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Fits faints and funny turns

Fits faints and funny turns. Mike Cheshire May 2007. nomenclature. Blackout Syncope Loss of consciousness All mean the same thing. TIA. Patient collapsed on the street and brought to A and E. Fully recovered in 6 hours.

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Fits faints and funny turns

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  1. Fits faints and funny turns Mike Cheshire May 2007

  2. nomenclature • Blackout • Syncope • Loss of consciousness • All mean the same thing

  3. TIA • Patient collapsed on the street and brought to A and E. Fully recovered in 6 hours. • 70 year old man with transient episodes of loss of consciousness lasting about 15 minutes 2 or 3 times a week.

  4. TIA • Transient, focal, neurological deficit of presumed ischaemic origin lasting for less than 24 hours.

  5. Epilepsy? • Up to half of all patients with epilepsy in some studies have not got it. • History not that helpful unless absolutely classical. • Loss of consciousness ? cause needs a careful framework for thought

  6. History • I must have doesn’t know • He said that I doesn’t know • I saw him very useful • They said he may be useful often not

  7. First checks • ABC • Glucose • History • Examination looking for: • Level of consciousness, Glasgow score • Pupils and eye movements • Full examination • Tests

  8. Causes of LOC • Neurological • Cardiovascular • Metabolic including drugs • Psychogenic • Time course and time line very important

  9. What is this? • He was ok yesterday and went about his usual business • But today he says he doesn’t remember anything about what happened

  10. ECG • Long QT syndrome • Arrythmias • Left bundle branch block • Heart block

  11. She faints when she rolls over

  12. Not to miss • Aortic stenosis • Mitral prolapse • Heart block and rhythm disturbance • Long QT • Postural hypotension

  13. student • Aged 24 • Found on the floor broken teeth on way back from toilet in early hours of morning

  14. Man aged 70 • Blacks out on the toilet doctor • Happened 3 times in the last month • Never before

  15. One drug • Cured

  16. Lost my vision • Sudden • Like a shutter coming down • Better now

  17. Apathetic for walking83 year old retired dentist • Usually rides a bike • Went on holiday to west coast USA • Well when he got on plane • Could not walk when he got off • Saw own GP when returned • Renal function worse than usual • Heart failure well controlled

  18. dentist • His cardiologist says he is fine • He cant walk • Examination legs normal • In a wheel chair • Cant walk doctor

  19. Can,t talkcould yesterday Is this parkinsons disease Jaw stiff Confused

  20. Female aged 54 • Vertigo • Itching • Nausea and vomiting • Not sleeping • Cant walk out of house

  21. copd • Usually breathless on exertion • Worse today • Called ambulance • Unconscious on arrival

  22. Things not to forget • Drugs started or stopped prescribed or recreational • Migraine • Have you ever had this before? • What do you think that this is? • How are you?

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