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Initial evaluation: Difference between revisions
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<span style="font-size:130%>This page is also available in Dutch: [[eerste evaluatie]]</span> | |||
==Flowchart for the initial evaluation of syncope== | ==Flowchart for the initial evaluation of syncope== | ||
[[File: | [[File:Seh_flowchart_tloc.jpg|1000px]] | ||
==Goal== | ==Goal== | ||
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#Is there an obvious cause and/or is there a high risk for acute cardiac death? | #Is there an obvious cause and/or is there a high risk for acute cardiac death? | ||
For T-LOC the most important diagnostic tool is the medical history. Start history taking with '''open questions''' | <span style="font-size:110%>For T-LOC the most important diagnostic tool is the medical history. Start history taking with '''open questions.''' <br /> | ||
''What happened? What did you feel? How did you do afterwards?'' </span> | |||
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<span style="font-size:120%>The following elements must be addressed in any case ('''<span style="color:#ff0000>RED</span>''': risk of acute cardiac death, '''<span style="color:#008000>GREEN</span>''': first epileptic convulsion):</span> | <span style="font-size:120%>The following elements '''must''' be addressed in any case ('''<span style="color:#ff0000>RED</span>''': risk of acute cardiac death, '''<span style="color:#008000>GREEN</span>''': first epileptic convulsion):</span> | ||
====Circumstances prior to T-LOC==== | ====Circumstances prior to T-LOC==== | ||
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====During the end of T-LOC==== | ====During the end of T-LOC==== | ||
*Pallor, sweating, nausea, abdominal discomfort, vomiting | *Pallor, sweating, nausea, abdominal discomfort, vomiting | ||
*Incontinence of urine <span style="color:#008000> | *Incontinence of urine or <span style="color:#008000>defecation</span> | ||
*<span style="color:#008000>Prolonged confusion</span> (i.e. dysfunctional imprinting; sleeping is not confusion) | *<span style="color:#008000>Prolonged confusion</span> (i.e. dysfunctional imprinting; sleeping is not confusion) | ||
*<span style="color:#008000>Myalgia</span> | *<span style="color:#008000>Myalgia</span> | ||
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*<span style="color:#FF0000>Familial acute death < 40 years old with an unknown cause</span> | *<span style="color:#FF0000>Familial acute death < 40 years old with an unknown cause</span> | ||
*Many episodes of T-LOC/long duration of T-LOC (psychogenic) | *Many episodes of T-LOC/long duration of T-LOC (psychogenic) | ||
*Medication (anti diabetic drugs, | *Medication (anti-diabetic drugs, anti-hypertensive drugs, psychiatric medication), intoxications | ||
====Useful information from anamnesis==== | ====Useful information from anamnesis==== | ||
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===Points of interest=== | ===Points of interest=== | ||
*Auscultation of the heart: are indications for structural heart disease present or an arrhythmia present? | *Auscultation of the heart: are indications for structural heart disease present or an arrhythmia present? | ||
*Supine and standing blood pressure and pulse | *Supine and standing blood pressure and pulse: After 5 minutes of supine rest the blood pressure and pulse must be measured at least twice. The patient then rises from supine to standing position. Within 3 minutes of standing the blood pressure and pulse must be measured again. One speaks of orthostatic hypotension if the systolic blood pressure drops with at least 20 mmHg, or the diastolic blood pressure drops with at least 10 mmHg within 3 minutes. If the blood pressure dropped it is wise to continue measuring while standing to see if it will drop further. One must also ask the patient if he/she experiences symptoms during standing. | ||
*Neurological examination: in particular attention for the lateral tongue bite | *Neurological examination: in particular attention for the <span style="color:#008000>lateral tongue bite </span> | ||
*Trauma (capitis) due to a fall during T-LOC | *Trauma (capitis) due to a fall during T-LOC | ||