Emergency Medicine: Ward Round

Syncope

Ms Dorothy 63 year old black female was brought to casualty with complain of black out while she was standing and praying at her church. She said she was quite well, while she felt dizziness and had "low feeling in stomach". She did not know how long she was unconscious but when woke up found herself surrounded by her church brother and sisters. No eyewitness was available to recount the incidence.
She denied having chronic illness and history of hospitalisation. she also denied for chest pain,short of breath, profuse sweating, palpitation or cough and cold. There were no history of abdominal pain, diarrhoea, vomiting or urinary symptom.
she walked into ER without help. She was oriented to time place and person,breathing normally, pulse rate was 80 per minute regular and of fair volume, all peripheral pulses were equal and no radio femoral delay. Her blood pressure was 180/98 and there were no postural drop;chest and cardiovascular examination were unremarkable. On CNS examination there were no neck stiffness, no focal deficit noted.

Following write up trying to explain two fundamental issues of emergency medicine:
1)What does the physician need to know in order to provide effective initial care in this scenario?
2) What does the physician have to be able to do in this case?

What to know?

Pathophysiology

1. Impaired Cardiac Filling
2. Impaired Cardiac Ejection
3. Valve and Vessel Obstruction
4. Interference with Cerebral Blood Flow
5. Combined Mechanism

What to do?

Initial Evaluation

Managment of the patient

Specific Clinical Settings

1) Common faint

2)Orthostatic Hypotension

3)Carotid Sinus Hypersensitivity

4)Sokes-Adams syndrome

5)Sick Sinus Syndrome

6)Valvular Aortic Stenosis

7)Hypertrophic Obstructive Cardiomyopathy

8)Cardiac Tamponade

9) Pulmonary Embolism

10)Hypoglycaemia

11) Hyperventilation

12) Transient Ischaemic Attack