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Loss of Consciousness in Syncope - Differential Diagnosis Framework

Syncopal causes:
• Orthostatic syncope
• Reflex syncope
• Cardiac arrhythmia
•
Loss of Consciousness ... pseudosyncope #Loss #Consciousness
There are different levels of consciousness, they are named in the diagram below but are better
different levels of consciousness ... Diagnosis #Levels #Consciousness
Causes of Syncope and Transient Loss of Consciousness

#Syncope #Differential #LOC #Causes #Diagnosis
Transient Loss of Consciousness
Dizziness and Vertigo Algorithm
Presyncope:
 • Feels "faint" or like they are going to "pass out"
 •
Associated with loss of consciousness ... faintness or loss of consciousness
3D-CAM Assessment for Delirium

Feature 1: Acute Change / Fluctuating Course
 • Assessment questions: Self report of
fluctuations in: consciousness ... Altered Level of Consciousness
Markers of Organ Dysfunction in Severe Sepsis 
Altered consciousness 
Confusion 
Psychosis 

Tachycardia 
Hypotension 
Altered CVP 
Altered
Sepsis Altered consciousness
Clinical features of shock from dehydration in an infant

Decreased level of consciousness 
Sunken fontanelle 
Dry mucous
Decreased level of consciousness
Toxidromes: Serotonin Syndrome, Neuroleptic Malignant Syndrome, Anticholinergic Delirium - Venn Diagram

All: Hypertension, Tachycardia

Anticholinergic Delirium:
- dilated pupils,
rigidity, fluctuating consciousness
Syncope - Cerebral hypoperfusion leading to transient lsos of consciousness causing alck of postural tone with
transient lsos of consciousness
Ottawa Subarachnoid Hemorrhage (SAH) Rule:

The Ottawa SAH rule contains 6 clinical variables to consider:
- Age >=40
-
Witnessed loss of consciousness