Collapse Flashcards by Emily Mosher

Causes of falls

. Delirium
. Cardiac, neuro, muscular-skeletal condition
. Side-effects from medications
. Balance, strength, mobility 
. Poor eyesight 
. Poor memory 
. Incontinence, unitary urgency

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Collapse

. Fall down and become unconscious

. Nonspecific term w/ mult. Etiologies

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Causes of collapse

. Alcohol
. Epilepsy 
. Infection
. Overdose
. Uremia 
. Trauma
. Insulin
. Psychogenic 
. Stroke

(AEIOU TIPS)

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Syncope

. Most common cause collapse
. Temporary loss of consciousness related to insufficient blood flow to brain
. Some stimulus causes neural reflex to certain triggers
. Characterized by bradycardia (+vagus nerve) an/or peripheral vasodilation (-sympathetic)
. Benign

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Cardiac Syncope

. Loss of adequate cerebral perfusion from sudden reduction in CO

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Cardiac syncope signs and symptoms

. Collapse
. Blurred vision
. Dizziness
. Pale/dusky appearance
. Cardiac arrhythmia/murmur

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Cardiac syncope etiology

. Ventricular rate <35 or >180 bpm

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Common history/ROS relating to cardiac syncope

. History of HTN, CVD, hypercholesterolemia,
. Assoc. w/ inc. physical activity, rising from seated position, dec. fluid intake, warm environment
. Collapse, palpitations, cough, chest pain, arm/jaw pain, diaphoresis, nausea/vomiting

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Physical exam findings related to cardiac syncope

. Abnormal vital signs, anxious appearance, respiratory distress, weakness, JVD, arrhythmia, cardiac murmur, muffled heart sounds. Bilateral crackles, peripheral edema
. OMM/musculoskeletal, sympathetic T1-5 on left, parasympathetic occiput, C1 C2 w/ lack of localized peripheral findings

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Cerebrovascular accident(CVA)

. Stroke

. Dec. (ischemic) or inc. (hemorrhagic) blood flow to specific brain region

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CVA signs and symptoms

. Headache
. Altered mental/confusion
. Vision changes
. Vertigo/dizziness
. Focal neurologic deficits (sensory/motor loss)
. Papilledema
. Retinal hemorrhage 
. Apraxia
. Agnosia
. Dysarthria
. Dysphagia

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CVA etiology

. Ischemic (thrombotic, embolic secondary to dissection/hypoperfusion)
. Hemorrhagic (spontaneous trauma)
. Embolic from mural thrombi
. Abnormal cardiac valves/rhythms

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Transient Ischemic Attacks (TIA)

. NOT STROKE
. Brief stroke-like event that resolve in minutes to hours but require immediate medical attention to distinguish from actual stroke
. Assoc. w/ decreased blood flow to specific portion of brain
. Warning sign for CVA

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History/ROS related to CVA

. Collapse
. Headache
. Altered mental/confusion
. Vision change
. Apraxia 
. Agnosia

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Physical exam findings related to CVA

. Abnormal vitals
. Acute visual acuity changes
. Focal neurologic deficits
. Rhomberg’s 
. Papilledema
. Retinal hemorrhage
. Carotid bruits 
. OMM: sensory/motor deficits

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Vasovagal syncope (neurocardiogenic syncope, fainting)

. Transient loss of consciousness assoc. w/ loss of tone from lack of oxygen to brain stem from dec. Cardiac output (CO)

Vasovagal syncope signs and symptoms

. Prodromal symptoms vague
. Lightheadedness
. Diaphoresis
. Dimming vision
. Nausea 
. Weakness
. Signs of resulting trauma

Vasovagal syncope etiology

. Reflex response causing vasodilation
. Initiated by pain/fear, cough, sneeze, GU/GI stimulation, volume depletion, drugs, hemorrhage
. Precipitating factors: stress, pregnancy, dehydration, previous history

physical exam findings related to vasovagal syncope

. Normal findings

. OMM: normal except possible injury from fall itself

Partial (focal) seizures

. Affect single area brain (medial temporal most common)
. Preceded bu aura
. Can secondarily generalize
. Simple partial (consciousness maintained)
. Complex partial (impaired consciousness)

Generalized seizures

. Affect brain diffusely
. Absence (petit mal): blank store, no post-Ictal confusion
. Myoclonic: quick repetitive jerks
. Tonic-clonic: grand mal, alternating stiffening and movement
. Atonic: drop seizures, mistaken for fainting

Seizure signs and symptoms

. Various 
. Altered level consciousness
. Involuntary muscular movements 
. Nuchal rigidity
. Papilledema (inc. ICP)
. Tongue lacerations
. Incontinence
. Post ictal confusion

Seizure etiology

. Infection
. Hypoxia
. Stroke
. Toxins
. Fever (usually children)
. Genetic
. Metabolic
. Trauma
. Idiopathic

Epilepsy

. Characterized by recurrent seizure activity

. Febrile seizures NOT epilepsy

Status epilepticus

. Continuous/recurring seizures may result in brain injury | . More than 5 minutes duration

Most common cause of seizure for infant

. Infection . Prenatal injury/ischemia . Genetic . Metabolic

Most common cause of seizure in children

``` . Fever (inc. neural irritability, dec. seizure threshold) . Genetic . Infection . Trauma . Metabolic ```

Most common causes of seizure in adults

. Tumor . Trauma . Stroke . Infection

Most common cause of seizures in elderly

``` . Stroke . Tumor . Trauma . Metabolic . Infection ```

How to diagnose seizure

EEG

Pulmonary embolism (PE/PTE)

. Pulmonary vessel obstruction causing ventilation-perfusion (VQ) mismatch to hypoxemia and hypocapnia (dec. carbon in blood) . Leads to respiratory alkalosis

PTE signs and symptoms

. Often variable and nonspecific . May have sudden onset dyspnea, cough, chest pain, tachypnea, collapse . Large embolis (traveled thrombus) or saddle embolis may cause sudden death

PTE etiology

. Majority from thrombus in deep veins of lower leg and pelvis . Can be from Fat, air, thrombus, bacteria, amniotic, tumor (FAT BAT)

PTE risk factors

``` . Obesity . Smoking . Trauma . Infection . heart disease . Immobility . Malignancy . Surgery . Factor 5 Leiden deficiency . Pregnancy . Oral contraceptives (OTCs) ```

Physical exam findings related to PE

. Normal/abnormal vitals . Conversational dyspnea . Respiratory distress . Unilateral adventitious (abnormal) lung sounds . OMM: T1-4 unilateral/bilateral, accessory respiratory muscle use

High risk patients w/ syncope

. Clinical history suggestive of arrhythmic syncope . Comorbities . EEG history suggestive of arrhythmic syncope . Family history of sudden death . Hypotension . Older age . Severe structural heart disease, congestive heart failure, coronary artery disease

Low risk patients w/ syncope

``` . Less than 50 y/o . No history of cardiovascular disease . Normal EEG findings . Symptoms consistent w/ neurally mediated or orthostatic hypotension syncope . Unremarkable cardiovascular findings ```