1 / 18

Assessing Syncope and Loss of Consciousness

Assessing Syncope and Loss of Consciousness. SYNCOPE. 70 yr old male presents following syncopal episode while shopping. He has had 2 previous syncopal episodes that have not been investigated. He currently feels a little unwell. At triage BP 120/80, PR 83. Should this man be admitted?.

tola
Download Presentation

Assessing Syncope and Loss of Consciousness

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Assessing Syncope and Loss of Consciousness

  2. SYNCOPE • 70 yr old male presents following syncopal episode while shopping. He has had 2 previous syncopal episodes that have not been investigated. • He currently feels a little unwell. • At triage BP 120/80, PR 83. • Should this man be admitted?

  3. SYNCOPE • Brief loss of consciousness associated with inability to maintain postural tone that spontaneously and completely resolves without medical intervention • PRE SYNCOPE • A warning of syncope that does not result in LOC

  4. Syncope accounts for 1-3% ED visits and 6% admissions. • In ED need to determine cause and if one cannot be found which pts are at greatest risk of serious outcome ie. risk stratification.

  5. CAUSES OF SYNCOPE • CARDIAC • Arrythmias • Ischaemia • Obstructive lesions • HOCM • Aortic Stenosis • Mitral Stenosis • NEUROLOGICAL • Seizure (usually easily differentiated) • TIA ( VBI) • SAH

  6. PULMONARY - PE • PERIPHERAL VASCULAR • vasovagal • - warning signs • - quick recovery • - <40 yrs 1st time • orthostatic • - intravascular volume depletion or autonomic dysfunction • blood loss /dehydration • drug induced • diabetes

  7. MISCELLANEOUS • Hypoglycaemia • Hyperventilation • Anaphylaxis • PSYCHIATRIC • conversion disorders (50% young pts) • personality disorders

  8. HISTORY • previous syncope • known -IHD,CCF, arrhythmias • medications • blood loss • circumstances of syncope • - prodrome • - position • - exertional • - associated symptoms • Family history

  9. EXAMINATION • Full exam but most importantly • BP (lying, standing) • pulse • PR • Injury assessment • INVESTIGATIONS • BSL • ECG • FBC • UEC

  10. SYNCOPE WITHOUT OBVIOUS CAUSE • San Francisco Syncope Rule (2002) • Identifies those pts at risk of serious • outcome (death, AMI, arrhythmia, PE, stroke, SAH, haemhorrage, return visit to ED.) • - systolic BP <90 in ED • - Abnormal ECG • - Hct <30 • - SOB • - history of CCF • If pt has none of above there is no risk of serious outcome related to the syncopal episode (100% sensitive, 49% specific) • Numerous studies since to validate (less sensitivity /specificity)

  11. OESIL (2002) • Predictors of mortality within 12 months- • cumulative score: • - age >65 yrs • - cardiovascular disease in history • - syncope without prodrome • - abnormal ECG • 0% score 0, 0.8% score 1, 19.6% score 2, • 34.7 % score 3, 57.1% score 4

  12. ROSE (British) • Elevated BNP, Haemoccult +ve, anaemia, low O2 sats,presence Q waves on ECG predict serious outcome at 30 days. • 87% sens, 98% neg pred value. • Many studies but no highly sensitive reliable tool is yet available. Cardiac disease is recurring theme – cardiac syncope kills. • ACEP level A recommendation for investigation of syncope – history and ECG.

  13. So should we admit this man ? • How long do we keep him for ? • What tests and monitoring does he receive?

  14. PROLONGED ALTERED STATE OF CONSCIOUSNESS • By definition NOT syncope • Glasgow Coma scale is a universal tool used to assess and document individual patients progress in globally understood terms.

  15. Prolonged altered states of consciousness with GCS <12/13 will be due to either a neurological cause, a systemic cause that leads to hypoperfusion of the brain or a toxic, infective or metabolic problem that may be affecting the whole body (but presenting as a neurological emergency).

  16. Different causes to those of syncope: • Neurological • vascular • neoplastic • oedema • infective • trauma • status epilepticus • Infective • generalised sepsis • Metabolic • hypo/hyperglycaemia • uraemia • hyper/hypocalcaemia • liver disease

  17. Toxins • alcohol et al • Respiratory • hypoxia/ hypercarbia • Biochemical • eg. Hyponatraemia • Hypo/hyperthermia • Endocrine • hypothyroid

  18. Approach to patient with altered LOC should always be the same. • A B C

More Related