Falls. fits, faints and funny turns Flashcards
What is syncope?
Why are the 3 characteristics of a syncope?
Other more common names for it
Transient loss of consciousness and postural tone due to global cerebral hypo perfusion
Characterised by:
- rapid onset
- short duration
- spontaneous recovery
Blackout
Faint
Loss of consciousness without global cerebral hypo perfusion is due to?:
- leads to seizures
- metabolic disorders
- drugs
Epilepsy
hypoglycaemia
hypoxia
hypercapniea
Medical
Recreational
Falls without loss of consciousness:
- mechanical
- neurological or MSK disorders leading to gait or balance problems
- sensory deficit
extrinsic cause - loose carpet
ageing delirium stroke PD peripheral neuropathy
sight or hearing
Falls without loss of consciousness:
What is a drop attack?
Who is it more common in?
What is the cause?
Sudden leg weakness with quick recovery
Older women
Due to leg weakness or vertebrobasilar insufficiency - can get reduced blood flow to the posterior circulation on looking up or to the side due to atherosclerosis
Falls without loss of consciousness:
Psychological causes
Functional
Panic attacks
Breath holding attacks
Falls history:
BAD BALANCE - mneumonic used
What happened before, after and during?
(B)anged their head? Any injury?
(A)rrhythmic symptoms recently or preceding fall - palpitations or chest pain
(L)oss of consciousness or do they remember the fall?
(A)lcohol - had they been drinking
(N)ew meds started recently
(C)ollateral history - witnesses
(E)ver happened before? How many, were and are they increasing or decreasing in frequency?
Before attack q’s to ask - 3
After attack q’s to ask? - 3
Q’s for the background of attacks?
Is there any warning?
In what circumstances do attacks occur?
Can the patient prevent attacks?
How much does the patient remember about the attack?
Is there muscle ache? - suggests tonic-clonic seizure
Is the patient confused or sleepy? - suggests epilepsy
When did they start?
Are they getting more frequent?
Typical Findings:
Cardiogenic syncope onset:
- is there a warning?
- positioning?
- any symptoms before or during?
Reflex VASOVAGAL syncope onset:
- positioning?
- presyncope symptoms? - 4
- 2 triggers
No warning
Can be in any position (including lying flat)
chest pains and palpitations at the time or recently
Standing or sitting but NOT lying flat
Nausea, pallor, sweating, visual fields narrow
Physical or emotional stress
Typical Findings:
What brings on orthostatic hypotension?
Typical findings with epilepsy
Standing up
Aura
Trigger before
Can be lying flat
Typical Findings:
Cardiogenic syncope - what happens:
- how long does it last?
- what happens to the bowels?
- Colour of skin
- What may you also have that could resemble epilepsy?
seconds to minutes
No incontinence
Pale during and after
Few clonic jerks
Typical Findings:
Reflex syncope - what happens:
- how long does it last?
- what may you have with this? - 2 distinguishing factors
Short - seconds
Myoclonic jerks
Urinary incontinence
Typical Findings:
Which 2 types of syncope have a fast recovery and which one has a slow recovery?
Cardiogenic and reflex syncope have a good recovery
Epilepsy has a slow recovery - known as post-ictal period
Falls investigations:
What needs to be done for anyone who is having falls?
What can be done to investigate orthostatic hypotension?
Why do you do a FBC and BM?
ECG
Lying and standing BP
FBC - anaemia - can cause faintness and falls
Glucose - hypoglycaemia can cause collapse
Falls investigations:
What can be checked if there has been a long lie without movement (muscle stasis) and why?
What should be done if serious head injury is suspected?
Creatine kinase
Rhabdomyolysis - due to breakdown for the muscle
Brain imaging - CT/MRI
Falls investigations:
Secondary referral - when should this be made? who needs to be contacted?
if you think there is a serious underlying condition
DVLA - patient should avoid driving for the time being
