ED-collapse

Why do people lose consciousness?

• People lose consciousness because either the O2 or nutrients supply to the brain is temporarily reduced.
• Thus, anything that interferes with O2 delivery to brain tissues will lead to syncope
1. Reduced blood flow
2. Altered brain metabolism (hypoglycaemia, hypoxia, CO2 narcosis, hypothermia)
3. Cerebral injury or pathology (head injury, intracranial bleeding, thrombosis, embolism, infection, swelling, tumour, fitting, etc…)

What are the causes of syncope?

Causes from the most common to least
1. Epileptic fits (incranial pathology?)
2. Postural hypotension
3. Vasovagal, micturation, cough.
4. Transient hypoglycaemia, electrolyte imbalance
5. Arrhythmias (typically high degree heart block)
6. Others include pulmonary embolism, transient blood loss, haemorrhage, infection



Scenario: Patients presents to the ED with a recent collapse. Take a history.

The attack!

1. When did this occur? What were you doing at that time?
2. Was there an actual LOC?
3. Was there an person present at that time when you were out?
4. How long was the attack? Was there any twitching, jerking, frothing, biting of tongue, blood? What colour was her face? (white or red means arrhythmia)
5. Was there incontinence?

Before the attack!

1. Did you feel any symptoms/warnings before the attack?
2. Was there any palpitations or chest pains? sweating, nausea?
3. Did you know what triggered it?
4. Can you prevent the attack?

After the attack!

1. Did you regain your conscious quickly?
2. Was there any muscle fatigue?
3. Confused or sleepy?
4. Did you hurt yourself?

Rule out ddx
• Cardiac – chest pain? Palpitations? Nausea, vomiting, sweating?
• Postural hypotension – Feel faint when you stand up suddenly?
• Sympathetics – Feel faint when you urinate, cough, emotional stress, exert yourself?
• Hypoglycemia - History of DM?
• Brain lesion – visual changes, speech disturbances, muscle weakness, balance disturbance, sensory changes.
• Brain – recent head trauma, nausea, vomiting?
• Infection – fever, chills, rigors? FUNDI. Cough, wheeze, sputum production. photophobia, neck stiffness, rashes
• Others – PE?

Background
• Increasing frequency? Once off event? Are they similar
• Patients concerns
• Medical hx - medication(e.g anti-hypertensives), medical conditions(heart problems, epilepsy)
• Family Hx - heart problems-arrhythmias, epilepsy
• Social History - living, marital status+kids, ADLs, occupation, financial status, diet, exercise