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“TOP TIPS”- BLACKOUTS

“TOP TIPS”- BLACKOUTS. Dr Siân Price Consultant Neurologist, Sheffield Teaching Hospitals. Blackouts. What do they mean? Take a detailed History Witness account Loss of consciousness? Loss of awareness? Something else? Sleep? Dizzy? Visual loss? NICE Guidelines.

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“TOP TIPS”- BLACKOUTS

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  1. “TOP TIPS”- BLACKOUTS Dr Siân Price Consultant Neurologist, Sheffield Teaching Hospitals

  2. Blackouts • What do they mean? • Take a detailed History • Witness account • Loss of consciousness? • Loss of awareness? • Something else? Sleep? Dizzy? Visual loss? • NICE Guidelines

  3. Loss of consciousness -Syncope • Hot, lightheaded. Standing, grey out of vision and fading of hearing, floppy to floor, often pale. Rapid recovery ( if lying), brief <2mins. May twitch a bit. Re-faint on re-standing?, hearing back first. • Clear provocation and a one off, examine, postural BP, ECG and safety advice. • No clear provocation, recurrent. As above and consider bloods FBC, U+E, Glucose, 9am cortisol. If ECG abnormal or “red flags” refer to cardiology. If significant postural drop consider referral to syncope clinic ( or endocrine if results suggest Addison's)

  4. Loss of consciousness- refer to cardiology? • Red Flags • Family history of sudden death • Age >65 • Chest pain, palpitations, exercise induced or sitting with light headed feeling or syncope. • Prolonged recovery? • Abnormal ECG ( QTc?), arrhythmia?, (heart block, WPW, LGL) • Murmur, ischaemic heart disease or cardiac failure • Consider echocardiogram and 24 hour tape

  5. Loss of consciousness- Refer to Neurology • Epilepsy? • Possible status epilepticus ? 999, Neurology afterwards. • At start :- Warning?, Automatisms? Posturing? • Stiff, noisy breathing, odd colour ( desaturating), jerking, eyes often open, may deviate. • Prolonged post ictal phase and confusion • Bite is usually side tongue, (wetting only means loss of consciousness). • Mixed type of attacks • Stop and stare? • Vacant with automatisms and or confusion • Myoclonic jerks • Odd blackouts ? Fits or not?

  6. Loss of consciousness- No markers or witnesses • Known heart disease refer to cardiology • Otherwise refer to Neurology

  7. Loss of awareness- Refer to Neurology? ( or Peads if <16) • Brief blanking+/- myoclonic jerks • With automatisms, confusion, refer to Neurology • Could it be psycogenic?

  8. Remember • Can have twitching with syncope • Fits with headache and fever- encephalitis? • More brain tumours present with fits than headache • Around half of people having one fit will get more. 1 in 100 or so will have a fit • High level initial incorrect diagnosis- always be prepared to think again. • Always remember safety ( including for syncope) and driving advice

  9. Rotherham Neurology • Outreach from Sheffield • Although 4 consultants visiting we only make about 1 and a bit FTE ( Siân Price, Ralf Lindert, Siva Nair, Danute Kucinskiene ( locum) • Specialist Nurses outreach from Sheffield too ( Epilepsy, MS, Parkinson’s ( separate from Elderly med), do clinics at Rotherham. • Some specialty services and tests done in Sheffield. We have no Rotherham beds but see ward referrals. • 2 WW via Sheffield • THANK YOU

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