Trainee Advanced Clinical Practitioner Diary- Day 18 - Critical Care Practitioner

Trainee Advanced Clinical Practitioner Diary- Day 18

Young patient presented with several episodes of dizziness and at least two episodes of brief periods of loss of conciousness.

History taking was very important in this case as being able to ascertain the cause of this was very reliant on understanding the pattern of the attacks.

The NICE guidelines on Transient Loss of Consciousness (TLOC) are an extremely helpful guide in this case and reference to them was made.

Tongue biting, prodromal events, presence or absence of any events during the TLOC, duration of the event and how long it took the patient to recover are questions that need to be asked.

Full examination including cardiac, respiratory and neuro exam were carried out.

A 12 lead ECG is very important to discount heart blocks or long QT intervals for example.

Red Flags:

  • ECG abnormality
  • TLOC during exercise
  • Family history of sudden cardiac death
  • Heart murmur
  • New or unexplained breathlessness

Definition is a loss of consciousness with or without full recovery.

Could be due to:

  • Transient Loss of Consciousness (TLOC)
  • Falls
    • Vertical to horizontal position involuntarily.
      • ?transient arrythmias
      • ?mechanical fall
      • ?peripheral neuropathy
      • ?any other injuries
      • ?head injury.
    • Need to be aware that the elderly who have fallen may not want to admit to it for fear of losing independence.
    • NICE Guidelines Falls
  • Shock
    • Sepsis
    • Anaphylaxis
    • Cardiogenic
    • Neurogenic
    • Elderly patients sometimes missed with sepsis because other factors considered first.
  • Reduced loss of consciouness
    • ABCDE
    • AVPU
    • GCS
  • History
    • Witnesses
    • Ambulance crew
    • Previous attendances
    • GP history
    • Residential home- call for history
    • Carer
    • Previous discharge letters
    • Prodromes
    • ?chest pain
    • ?palpatations
    • blood sugar
    • Alcohol- exclude everything else first.

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