Physicians are trained to consider the worst possible scenarios first; this is usually wise to prevent serious harm. In the case of falls, these include such problems as life-threatening cardiac arrhythmias, pulmonary emboli, seizures, stroke, advanced valvular heart disease, myocardial infarction, and gastrointestinal hemorrhage.

In patients that have fallen, these most serious problems are often ruled out quickly by the history, physical exam, and some basic tests.

Ruling out these more serious problems leaves the majority of falls unexplained, because most falls are multi-factorial and expose the patient’s “weakest links.”

• Consider the most serious etiologies at first
  
  
• Once they are excluded to a reasonable degree, look for explanations