Syncope

Question 1

When a patient experiences a loss of consciousness, how do you determine if they had a seizure?

Answer 1

• more than 20 jerks that are occurring bilaterally
• post-ictal state
• possible aura
• returns back to normal gradually, usually longer than five minutes

Question 2

When a patient experiences a loss of consciousness, how do you determine it was syncope?

Answer 2

• rapid come back, less than one minute
• less than 10 jerks occurring unilaterally
• may or may not have an aura

Question 3

If the syncope is happening vasovagally, what are some causes?

Answer 3

• visceral
• baroreceptors, like the carotids
• psychogenic

Question 4

How do you dx vasovagal syncope?

Answer 4

• A carotid massage; if the systolic bp drops 50 points or if the monitor turns into asystole, then it is a positive dx

Question 5

tx for vasovagal syncope?

Answer 5

beta blockers

Question 6

How is orthostatic syncope dx?

Answer 6

Perform orthostatic bp… have the patient lie down for five minutes… take bp. then have the patient stand for five minutes… take bp

– if the patient cannot stand for the entire five minutes, then let the patient sit down and take the bp… should show orthostatic bp

Question 7

Tx for orthostatic syncope?

Answer 7

• Patient could be volume depleted… diarrhea, hemorrhage… give IV fluids
• If patient has a poor autonomic nervous system response (elderly and parkinsonian)… compression stockings may help

Question 8

If a patient has a mechanical heart valve issue that is causing syncope, how can you diagnose it?

Answer 8

• Murmur on physical exam

- Get echocardiogram…. will determine if the patient needs surgery or not to have the valve fixed

Question 9

If an arrhythmia is causing syncope, how do you diagnose the problem?

Answer 9

• Holter monitor

* looking for the arrythmia

Question 10

Syncope can be faked or related to psychogenic causes. How can you tell if a patient is faking syncope?

Answer 10

• Have them hold their hand in front off their face from above their head. if the hand falls on their face, then they are not faking it and should be placed in observation in the hospital.

If the hand does not fall back, then they are faking it.

Question 11

Syncope can be checked by ordering a BMP. Which electrolytes are you looking for?

Answer 11

Na, Ca–> can cause altered mental status

Mg, K–> can cause weakness