Syncope, Vertigo, and Altered Mental Status Flashcards
What is delirium
mental state that is acute onset in nature, usually reversible (treatable)
What is dementia
mental state that is slow in onset, progressive, degenerative mental status (can’t reverse)
What is psychosis
mental state that is sudden in onset, need to rule out organic causes
What are the initial actions in altered mental status
Look for reversible causes and address ASAP (DON’T)
Dextrose - POC glucose
Oxygen - pulse ox
Narcan - check pupils
Thiamine - ETOH
How are you going to initially assess for AMS?
Good history
What is going to be included in your PE for AMS?
Full exam of all systems (look for everything)
What are you going to run for tests to rule in/out AMS?
Testing aimed at symptoms for example
ETOH, serum ETOH
Insulin, check POC glucose
Uremia (BMP, BUN/Cr)
How do patients describe vertigo?
Dizziness, room is spinning, lightheadedness, “head feels funny”, and “faint”
Are cardiac and neuro exams normal or abnormal with vertigo?
Normal
What is the vestibular system
Complex arrangement of bones and cartilage in the ear, network of semicircular canals filled with fluid. Fluid position changes with movement, sensor in ear sends info to brain to contribute to balance.
What are the problems causing balance issues associated with vestibular system imbalances
Meds
Infection
Inner ear problems (circulation)
Calcium debris in semicircular canals
Central problems in the brain (TBI)
What is the diagnostic approach to vertigo and dizziness complaints
TiTrATE
Timing of the symptoms
Triggers that provoke the symptoms
And a
Targeted Evaluation
What are the three main diagnosis categories of vertigo?
- Triggered episodic vertigo
- Spontaneous episodic vertigo
- Continuous vestibular vertigo
What is triggered episodic vertigo
Brief episodes lasting seconds to hours (intermittent) and triggered by movement or positional changes
What is spontaneous episodic vertigo
Lasts seconds to days, it has no triggers
What is continuous vestibular vertigo
Lasts days to weeks (need to ask about hearing loss)
What is BPPV
Benign Paroxysmal Positional Vertigo, caused by displaced canaliths (crystals) in semicircular canals
What is the epidemiology of BPPV
No known cause, most commonly occurs between 50-70 year old
Can occur with head trauma in younger adults
When does BPPV often occur
When rolling over in bed, always with change in head position
Where can BPPV occur
Posterior canal (MC) or horizontal canal (rarely)
What maneuver is used to diagnose BBPV
Dix Hallpike Maneuver, (+) with transient upbeat-torsional nystagmis, vertigo
What maneuver is used to treat BPPV
Epley Maneuver - move the rock (canaliths) around in the semicircular canals (patient can do this at home)
What is orthostatic hypotension
A change in vitals with change from supine to standing for one minute
What are the diagnostic criteria vital changes for orthostatic hypotension
SBP down 20mmHg
DBP down 10mmHg
HR up 30bpm
What are some causes of spontaneous episodic vertigo
Meniere’s Disease
Vestibular migraine
What two nerve bundles make up the vestibulocochlear nerve (CN 8)
Vestibular Nerve (balance/eye movements) and Cochlear nerve (hearing)
What is persistent postural-perceptual dizziness (PPPD)
Fluctuating dizziness and disequilibrium, present at rest, and worse with standing
More intense symptoms while moving
What is the cause of pre-syncopal dizziness
Brain hypoperfusion (often due to low BP)
What co-occuring symptoms can present with pre-syncopal prodrome
poor hearing, feeling warm/cold, pallor, diaphoresis, abdominal pain, palpitations, hearing strange sounds
Does syncope require resuscitation?
No, it spontaneously resolves
What is the most common cause of cardiogenic syncope
Arrhythmia
What are the risk factors for cardiogenic syncope
Family hx of sudden cardiac death or MI
Cardiac disease
Cardiac symptomatology
What are the most common causes of general syncope
Neurocardiogenic (carotid sinus hypersensitivity, neck pressure)
Reflex syncope
Vasovagal syncope (activation of vagus nerve via the PNS)
What are some common triggers for vasovagal syncope
Urinating, defecating, coughing, blood pooling in extremities due to prolonged standing, emotional stress
What are some differential diagnoses for syncope
Seizure
Stroke
Trauma/Head Injury
Sleep Disturbance
What is the immediate management of syncope
Goal is to restore perfusion to the brain - lie on ground, elevate legs or sit with head between knees
