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Syncope

  • Common ddx

    • vasovagal, hypoglycemia, febrile seizure, arrhythmia, dehydration, heat stroke in summer, hyperventilation, medication
  • Serious ddx

    • brain hematoma, mass, stroke, MI, tamponade, PE, DKA, HCM
  • Labs

    • CBC, chem, glucose
    • TSH
    • cardiac enzymes
    • UA, Utox, pregnancy test
    • EKG
    • head CT if trauma
    • EEG if seizure
    • holter monitor if arrhythmia
  • Admission orders

    • Admit: Telemetry
    • Diagnosis: Syncope
    • Condition: Guarded
    • Vital Signs: Telemetry routine
    • Allergies:
    • Nursing: O2 to maintain sat > 92%, Daily weight
    • Diet: Regular
    • Activity: Fall Risk, Up with Assistance Only
    • Labs:
      • CBC, chem
      • cardiac enzymes: CK, CK-MB, troponin now and in 8 hours
      • EKG
      • Echocardiogram
    • IV: Heplock IV
    • Special: consider cardio, neuro, psych consult
    • Medications:
      • Heparin 5000 units SQ q 8 hours
      • Docusate 250 mg PO bid prn (hold for loose stool)
      • Hold furosemide, antihypertensives, analgesics
  • Discharge

    • outpatient studies: holter monitor
    • education: driving risk
  • Endo ddx

    • Addison's crisis, DKA
  • Neuro ddx

    • brain hematoma, mass, stroke, vasovagal, epilepsy, seizure disorder, carotid sinus hypersensitivity, febrile seizure, hyperventilation
  • Cardio ddx

    • arrhythmia, aortic stenosis, subclavian steal, MI, tamponade, HCM
  • Pulm ddx

    • PE
  • Heme ddx

    • anemia, hemorrhage
  • FEN ddx

    • hypoglycemia, dehydration, heat stroke
  • HPI

    • onset
    • triggering event
    • quality: vertigo, dizziness, weakness, prodrome, postictal
    • loss of consciousness
    • current status
  • ROS

    • head trauma, fall history
    • neuro: headache, weakness, prodromes, postictal state
    • cardio: chest pain, palpitations
    • pulm: dyspnea
    • GI: abdominal pain, diarrhea, nausea, vomiting
    • FEN: orthostasis, hydration status, missed meals
  • PMH

    • stroke, TI
    • diabetes
    • CAD
    • PE, DVT
    • panic/anxiety disorder
    • recent surgery
  • FH

    • CAD
  • SH

    • recent travel, stasis
    • heat exposure
    • CO exposure
  • Meds

    • antihypertensives
    • diuretics
    • insulin usage
    • chronic steroid usage
  • Allergies

  • Px

    • vitals: BP, temperature, O2 sat
    • orthostatic bp
    • gen impression
    • cardio: JVD, murmurs, gallops, irregularity, unequal pulse
    • pulm
    • neuro: bilateral grip, strength, sensation, finger-to-nose, gait
    • extremities: edema, tenderness

  • Print | Citations

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