loss of consciousness - simply revision · loss of consciousness author: alice thomas created date:...
TRANSCRIPT
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Loss of Consciousness
Dr. Alice Thomas
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Faints, Fits and Funny turns
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Overview
• Causes• History: Syncope vs Seizure• Examination/Investigations• Driving/Flying• Law and medicine• Summary
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Syncope
‘Transient loss of consciousness due to global cerebral hypoperfusion.’
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Categories: Seizure vs Syncope
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Syncope: Cardiac
1. Structural
1. Arrhythmia
1. Vasculature
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1. Structural• Aortic stenosis
Sx: Syncope/Pain/Breathless
Signs: slow rising pulse/ Narrow pulse pressure/ Ejection systolic murmur/ Carotids/ Expiration
Mx: Valve replacement./ Transcatheter Aortic Valve Implant
Sx: same
Signs: Displaced forceful apex beat/ ejection systolic murmur
Mx: Activity/ Medications/ myomectomy/ catheter septalablation/ pacemaker
• HOCM
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2. Arrhythmia• Tachycardia
• Bradycardia
• Brugada/Torsades de points
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3. Vasculature
• Volume depletion
• Medications• Diuretics/ TCA/ anti-
hypertensives
• Anatomical• Carotid sinus hypersensitivity• Subclavian steel syndrome
• Autonomic• Parkinsons/ DM
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Syncope: Other
• Vasovagal• Emotion/ Pain/ Stress
• Situational: Cough/ Micturition
• Hypoglycemia• Drop attack• Stroke• Psychiatric
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CARDIAC ARREST!!Reversible Causes
• H’s:• Hypovolaemia• Hypothermia• Hypoxia• Hyper K/Ca2+
• T’s:• Tension Pneumothorax• Toxins• Tamponade• Thrombosis
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Venous thrombosis risk factors• Pulmonary embolism/DVT
P:regnancy/PillI:mobilityM:alignancyS:urgeryF:ractureD:isorders of clotting
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Arterial thrombosis risk factors
1. Hypertension2. Hypercholesterolaemia3. Diabetes4. Smoking
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Seizures
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Seizure:
‘Abnormal event due to electrical discharge in the brain’
• EPILEPSY: Tendency to have seizures
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Triggers
• Flashing Lights, fatigue• Infection• ETOH withdrawal/illicit drugs• Headache (SAH, SOL)• Trauma• Taking meds late/Non compliance
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Seizure Classification
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History
• Before
• During
• After
• PMH/FH/DH/SH
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Acute Mx: Seizure
• ABC…DEFG
• OXYGEN• Benzodiazepines: iv 4mg Lorazepam (5 mins repeat)• No iv access:
• Rectal Diazepam 10mg (10 mins repeat)• Buccal Midazolam 10mg
• STATUS:• Phenytoin in 0.9% N.Saline (15mg/Kg)• Phenobarbitol 15mg/Kg• ITU!
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Examination
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Investigations
• Bloods: CK, prolactin, toxicology, lactate
• ECG: 24 hour
• BP: L/S
• CXR
• Echo
• CT/MRI
• EEG
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Investigations and management
• 1st seizure: Bloods/ MRI• 2nd seizure: Anticonvulsants
• Generalised: Sodium valproate• Partial: Carbamazepine• Absence: Ethosuximide• Lamotrigine• Phenytoin
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Counseling
• Avoid Precipitants• Recreational activities• Pregnancy• Driving
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Flying and Driving
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Law and Medicine
• Consent:• Understand/ Retain/ Weigh up material/Communicate
IMPLIED IN AN EMERGENCY
• Law: Defense of automatism
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Categories: Seizure vs Syncope
Cardiac:-Structural-Arrhythmia-Vascular
Neuro (Seizurees)-Primary: Partial/Generalized-Secondary
Other:-Vasovagal-Hypoglyc-Stroke-Psychiatric
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Overview
• Causes• History: Syncope vs Seizure• Examination/Investigations• Driving/Flying• Law and medicine• Summary
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Thank you! Questions?
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Case 1
• Enjoy!:http://youtu.be/8bygOaphU4o
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How to treat a hypoglycaemic episode
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Algorithms:
ALS
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Tachycardia:
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Bradycardia:
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P450 InducersMomma - ModafinilGrizzly - GriseofulvinBear - BarbituatesCruelly - Chronic alcohol Steals - St. John’s wortPhen-phen- Phenytoin +Phenobarbital
AndRaces- RifampinCars - Carbamazepine
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P450 InhibitorsMy - MacrolidesSullen - SulfonamidesRobot - RitonavirAnd- AmiodaroneAcute - Acute alcohol Kangaroo - KetoconazoleCouldn’t - CiprofloxacinQuickly - QuinidineGet the - GemfibrozilCement -CimetidineGliding on – GrapefruitIce - Isoniazid