Fits, Faints And Funny Turns

Question 1

What are important questions to ask about fits, faints and funny turns?

Answer 1

Onset (sudden vs gradual)
Precipitating factors (breathing, visual, sweating, hunger, fear)
Associated symptoms
Drug history (alcohol, anti epileptics, antihypertensives, benzos, SSRIs)
Past turns

Question 2

What are important examination points for fits, faints and funny turns?

Answer 2

• mental state (especially anxiety)
• evidence of anaemia, alcohol abuse, infection
• cerebrovascular examination: carotid arteries, ocular fundi, bruits
• cardiovascular examination: pulses, BP (lying, sitting, standing), heart
• cervical spine

Question 3

What are important investigations to perform for fits, faints and funny turns?

Answer 3

• FBC (anaemia, polycythemia)
• BSL (diabetes, hypoglycaemia)
• EUC
• ECG (ischaemia, arrhythmia)
• 24 hour holter monitor (?arrhythmia)
• X-ray neck, chest
• CT or MRI brain
• carotid Doppler scan (?carotid artery stenosis)

Question 4

What are red flags in fits, faints and funny turns?

Answer 4

Onset in older person
Neurological symptoms and signs
Headache
Tachycardia
Irregular pulse
Fever
Drugs: social or prescribed
Cognitive impairment
Confusion: gradual onset