Blackouts (1*) Flashcards
What is it?
What are the different causes of it?
➊ Transient, spontaneous LOC followed by complete recovery
➋ • Neurally-mediated syncope (Vasovagal syncope)
• Epilepsy
• Postural hypotension
• Cardiac abnormalities
What does Neurally-mediated syncope include?
What is the most common cause?
→ What occurs here?
→ What are the 3 main features of it?
Which features would suggest Epilepsy?
Which features would suggest Postural hypotension?
Which features would suggest a Cardiac abnormality?
→ What’s a common cause here?
➊ • Vasovagal syncope (fainting)
• Carotid sinus syndrome (hypersensitive carotid sinus baroreceptor → excessive bradycardia +/- vasodilation on minimal stimulation e.g. head-turning)
• Situational syncope (faint w/identifiable trigger)
➋ Vasovagal syncope
→ LOC lasting around 2 mins, with a very quick recovery
→ • Posture - blackout occurred after prolonged standing
• Provoking factors - e.g. pain or a medical procedure
• Prodromal symptoms - sweating or feeling hot before blackout
➌ Tonic-clonic movements, tongue-biting, urinary incontinence, post-ictal drowsiness/confusion
➍ Unsteadiness, Light-headedness, Use of antihypertensives/diuretics
➎ ECG changes, evidence of heart failure, faint on exertion, prodromal palpitations
→ Aortic Stenosis
What are the important things to find out in the history?
• Before – Any prodrome? What were they doing? Trauma?
• During – LOC? Limb jerking? Tongue-biting? Incontinence? Pallor? Duration?
• After – Time to recover? Lethargy? Confusion? Ache/weakness?
• Previous episodes, FHx, Drugs
Investigations:
What is very important to tell the pt whilst the cause is being investigated?
After taking the hx from the pt, what else needs to be taken if possible?
What is involved in finding the cause?
➊ They must not drive!
➋ Collateral hx
➌ • Assess vital signs, L/S BP
• ECG
• Documenting details of the event (w/collateral hx from a witness if possible)
• Determining whether there have been any previous blackouts, considering the person’s medical and family hx of cardiac disease/sudden cardiac death, and reviewing whether any current medication may have contributed
