From the Guidelines
The patient should be immediately evaluated at an emergency department or urgent care facility due to the potential risk of head injury from the fall, and the hemorrhoids with slight bleeding should be assessed concurrently. The combination of headache and vertigo following a witnessed assisted fall raises concern for possible head injury, including concussion or intracranial bleeding, as suggested by guidelines for the management of aneurysmal subarachnoid hemorrhage 1. Although the vital signs are currently stable, the symptoms described could indicate a developing complication that requires prompt medical intervention.
At the medical facility, the patient should expect a neurological examination, possibly brain imaging (CT scan or MRI), and monitoring of vital signs. For the hemorrhoids with slight bleeding, a focused medical history and a complete physical examination, including a digital rectal examination, should be performed to rule out other causes of lower gastrointestinal bleeding, as recommended by the guidelines for anorectal emergencies 1. The patient's vital signs should be checked, and hemoglobin and hematocrit levels should be determined to evaluate the severity of the bleeding.
While waiting for medical care, the patient should be kept calm, comfortable, and under observation for any worsening symptoms such as increased headache severity, confusion, vomiting, or changes in consciousness. No medications should be given until cleared by a healthcare provider, as some medications like aspirin or NSAIDs could worsen bleeding if there is an intracranial injury. This cautious approach is warranted because even seemingly minor falls can cause serious injuries, particularly in older adults.
In terms of managing the hemorrhoids, a cream or ointment may be considered to alleviate symptoms, but this should be done under the guidance of a healthcare provider after a thorough assessment. The primary concern at this point is to rule out any serious complications from the fall and to assess the severity of the bleeding from the hemorrhoids, as emphasized by the guidelines for anorectal emergencies 1.
From the Research
Patient Assessment and Monitoring
- The patient presented with headache and vertigo after a witnessed assisted fall, but no severe injury was observed and vital signs are stable 2, 3.
- Monitoring of the patient's neurological status and vital signs is essential, especially in cases of mild head injuries 3.
- The patient's symptoms of headache and vertigo may be related to benign paroxysmal positional vertigo (BPPV) or other inner ear causes, which can be diagnosed using provocation maneuvers such as the Hallpike-Dix test 4, 5.
Management of Hemorrhoids and Bleeding
- The patient also presented with hemorrhoids and slight bleeding, which may be managed with topical creams or ointments.
- However, it is essential to consider the potential causes of rectal bleeding, including chemical aggression of the rectal mucosa by suppositories containing acetylsalicylic acid 6.
- A thorough medical history and physical examination are necessary to determine the best course of treatment for the patient's hemorrhoids and bleeding.
Treatment Options
- For the patient's vertigo, treatment options may include canalith repositioning maneuvers, such as the Epley maneuver, which can be effective in resolving symptoms 4, 5.
- Topical creams or ointments may be prescribed to manage the patient's hemorrhoids and bleeding, but the underlying cause of the bleeding should be investigated and addressed.
- Further evaluation and monitoring may be necessary to determine the best course of treatment for the patient's symptoms and to rule out any underlying conditions that may be contributing to their symptoms 2, 3.