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what are the causes of syncope and how can you remember them?
- HEAD-represents central nervous system
- HEART-cardiac pumping dysfunction
- VESSELS-loss of vascular tone
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what does H.E.A.D. stand for?
HEAD- loc d/t CNS dysfunction
- H. Hypoxia, Hypoglycemia
- E. Epilepsy
- A. Anxiety, psych
- D. Dysfunction of brain stem
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what does H.E.A.R.T. stand for?
syncope d/t cardiac pumping dysfunction
- H. heart attack
- E. embolism of pulmonary artery
- A. aortic obstruction
- R. rhythm disturbance
- T. tachydysrhythmia
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What does V.E.S.S.E.L.S stand for?
syncope d/t loss of vascular tone
- V. vasovagal
- E. exsanguanation (ectopis, ruptured aa, GI bleed
- S. situational
- S. subclavian steal
- E. ENT reasons, glossopharangeal neuralgia
- L. low systemic vascular resistance
- S. sensitive carotid sinus
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name some life threatening causes of syncope
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do strokes cause syncope?
strokes from carotid artery disease rarely do...there is no rapid return to consiousness and there is usually focal neurologic deficits
vertebrobasilar insufficiency may cause syncope with signs of brain stem dysfunction...ataxia, diplopia and vertigo
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what are the initial concerns for treaing a patient with syncope? 3
- 1. ABCs
- 2. start IV, monitor, and o2, glucose
- 3. treat any injuries d/t fall
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what components to syncope hx are most important?
what was patient doing prior to event/position
was there any prodrome
witnesses, abnormal movements
clues to hypovolemia, bleeding, thirst, vomiting diarrhea, heavy vag bleeding
family hx of sudden death eg long qt syndrome
duration of event,prior episodes
medications/drug use/last meal
associated sxs-face pain,cp,palp, ha,cough,nausea, dizzy,weakness, diaphoresis
pmh- cad,valve disease, cerebrovasc dz,
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how can i tell the difference between syncope and seizure
***slow recovery from seizure..post ictal somnolent and confused
incontinence
lateral tongue biting
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important things to check on physical exam?
recal exam in elderly
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tests needed for syncope work up
vs including orthostatic vs
fs
ekg
occasionally head ct, spiral t of chest, echocardiogram, carotid us, cbc
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low risk patients with syncope
<30 years old with no history of syncope and no evid of cardiogenic syncope
<70 years old with clear vasovagaaal syncope
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intermediate risk patients with syncope
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high risk paitients with syncope
must be admitted
frequent episodes that occur with little reason
syncope that occurs when pt is recumbent
syncope w assoc card sxs-e.g. cp, pap,dyspnea
abnormal ecg
elderly w unexplained etiology
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