Collapse Flashcards
Causes of falls
. Delirium . Cardiac, neuro, muscular-skeletal condition . Side-effects from medications . Balance, strength, mobility . Poor eyesight . Poor memory . Incontinence, unitary urgency
Collapse
. Fall down and become unconscious
. Nonspecific term w/ mult. Etiologies
Causes of collapse
. Alcohol . Epilepsy . Infection . Overdose . Uremia . Trauma . Insulin . Psychogenic . Stroke
(AEIOU TIPS)
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
Cardiac Syncope
. Loss of adequate cerebral perfusion from sudden reduction in CO
Cardiac syncope signs and symptoms
. Collapse . Blurred vision . Dizziness . Pale/dusky appearance . Cardiac arrhythmia/murmur
Cardiac syncope etiology
. Ventricular rate <35 or >180 bpm
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
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
Cerebrovascular accident(CVA)
. Stroke
. Dec. (ischemic) or inc. (hemorrhagic) blood flow to specific brain region
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
CVA etiology
. Ischemic (thrombotic, embolic secondary to dissection/hypoperfusion)
. Hemorrhagic (spontaneous trauma)
. Embolic from mural thrombi
. Abnormal cardiac valves/rhythms
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
History/ROS related to CVA
. Collapse . Headache . Altered mental/confusion . Vision change . Apraxia . Agnosia
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
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
