Funny turn - collapse

Question 1

Differential diagnosis

Answer 1

Postural hypotension
Seizure
Vasovagal syncope

Question 2

HPC questions to ask

Answer 2

Explore what happened before, during and after

Did they lose consciousness?
Did they bite their tongue or lose continence?
How long did it last?
How quickly did they recover?

Has anything like this happened before?

Any chest pain at the time? (may be associated with cardiogenic syncope)

Question 3

PMH

Answer 3

Epilepsy
Heart arrhythmias
Other PMH

Question 4

DH

Answer 4

Any recent changes to medications?

On any anti-hypertensives

Other meds?

Question 5

SH

Answer 5

Effect on day-to-day life
The rest - normal Qs
(Driving)

Question 6

Examination and investigations

Answer 6

Lying and standing BP
Cardiac examination 
Neurological examination
ECG
Bloods - FBC, U+Es, LFTs, glucose

Question 7

Treatment for postural hypotension

Answer 7

Be cautious when driving

Stand up slowly (go from lying to sitting to standing)

Raise head of bed a few inches

Drink plenty of fluid - 2L per day

Leaflet

Question 8

Treatment for seizure

Answer 8

Avoid triggers

What to do to make safe during a seizure (recovery position)

If longer than five minutes call an ambulance

Avoid driving and inform DVLA

Refer for urgent neuro assessment if first seizure

Question 9

Treatment for vasovagal syncope (faint)

Answer 9

Reassurance - no treatment needed

Learn to recognise symptoms and avoid triggers

No need to inform the DVLA if uncomplicated faint