Blackouts, Head Injury and impaired conscious level Flashcards
List some synonyms of blackouts:
What are common points about blackouts?
Blackouts = loss of consciousness = syncope
- usually temporary
- potential many causes
- circumstances before, during and after are helpful in diagnosing the cause
List some cardiovascular causes of blackouts:
Neurological:
Metabolic:
Other:
Cardiovascular: vasovagal faint, postural hypotension, cardiac arrhythmia, aortic stenosis, cardiomyopathy, carotid sinus hypersensitivity
Neurological: epileptic seizure, transient ischaemic attack
Metabolic: hypoglycaemia, hypocalcaemia
Other: drop atacks
What may cause a vasovagal faint?
Signs/symptoms?
Management?
Vasovagal faint
- caused by fear, emotion, heat, prolonged standing, hunger
- feeling faint, nausea, visual fields closing in
- transient loss of consciousness, pallor and fall to ground - due to low BP and low HR
- recover within 2 mins
Management: lie flat and elevate legs to increase venous return
What is postural hypotension?
What group of patients is it most common?
How can you diagnose?
Postural hypotension:
- blood pressure usually rises when we stand , in some conditions BP falls when standing, reducing cerebral perfusion
- more common in the eldery (could be due to meds)
- check lying and standing BPs to diagnose
List some drugs which cause postural hypotension:
Autonomic dysfunction:
Intravascular volume depletion:
Drugs: antihypertensives, diuretics, tricyclics
Autonomic dysfunction: Diabetes Mellitus, Parkinsons Disease
Intravascular volume depletion: blood loss, dehydration, shock
How are head injuries managed and what monitoring takes place?
Managed in hospital, monitoring for complications:
- extradural haemorrhage
- subdural haemorrhage
- diffuse axonal injury and coma
- maxillofacial and skull injuries
List some intrinsic brain disorders which cause drowsiness (impaired conscious level)
Diffuse brain dysfunction:
Intrinsic brain disorders: head injury, stroke, tumour/mass lesion, epilepsy
Diffuse brain dysfunction: metabolic/endocrine disorder, drugs/alcohol/poisoning, CNS infection, sepsis, liver failure, respiratory failure, renal failure
How is conscious level assessed?
How is eye opening scored?
Motor response?
Verbal response?
What are the maximum and minimum response scores?
Glasgow Coma Scale (GCS)
Eye opening: spontaneous 4, voice 3, pain 2, no response 1
Motor response: obeys commands 6, localises to pain 5, withdraws to pain 4, abnormal flexion to pain 3, extensor posturing 2, no reponse 1
Verbal response: orientated 5, confused/disorientated 4, inappropriate words 3, incomprehensible sounds 2, no verbal response 1
3 = lowest, no response
15 = responsive
Name another way to assess conscious level, other than Glasgow Coma Scale:
ACVPU
Alert, Confusion (new), Verbal, Pain, Unresponsive
List causes of impaired conscious level in terms of metabolic causes:
Metabolic causes:
- hypoglycaemia - always check blood glucose
- hypoxia
- hypercapnia
- hyponatraemia
- hypercalcaemia
- hypothyroidism
List causes of impaired conscious level in terms of infections:
Brain:
- encephalitis, meningitis, cerebral abscess, malaria and other tropical illnesses
Any other severe bacterial infection causing sepsis
- pneumonia, urinary tract, wherever infection is
List causes of impaired conscious level in terms of drugs and toxins:
- alcohol
- opiates
- other recreational drugs
Any prescribed sedating medication in overdose:
- benzodiazepines, tranquillisers, antidepressants, opiates, anti-epileptic
What is the clinical approach for impaired consciousness?
- ABCDE approach
Common cause is airway obstruction, recovery position, give oxygen, check blood sugar, grade AVPCU/GCS
- Identify cause
- Treat cause - usually hospitalisation
