Unconsciousness Flashcards
Define syncope
Transient loss of consciousness. This is due to global cerebral hypo perfusion.
Have a loss of postural tone.
Presentation of syncope?
Pallor
Sweating
Narrowing of vision
Changes to hearing
Nausea
Lightheadedness
Feeling unwell
Rapid onset
Short duration - Only lasts 30s
Understand what has happened - no pure confusion. I.e spontaneous complete recovery.
Causes of loss of consciousness?
The list is endless but here are some:
Epilepsy/seizures
Syncopal episode / vasovagal syncope
Neurocardiogeneic syncope
Cardiac syncope
Hypoglycaemia
Arrhythmia
Head injury
Cataplaxy - this is where pt gets sudden muscle weakness while awake. Can be triggered by strong emotions.
Investigations for syncopal episode?
(CVS exam)
Bedside:
12 lead ECG
BP - sitting and standing.
Blood glucose
Pregnancy test if female
Tilt table test.
Bloods:
FBC
Cardiac enzymes
U+E eGFR - may be dehydrated
Serum cortisol - may be adrenal insufficiency.
Imaging - if necessary based on Hx
Define a coma
Absence of consciousness.
Lots of different states/types:
- minimally conscious
- vegetative state
- brain dead
- neglect syndrome
- encephalopathy
- mass lesion coma
Immediate Management of coma?
ABCDE.
GCS
Depends on cause:
- Drug overdose - need appropriate meds.
- Increased ICP - relieve pressure
- seizure control
- abx for infective cause
- glucose if hypoglycaemic.
Investigations for coma?
Bloods: FBC, U+E, Glucose, TFTs, LFTS, Alcohol or drug concentration,
LP for infection
CT scan, MRI, EEG
How is consciousness lost?
Problems with reticular activating system or the cortex
What are some typical pre-syncope symptoms?
Faint
Hot
Sweaty
Muffled hearing
Blurred vision
Tinnitus
Dizziness
Typical symptoms suggestive of unconsciousness due to temporal lobe epilepsy?
deja vu, jamais vu, olfactory and gustatory(taste) hallucinations
