Approach to syncope (Ming Jun) WIP (Talleys 41) CAUSES CVS -Orthostatic -LV outflow obstruction -Arrhythmias Chest

pain Diaphoresis Palpitations Giddiness Change in posture Exertion (LV o/f obstru) How long? Breaked fall? Head injury/other injuries? Foaming mouth? Thrashing limbs? Where were you? Could you recognise the place? Was there hemiparalysis? How long? (<30 minutes = TIA) Urine/feces on the floor? Could you bear weight? Tongue biting, blood in mouth? (GTC) Joint aches, muscle aches? (GTC) Neuro Metabolic Drugs Anti arrhythmics Macrolides Antipsychotics Antihypertensives Anti Parkinsonian Vasovagal (most common)

Before

During

Headache Blurring vision Nausea/vomiting Aura Emotional stress (can also be vasovagal) Tongue biting Jerky movements Head turning Sleepiness Cyanosis Joint aches, muscle aches

Diarrhea Poor oral intake Insulin (overdose) Infections

Emotional stress (can also be neuro) A/w nausea, clamminess

After

Special cases -Peads: ask for birth history, skin marks (Neurocutaneous syndromes), aura -Rhabdomyolysis: ask about urine color -Hyperthyroid with hypoK + proximal myopathy hypokalemic periodic paralysis