Collapse Flashcards
Introduction
- *W**ash hands
- *I**ntroduce yourself
- *P**atient’s consent
- *E**xplain procedure/purpose for Hx
PC
“What brought you in today?”
HPC
Ask to speak to a witness - “could I please speak to someone that saw you collapse?”
Onset - “when did you collapse?”
Event duration - “how long did it last?”
Aura/post-ictal phase - “did you get a warning sign before it happened?”, “did you feel any fatigue/tiredness after you collapsed?”
Sx of lightheadedness/feeling faint - “did you feel light-headed or faint before your collapse?”
Visual disturbance/eye rolling - “did you get any changes in your vision?”, “did you notice their eyes rolling?” (for the witness)
Facial weakness/slurred speech - “before the collapse did you get any facial weakness/slurred speech?”
Myocolonic jerks/twitching - “were there any jerks/twitching/abnormal body movements?” (for the witness)
Tongue biting/incontinenc- “did you get any tongue-biting?”, “was there any incontinence, for example wetting/soiling yourself?”
SOB - “did you feel short of breath?”
If female: menstruation and pregnancy - “when was your last LMP?”, “Is it regular?”, “how many days does it last?”, “do you bleed heavily?”, “are you pregnant/have you done a pregnancy test recently?”
Chest pain/palpitations - “did you get any chest pain?”, “did you get any feelings of your heart beating fast or fluttering?”
No symptoms of blood loss e.g., black stool - “did you pass any black/musty stool?”
ICE
Ideas - “what do you think could have caused your collapse?”
Concern - “is there anything that your worried about regarding your collapse?”
Expectation - “what were you hoping we would do for you today?”
PMH
“Do you have any medical conditions like epilepsy or a previous seizure/fit?”
DH
- “Are you on any medications that have been prescribed by your doctor?”, “do you take any over the counter medications?”*
- “Do you have any allergies to any medications? What happens when you take the medication?”*
Identifies recently started on amlodipine (G if notes drug taken in the morning)
Asks about drugs that lower seizure threshold - “are you currently taken any medications like bupropion, antibiotics like erythromycin, tramadol?”
SH
Alcohol, smoking, recreational drugs (including IVDU) - “do you smoke?”, “how much do you smoke each day?”, “how long have you smoked for?”, “have you ever smoked? How much did you smoke and for how long?”(if the patient said they don’t smoke),”do you drink?”, “how much/what do you drink each day?”, “do you use recreational drugs?”, “have you ever injected drugs or shared needles with other people?”
Occupation - “do you work?”, “what do you do for work?”
Home situation - “what’s your home situation like?”, “do you need help with things like cooking, washing/cleaning yourself?”
FH
“Do you have any FHx of loss of consciousness, epilepsy or fits?”
Examination
Ask to examine patient
“I’d like to examine you now and take your pulse, your blood pressure and listen to the arteries in your neck. Is this ok with you?”
DDx
Considers differential in non-technical language:
“From what you’ve told me and from your examination, it is likely that you had a faint. You could also have had a fit or a mini-stroke or very low blood sugars”
Identifies factors consistent with syncope - “However, the most likely cause is a faint. This is because your currently on amlodipine, which increases the risk of having a faint”
Counselling
Takes practical steps to resolve the problem:
Asks about driving - “Do you currently drive?”
Suggests shifting amolodipine from morning to evening or reducing the dose - “We would advise that you take your amlodipine in the night instead of in the morning. You could also consider reducing the dose to one that is still able to control your blood pressure.”
Practical advice: hydration, standing up slowly, avoiding baths/climbing up ladders - “Other practical things you can do would be to make sure that you’re well hydrated, stand up slowly when you’re getting up and also avoiding baths/climbing up ladders.”
Investigations
Suggests investigations - “We also like to do some investigations like an ECG, checking your full blood count, blood sugar/Hba1c”
Safetynetting
“If you notice any further symptoms like palpitations, slurred speech or if you have a head injury, it’s important that you come back to the surgery for a review”
Close consultation
“Thank you so much for speaking with me today. Before you go I’d like to give you a patient information leaflet. A great website to go to is NHS choices, which I’ll write on a piece of paper for you to take home with you.”
