Management of Elderly Female with Scalp Laceration After Fall

Initial Evaluation and Monitoring

The American College of Emergency Physicians recommends performing a complete head-to-toe examination even with seemingly isolated scalp injury, as traumatic injuries may be "occult" in older adults 1
The American Heart Association suggests assessing vital signs with particular attention to blood pressure <110 mmHg and heart rate >90 bpm, as these indicate increased mortality risk in elderly trauma patients 2
Serial neurological assessments every 1-2 hours including GCS, pupillary response, focal deficits, and mental status changes should be performed, as recommended by the World Journal of Emergency Surgery 2
Vital signs monitoring with attention to occult hypoperfusion is crucial, as elderly patients may have chronic elevated blood pressure making "normal" readings actually hypotensive 2

The American Geriatrics Society recommends a comprehensive fall evaluation with assessment of gait and balance, medication review, vision assessment, cognitive screening, and home safety evaluation 1, 4
Perform "Get Up and Go Test" - time >12 seconds indicates increased fall risk and need for intervention, as suggested by the American Geriatrics Society 1, 4
Screen for depression using PHQ-2, as late-life depression contributes to falls, and consider vitamin D supplementation (800 IU daily) for fall prevention 3, 4
Arrange physical therapy referral for gait training and balance assessment, with prescription for balance training ≥3 days/week and strength training twice weekly, as recommended by the American Physical Therapy Association 3, 4
Coordinate occupational therapy home safety assessment with direct intervention, including removal of loose rugs, adequate lighting, grab bars in bathroom, and proper footwear, as suggested by the American Occupational Therapy Association 3, 4

Arrange expedited outpatient follow-up within 1-2 weeks for continued fall risk assessment and intervention monitoring, as recommended by the American College of Emergency Physicians 1, 3
Order DEXA scan to assess fracture risk, as this patient is at high risk for future falls, and consider proper fitting and training for assistive devices to prevent falls 3, 4