BLACKOUT Flashcards
Transient loss of conscious can be divided into
Syncopal and non syncopal
TYPES OF SYNCOPAL
Reflex
Vasovagal- Brady cardia, reduced perfusion, cerebral hypoperfusion. Pain, fear, straining.
Carotid sinus hypersensitivity
Situational syncope
Types of syncope
Cardiac
Arrhythmias- reduction in cardiac output
Structural pathology eg aortic stenosis
Massive pe
Types of syncope
Orthostatic *when he stand there is a drop in by, compensated by vasoconstriction. TO prevent a transient fall in by as this mechanism takes a few seconds there is an increase in HR. If a patient has a reduced intravascular volume eg from dehydration this response is blunted.
Dehydration
Drugs- anti htn, anti sums
Autonomic instability
Types of non syncopal transient loc
Intoxication eg alcohol sedatitives Head trauma Hypoglycaemia Non epileptic seizure Epileptic seizure Narcolepsy
MOST COMMON CASES OF LOC IN A 25 YEAR OLD
Vasovagal syncope
May have warning signs- calmly, sweating, pale, odd sensation in tummy, ear fullness
Most common cause of LOC in 55 year old
Vasovagal syncope or arrhythmia
Most common cause of loc in elderly
Orothsatic hypotension causes by meds
Diuretics - reduced blood volume and vasodilation
ACE- ‘’
b blockers- inability to increase HR
A blockers- inability to vasoconstriction
CCB- Inability to vasoconstrict
Epilepsy BEOFRE DURING AND AFTER
Before;
May have stereotypical aura or no warning
During;
Lasts minutes, incontinence, tongue biting, jerking, dropping, stiffening.
After;
Slowed recovery confused for 5-30minutes
Vasovagal before during after
Before;
Vagal symtptoms- sweating pallor, nausea, may be a precipitent
During
Lasts seconds, may be twitching or incontinence
After;
Rapid recovery on sitting/lying.
Arrhythmia before during and after
Before; No warning During Lasts seconds, may be twitching/ incontinence After Rapid spontaneous recovery
Past medical hx questions to ask after LOC
Previous episode Diabetes Epilepsy Cardiac illness PVD- claudication Anemia - hypoxia Psychiatric illness- panic attacks, non epileptic seizures
Drug hx after LOC
Insulin Oral hypoglycemics HTN Vasodilators Anti arrhythmias Anti depressants- hypotension Recreational drugs
Exam after LOC
Tongue- bitten - look at sides
Dehydration- dry mucous membranes, tachycardia, hypotension, decreased skin tugor
Head trauma- did it happen before/during/after LOC
Heart- rate, rhythm, jvp for cannon waves- complete heart block
Murmurs- aortic stenosis
Carotid brutish
BP- orthostatic hypotension. Lying down and within two minutes of standing. Drop in 20mm systolic or 10 diastolic on standing
Focal neuro signs- peripheral neuropathy, Parkinson’s. Full neuro recovery.
Investigations LOC
O2 says
Bloods- glucose FBC- anemia, U&E- electrolyte abnormality
ECG- BBB, short PR, long QT