I keep a little, ever-expanding note on my phone where I jot down little morsels of goodness that I pick up while listening to or reading one of the many excellent sites/podcasts in the useful resource section.
I’ll try and transfer them here for your enlightenment.
From the mighty ER Cast on paediatric syncope:
- When you think of exercise related syncope it’s worth splitting it into 2
- exhaustion/dehydration related syncope with prodrome (not so worrying)
- sudden with no warning (more worrying)
- The examination is all about murmurs but you will never know all the ins and outs so remember what’s normal
- the HOCM murmur should get louder with valsalva (the innocent ones should get quieter)
- ECG is probably the most useful test. Some points
- if speed is a problem speed up the paper to 50mm/sec
- look for WPW
- look for long QT (unfortunately they don’t give us a useful number to think of; in kids they vary; in adults >450 is abnormal but I don’t get excited till >500)
- long QT can be congenital or acquired; macrolides and anti-psychotics will commonly bump up your QT
- old man LVH should make you think HOCM
- look out for Brugada
- they make the important point that checking a blood sugar is useless in the awake patient in front of you. If low sugar caused them to go down then if they’re awake now the sugar will be normal. If they’re altered then go ahead but if they’re normal then it’s not useful
- they also note all the silly names for common fainting that have no clinical relevance though it does make us look smart when we use them
- anyone know if the long QT/Brugada/WPW have arrhythmias that are exercise induced?