Wednesday, April 6, 2016

Step 2 CS: Loss of consciousness

Differentials:
Seizure - Ask for shaking, tongue biting, rolling of eyes, incontinence

Hypoglycemia - Sweating, fatigue, excessive hunger

Orthostatic hypotension - Ask for palpitations, positional syncope or hypotension associated with large meals. Medications can cause this. Counsel this patient properly by warning them and ask them to get up slowly, etc.

Vasovagal syncope: What were you doing when you lost consciousness?
Vasovagal syncope is provoked by intense emotion, pain, and/or orthostatic stress, whereas the situational reflex syncopes have specific localized stimuli (Like micturition) that provoke the reflex vasodilation and bradycardia that leads to syncope.

Ask for syncopal prodrome: Lightheadedness, visual or auditory symptoms

Examination:
Check mouth for tongue trauma
Neck for JVD, carotid bruits
Chest for apical impulse, auscultate
Extremities for pulses
Neurology do Romberg and gait

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