Collapse, loss of consciousness

Question 1

What are the parts of HPC you need to know for collapse?

Answer 1

if it happened BEFORE (no warning-usually cardiac. Seizure-usually aura, except generalised seizure), DURING (tongue bite?) and AFTER (confusion?)

collapse= Loss of consciousness-
balance loss etc-not collapse

Question 2

What are examinations needed for collapse?

Answer 2

Heart sound, BP, lung, abdominal cranial nerves, leg muscles strength/etc

Question 3

What are some causes of collapse?

Answer 3

first aid–ABC, DNEFG (do never ever forget about glucose)

ALWAYS REMEMBER HYPOGLYCEAMIA

Cardiac-VAOP. V-Vasovagal A-Tachyarrthmia, Outflow onstruct-aortic stenosis, PE. P-postural hypotenuse

Brain-seizures (tons of types)

(keep in mind heamorghagic stroke(expect headache)-rarer)

Question 4

What are the cardiac causes of collapse?

Answer 4

VAOP-
Vasovagal-vagal nerve overpowering the rest

arrthmias-tachy/brady-check ECG (long QT syndrome, cardiac monitor), 3rd degree HB

Outflow obstruct-Left-aortic stenosis-(slow rising, ESM, cardiogram). Right-PE-check

Postural hypo-check as standing or not

Question 5

What is long QT syndrome?

Answer 5

Abnormal ventricular repolarisation-T wave closer to next p than the QRS

Can be congenital, or drug related—> predispose to arrhythmia

Question 6

What are the main investigation you want to do for a patient with loss of consciousness and no signs before?

Answer 6

LISTEN with stethoscope-aortic stenosis
ECG-previous MI, current MI, conduction disease, tachy/bradycardia that caused the disease, or a predisposition to that.
Lying and standing BP
24h telemetry-long ECG–might pickup the abnormal rhythms

EEG-outpatient

Question 7

What are the most common arrhythmia causing syncope?

Answer 7

AFib, Ventricular tachycardias, Supraventricular tachycardia, A flutter
3rd degree HB (bradycardia)

Question 8

How do seizures caused loss of consciousness tend to present

Answer 8

Usually comes with signs before hands-can be shivering, feel it coming.
During-bite tongue and other things
ex: generalised seizures, complex partial seizures

Question 9

What test do with a loss of conciousness + signs before hands?

Answer 9

Calculate GCS
Want to still check its not a weird cardiac presentation (ECG), want EEG (might be a bit later), and check MRI/CT scan if can

ca

Question 10

How do we classify seizure types

Answer 10

Focal-one part of brain starts the seizure-can be aware of it (for hours) -atonic, clonic, myotonic, spasms or can have impaired conciouness
again can be motor or not or bit of both

Generilsed onset-
Motor-myoclonic, tonic, etc
Or non motor (absence)

Unkown onset-motor, non motor (behaviour arrest)

But to diagnose you want to be able see what happens directly-film what happens