Syncope or collapse

Question 1

Causes of collapse

Answer 1

Primary:
- missed meals, extended standing
- dehydration
- vasovagal (surprise, pain, blood)

Secondary:
- Metabolic: hypoglycaemia, electrolyte imbalance
- Cardio: arhhythmia, MI, HOC
- Neuro: seizure
- Postural hypotention
- Infection
- Anaphylaxis

Question 2

Airway

Answer 2

Check airway patency (rule out anaphylaxis)

Question 3

Breathing

Answer 3

Look: respiratory distress
Listen: lung sounds
Feel: chest expansion, tracheal deviation

RR, O2

?XCR if sepsis suspicion
?ABG

Question 4

Circulation

Answer 4

Look: anaemia, peripheral shutdown
Listen: S1,S2+0
Feel: apex beat CRT pulse

CRT - prolonged if dehydrated

BP, HR (?fast - rule out arrhytmia)

Ecg: Rule out arrhythmia

Bloods: FBC (anaemia), UEs (arrhythmia, seizures), LFTs, CRP, BM, VBG (glucose, lactate)
Consider echocardiogram

Question 5

Management

Answer 5

Dehydration:
- Rehydrate with 500 -1000 ml over 15 minutes

Hypoglycaemia:
- food if >4 mmol/L, <4 mmol/L - give glucose, sucrose dissolved in water
- If refractory after 3 treatments, IM glucagon or glucose 10% IV infusion

Hypoxia - 15L/min O2

Arrhythmia - ECG, cardiac monitoring

Postural hypotention - rehydration, medication review

Anaemia:
- examine for bleeding, history for diet, pregnancy
Iron deficiency:
- PO ferrous sulphate (200mg BD/ TDS)
- Ferinject IV
- Transfusion cross match first

Question 6

Disability

Answer 6

GCS
BM - hypoglycaemia
neuro exam
PEARL

Question 7

Exposure

Answer 7

Injury / bleeding from fall
Rashes
Calves
Temperature