and assistance requests.
   • Review fall risk interventions: bed alarms, non-slip socks, toileting rounds, and medication review.
   • Collaborate with physical therapy if balance or strength is impaired.

Real-World Application

This scenario is standard in hospital simulation and onboarding programs.
It evaluates your ability to combine emergency response, clinical reasoning, and documentation discipline.

Interviewers assess:

• Safety-first mindset
• Neurological awareness
• Adherence to fall response policy
• Communication clarity under stress

This is especially relevant for med-surg, rehab, and geriatrics units, where fall risk is high.

Tip: In interviews, summarize confidently —
“If a patient falls, I stay with them, assess for head injury before moving, notify the provider, document objectively, and initiate neuro checks.”
That demonstrates situational control, safety accountability, and clinical maturity.