Tasty Morsels of EM 132 – #FRCEM Transient Loss of Consciousness

27 Aug

I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here.

There is guidance from NICE 2010 on this. RCEM has a brief summary

What does not NICE consider as red flag on the ECG?

  • conduction abnormality
    • they include RBBB and LBBB in this
  • long or short QT
  • any ST segment or T wave abnormalities

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Who should we refer for urgent CV assessment?

  • (this can be within 24 hrs but I suspect this means for most of us – admit)
  • ECG abnormality
  • heart failure (by history or signs)
  • exertional
  • FHx sudden cardiac death <40
  • New/unexplained breathlessness
  • Murmum
  • They also add anyone over 65 without clear prodrome

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Describe some ECG causes of syncope
When should we do a tilt test?

  • suspected vasovagal that is recurrent and adversely affecting quality of life
  • tilt test is only to assess for a severe cardioinhibitory response (asystole)

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What do we do with syncope during exercise?

  • offer EST within 7 days unless you suspect something more significant (AS or HOCM which would both be a bad idea to stress!)

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