Next, the history and physical examination should focus on intrinsic, situational, and extrinsic factors. The history should also include questions about present and past medical problems and drug use. Witnesses to the fall should be questioned. The pattern of injury is useful. Evaluating the cardiovascular system helps exclude arrhythmia, valvular heart disease, and heart failure.
Blood pressure is measured with the patient supine and standing to rule out orthostatic hypotension.
Vision screening, at least for acuity, is essential. The neck, spine, and extremities should be evaluated for deformities, pain, and limitation in range of motion. If the patient can stand on one leg for 30 seconds with the eyes open and have an accurate 10-foot tandem gait, the intrinsic postural control deficit is likely to be minimal. Vestibular function should be evaluated. Tests such as ECGs, ambulatory cardiac monitoring, measurement of cardiac enzymes, and echocardiograms are recommended only when a cardiac source is suspected.