Syncope, coma and brain death

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  • Created by: LaurenSE
  • Created on: 14-10-15 18:04

Syncope

Transient loss of consciousness caused by transient global cerebral hypoperfusion
Characterised by rapid onset, short duration and spontaneous complete recovery

Causes:
Neurally mediated syncope - vasovagal, situational, carotid sinus hypersensitivity, glossopharyngeal neuralgia
Orthostatic hypotension (postural)
Autonomic failure - multiple system atrophy, Parkinson's diabetes, amyloidosis, antihypertensives, haemorrhage, vomiting, diarrhoea, Addison's, post-exercise, postprandial (after lunch/dinner)
Cardiac arrhythmias - sick sinus syndrome, AV malformation, supraventricular tachycardia, ventricular tachycardia, long QT syndrome, Brugada's syndrome, malfunction of pacemaker
Structural - obstructuve cardiac valvular disease, ACS, hypertrophic obstructive cardiomyopathy, atrial myxoma, aortic dissection, pericardial tamponade, PE, pulmonary hypertension
Substance/alcohol intoxication
Psychogenic - factitious, anxiety, panic attacks, hyperventilation

Investigations:
- BP
- FBC (acute anaemia)
- fasting blood glucose
- ECG

Management generally involves reassurance and education


Glasgow Coma Scale

Best eye response (E):
4 - spontaneous, open with blinking at baseline
3 - opens to verbal command, speech or shout
2 - opens to pain, not applied to face
1 - none

Best verbal response (V):
5 - oriented
4- confused conversation, but able to answer questions
3 - inappropriate responses, words discemible
2 - incomprehensible speech
1 - none

Best motor response (M):
6 - obeys commands for movement
5 - purposeful movement to painful stimulus
4 - withdraws from pain
3 - abnormal (*******) flexion
2 - extensor (rigid) response
1 - none

Common causes of coma - drugs, toxins (opiates), post arrest, bleeds, herpes simplex encephalitis, bacterial meningitis, brainstem infarcts, hypoglycaemia, DKA, hepatic encephalopathy, uraemia, Wernicke's, SAH, epilepsy

Example 1: 52 year old male, previous fit and well, presents with coma and serial seizures to A&E, family tell you that he has had a fever, cough and marked confusion. He is found to have a fractured right humerus. Phenytoin is given and a CT scan ordered.

Example 2: 28 year old male is brought to A&E at 2am on Sunday morning. The collateral history is obtained…

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