The Patient with Collapse
Key Points
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The history plays a pivotal role in the assessment of a patient with collapse. The key is to establish whether the collapse fits the typical history of a simple faint (vasovagal syncope) or whether there are atypical features in the history.
- A simple faint is characterised by three key features – posture, prodrome (light headedness) and prompt full recovery after assuming the supine position.
- Atypical features suggesting a more serious aetiology include onset of symptoms in the supine position or with exercise, absence of prodromal symptoms, localising symptoms such as acute chest pain, acute headache or focal neurological deficit and failure of the symptoms to promptly resolve on assuming the supine position.
- The ABCD approach to assessing patients with collapse involves an Assessment of the patient for indicators of serious illness, a focused history and examination of the patient to Be sure its syncope and a Check for high risk features and Discharge and follow up in low risk patients with features typical for simple faint.
Collapse is a common a presentation to the general practitioner and the emergency department. Although many cases are the result of benign causes such as vasovagal syncope it is important to always consider and exclude serious disease such a cardiac dysrhythmias, mechanical outflow obstruction (eg. aortic stenosis, HOCM), hypovolaemia / haemorrhage, postural hypotension (eg drugs), metabolic disorders (eg hypoglycaemia) and acute CNS disease (eg. subarachnoid haemorrhage, vertebro-basilar ischaemia). Table 1 below lists the critical diagnoses that need consideration and the associated clinical clues the suggest these causes.
History, clinical examination, ECG, BSL and urinalysis are key factors in assessing patients who present with collapse. Unless suspected on history and examination routine biochemistry and haematology investigations, CXRs and CT scans are of minimal value to the assessment of a patient with an uncomplicated collapse.
Table 1 : Differential Diagnosis of Collapse and Clinical clues
Cardiac
Central Nervous System
Others
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