Loss of Consciousness (LOC) Flashcards
What key history would you obtain from a patient who presents after losing consciousness?
Presence or abscence of preceding symptoms (nausea, diaphoresis, palpitations, pallor, lightheadedness) Context (exertional, postural, traumatic; stressful, painful, or claustrophobic experience; dehydration) Associated tongue biting Incontinence Tonic-clonic movements Prolonged confusion Dyspnea or PE risk factors History of heart disease or arrhythmia Alcohol and drug use
What key physical exams would you obtain from a patient who had a history of loss of consciousness?
Vital signs including orthostatics
Complete neurologic exam
Carotid and cardiac exam
Lung exam
26 yo M presents after falling and losing consciousness at work. He had a rhythmic movements of the limbs, bit his tongue and lost control of his bladder. He was subsequently confused (as witnessed by his colleagues). Differentials?
Complex tonic-clonic seizure Convulsive syncope Substance abuse/overdose Malingering Hypoglycemia
26 yo M presents after falling and losing consciousness at work. He had a rhythmic movements of the limbs, bit his tongue and lost control of his bladder. He was subsequently confused (as witnessed by his colleagues). Differentials: complex tonic-clonic seizure, convulsive syncope, substance abuse/overdose, malingering, hypoglycemia. Workup?
CBC, electrolytes, glucose Urine toxicology EEG MRI - brain CT - head LP - CSF analysis ECG
55 yo M complains of falling after feeling dizzy and unsteady. He experienced transient LOC. He has hypertension and is on numerous antihypertensive drugs. Differentials?
Drug-induced orthostatic hypotension (causing syncope) Cardiac arrhythmia Syncope (vasovagal, other causes) Stroke MI Pulmonary embolism
55 yo M complains of falling after feeling dizzy and unsteady. He experienced transient LOC. He has hypertension and is on numerous antihypertensive drugs. Differentials: drug-induced orthostatic hypotension (causing syncope), cardiac arrhythmia, syncope (vasovagal, other causes), stroke, MI, pulmonary embolism. Workup?
Orthostatic vital signs CBC Electrolytes CT- head ECG V/Q scan CT - chest with IV contrast
65 yo M presents after falling and losing consciousness for a few seconds. He had no warning prior to passing out but recently had palpitations. His past history includes coronary artery bypass grafting (CABG). Differentials?
Cardiac arrhythmia (causing syncope) Severe aortic stenosis Syncope (other causes) Seizure Pulmonary embolism
65 yo M presents after falling and losing consciousness for a few seconds. He had no warning prior to passing out but recently had palpitations. His past history includes coronary artery bypass grafting (CABG). Differentials: cardiac arrhythmia (causing syncope), severe aortic stenosis, syncope (other causes), seizure, pulmonary embolism. Workup?
ECG Holter monitoring CBC, electrolytes Glucose Echocardiography CT - head
