Syncope, Seizures & Collapse

“Patients who have fallen should be assessed for injury, but why they have fallen is also a question that needs answering – this may not be answered in the ED.”

CAP 15 – Fits/Seizures

EM Curriculum: (click to view)

BACKGROUND

Syncope is a common presentation with an estimated incidence of 6.2 per 1000 population in the Framingham Study, accounts for 3-5% of Emergency Department (ED) attendances and 1-6% of urgent hospital admissions.

Each year in the UK there are approximately 650,000 older people attending emergency departments for fall-related injuries and 82,000 hip fractures. Falls cost the NHS billions of pounds, therefore preventing falls is a national priority.

Patients who have fallen should be assessed for injury, but why they have fallen needs to be considered. A multi-factorial assessment is required if the patient has an abnormal gait and balance, or if they have fallen more than once in the last 12 months.

Epilepsy is common with an estimated developed world prevalence of 5-10 per 1000 people, and an annual incidence of 50 per 100,000 people. If status epilepticus is left untreated the mortality rate approaches 30%.

Learning Outcomes from completing the tasks

  • Recognise common causes of syncope.

  • Determine which patient requires admission into hospital for further investigations and which can be discharged home safely following syncope.

  • Be able to recognise and manage a patient with status epilepticus in the Emergency Department.

  • Be familiar with the ESC guidlines on syncope and when to consider pacing for a patient.

  • Review the DVLA advise on fitness to drive.

Learning Outcome from face-to-face teaching

  • Revise the management of syncope and collapse.

  • Recognise the various arrhythmias that could present with syncope and collapse in the ED setting.

  • Recognise the various common seizure syndromes.

  • Recognise the appropriate use of a first fit clinic.

Tasks

Complete the following before the face to face session:

Task 1: Falls and Blackouts

Duration: 40 mins

This video is a summary taken from the excellent Emergency Medicine Ireland website and is a teaching session delivered to a group of registrars. It covers a range causes to look out for, including features in history and examination.

A talk I gave for our registrars at a recent teaching session. Inspired heavily by Amal Mattu, the LITFL guys (inc Ed Burns), sonocloud.org and one of the Irish SpRs Rosa McNamara. So blame them if i'e got it all wrong... ;-)

Task 2: Summary of DVLA guidelines

Duration: 15 mins

Read this summary document from RCEM - it is worth knowing the specifics for some common conditions, however it is also important to know this document exists and be able to refer to it if you are unsure after seeing a patient.

Task 3: Status Epilepticcus

Duration: 60 mins

This RCEM eLearning module covers the diagnosis and management of a patient with Status Epilepticcus.

Task 4: Nothing is ever simple

Duration: 6 mins

A short podcast from the Best Case Ever series about a gentleman with recurrent falls and a painful wrist. Without giving away any spoilers it illustrates why a full assessment is required even if the presentation initially seems simple.

#EM3 Content

Lightning Learning

SIMBLOg:

CASE DISCUSSION

We have written a series of interactive cases (wikis) with short answer questions to be answered by trainees prior to the face to face teaching sessions. Currently this is only available to East Midlands Trainees.

Answer one or two questions before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. We will also provide tutor comments. If you find good resources that answer a question why not include links in your comment.

Part of the face-to-face teaching will be spent discussing the case(s) below:

“A 52 years old woman with known Down’s syndrome presents to the majors department in the ED following a collapse at home.”
“A 37 years old man is found by his 15 years old son at his home fitting. He was lying on the living room sofa with jerking movement of all 4 limbs.”

Additional Resources

Have a look at the following additional resources relevant to this topic:

Course Feedback

Once you have worked through the exercises, discussed the example cases and attended the face-to-face teaching, please complete the following form:

Updated: 19th October 2016