syncope

Podcast summary of articles from the July 2023 edition of the Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include pediatric missed diagnoses, resistant urinary tract infections, syncope, tidal volume calculations, difficult IV access, and hyperglycemia.  Guest speaker is Dr. James O'Hora.

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Atrial fibrillation is the most common arrhythmia in the United States.  A skipped heartbeat is not so uncommon, but if you have shortness of breath or fainting or loss of consciousness, see a doctor right away, preferably a cardiologist.  

Wearable devices such as the Apple Watch or Kardia or other wearable devices can detect a skipped heart beat. The Apple watch study changed the way cardiologists view wearable devices.  That study published in 2019 had 419,000 participants with 40.1% with non-atrial fibrillation heart arrhythmias!

This showed that wearable devices play a role in heart health.

Atrial fibrillation is an important cause of stroke and heart attacks. It is important to see your physician if you feel a skipped heart beat.  Don't ignore your body's signals.

This week we will discuss a debilitating neurological disorders of COVID-19 syndrome in survivors, the scope of SARS-CoV-2-induced dysautonomia (DNS) is yet to be understood, though the implications are enormous. Our guest today ended up with POTs (a form of dysautonomia) after receiving the first dose of the Pfizer vaccine.  Chelsea, a 21 yr old former nursing student was diagnosed after having so many symptoms she couldn't complete her studies.  Studies are just now surfacing that give credence to her claims it was the vaccine that made her ill. 

Since the vaccine is very safe for the majority of individuals we would NEVER SUGGEST TO OPT OUT of the vaccine.  But knowledge is power, and researchers will find out more about this possible link thanks to stories like hers getting into the mainstream media.  

Postural Orthostatic Tachycardia Syndrome or POTs is a debilitating condition  affecting the autonomic nervous system.  

 With neurocognitive impairments or “brain fog”; problems with body temperature regulation; gastroenterological symptoms like nausea, abdominal pain, diarrhea, or constipation; and dark red-blue discoloration of the legs being the most common symptoms. Some people with POTS also may have one or more associated conditions, including migraine, irritable bowel syndrome, and joint hypermobility syndrome.  Some people with POTs can have pre-syncope or syncope episodes where they feel like they might pass out or actually do pass out.  It's a serious condition that needs proper testing and follow up with a physician.

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L et J Poésie d’amour: le coeur en syncope♥️

J’ai le coeur en syncope de lui écrire des poèmes
Des mots qui s’envolent, des mots qui aiment
Qui parlent du passé, du futur, du présent
Qui disent la pureté et la vérité de mes sentiments. 

J’aurais les doigts qui brûlent de lui envoyer un message
Peut-être la réponse serait le mépris ou le silence
Certainement de la gêne, de l’indifférence
Rien de bon ne viendrait, même si je faisais preuve de courage. 

J’aurais les oreilles qui saignent de l’entendre
Si elle n’avait à me dire que je ne dois me méprendre
Que je suis devenu un spectre poussiéreux et embarrassant
Que je suis devenu un bibelot translucide et transparent. 

J’aurais les yeux qui se ferment de la voir
Si elle n’était plus la même, si la trahissaient mes yeux miroirs
Je scruterais toutes les dissemblances des temps de notre union
Je scruterais toutes les dissonances de notre désunion. 

Seulement, j’ai les doigts orphelins des siens
J’ai les oreilles vides de ses facéties de lutin
J’ai les yeux voilés par l’obscurité de son absence
Et les murs se renferment sur tous mes sens.

À lire: L etJ, Liste de 100 poésies d’amour à lire ❤

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Today on Brainstorming we talk Dysautonomia, what it is, what it looks like, and some possible symptoms. If you've never heard of dysautonomia you might want to give it a listen, I bet you're surprised at some of the signs and symptoms!

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Dr. Kolby Condos

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Dr. Glenn Harrison

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This episode covers syncope.

Written notes can be found at https://zerotofinals.com/paediatrics/neurology/syncope/ or in the neurology section in the Zero to Finals paediatrics book.

The audio in the episode was expertly edited by Harry Watchman.

Arrhythmia is one of the most worrisome causes of syncope. Electrocardiographic (ECG) monitoring is crucial for the management of non–low risk patients in the emergency department (ED). However, its diagnostic accuracy and optimal duration are unknown. We aimed to assess the diagnostic accuracy of ECG monitoring in non–low risk patients with syncope in the ED.

We are speaking today with Christalle Bodiford.  Christalle is an artist, advocate, writer, and an adventurer who lives with Epilepsy. 

Seizures and epilepsy are not the same. An epileptic seizure is a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain. Epilepsy is a disease characterized by an enduring predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological, and social consequences of this condition. Translation: a seizure is an event and epilepsy is the disease involving recurrent unprovoked seizures. (https://www.epilepsy.com/learn/about-epilepsy-basics/what-epilepsy )

Keith Flynn was born in 1975 and shortly after birth, he was diagnosed with Ventricular Septal Defect, Double Inlet Left Ventricle, Pulmonary Atresia, and Hypoplastic Right Ventricle. He had two Blalock-Taussig shunts at age 6 months and 5 years, and a modified Fontan procedure when he was 15. Despite experiencing atrial arrhythmias in early adulthood, Keith received limited cardiac care in his 20s and early 30s. 

In his 30s, Keith started experiencing syncopal (or fainting) episodes, and on one occasion was rescued by his wife after fainting while swimming. As a result of these episodes, Keith received a pacemaker and recording device and was treated with Sotalol, a beta-blocker. However, Keith had also begun to experience fluid retention related to heart failure, and doctors told him that he would need a heart and liver transplant. He is currently undergoing the required testing to be listed for both organs. 

Over the years, Keith worked for a variety of retail and restaurant businesses, before working his way up to managing and owning businesses. He also started doing stand up comedy. Most recently, he has worked in the health and disability rights fields and earned his Bachelor’s degree in Accounting. He met his wife in 2003 and currently lives in Baltimore.

In this episode, Keith will share more about his life -- living with a congenital heart defect -- with Anna. He will also explain how he has come to need to be listed for two different organs. He will also share with Anna what he believes keeps him going, even when the going gets rough.

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Core Questions: 

1. List 10 life-threatening causes of syncope 
2. List 10 medications that can precipitate syncope 
3. What are the red flags on history and physical exam in syncope? 
4. What are markers of increased short-term risk in syncope patients? (box) 
5. What are 5 ECG findings to look for in the syncopal patient? 
6.  List five indications for admission and inpatient evaluation for the patient with syncope?

Wisecracks: 

1. What is the significance of a patient presenting with syncope vs. near syncope? 
2. What is the utility of orthostatic vital signs?
3.  What degree of cerebral hypoperfusion is needed to cause unconsciousness?

Core Questions: 

1. List 10 life-threatening causes of syncope 
2. List 10 medications that can precipitate syncope 
3. What are the red flags on history and physical exam in syncope? 
4. What are markers of increased short-term risk in syncope patients? (box) 
5. What are 5 ECG findings to look for in the syncopal patient? 
6.  List five indications for admission and inpatient evaluation for the patient with syncope?

Wisecracks: 

1. What is the significance of a patient presenting with syncope vs. near syncope? 
2. What is the utility of orthostatic vital signs?
3.  What degree of cerebral hypoperfusion is needed to cause unconsciousness?

You can find more of our podcasts on our website at http://www.mdedge.com/podcasts.

This week in cardiology:

1. Novel cardiogenic shock, PCI protocol nets 72% acute survival
2. Energy drinks increase BP and disrupt the heart's electrical activity
3. Syncope during pregnancy increases risk for poor outcomes
4. Ethnicity seems to affect predisposition to components of metabolic syndrome

Podcast summary of articles from the November 2018 edition of Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include upper airway obstruction, bedside skin ultrasound in pediatric patients, syncope, hypercalcemia, ketamine for psychiatric agitation, and board review on congestive heart failure plus bonus material on rheumatoid arthritis.  Guest speaker is Dr. Daniel Kinker.

Podcast summary of articles from the September 2017 edition of Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include rapid chest pain rule out, pediatric extremity pain and fever, disaster management, CT brain before lumbar puncture, intranasal midazolam, and board review on syncope and lacerations.  Guest speakers include Dr. Ken Iserson from the University of Arizona and Dr. Mengda Zhang of the MetroHealth Emergency Medicine Residency Program.

Podcast summary of articles from the April 2017 edition of Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include respiratory compromise, Ibuprofen in orthopedic injuries, ovarian torsion, pyogenic liver abscess, syncope, and board review on rashes.  Guest speaker is family physician Dr. Colin Crowe of the Metrohealth System.

“Syncope is a sudden, transient, self-limiting loss of consciousness associated with an inability to maintain postural tone”. In this webinar excerpt, Associate Professor Geoff Couser discusses an approach to patients presenting with syncope. Geoff (FACEM MEd) is a senior staff specialist in emergency medicine at the Royal Hobart Hospital and a Clinical Consultant with Ambulance Tasmania. He was discipline lead in emergency medicine at the University of Tasmania until 2017 and has authored numerous textbooks and papers relating to emergency medicine. Geoff outlines potential serious causes of syncopal episodes, as well as dealing with the uncertainty of unknown causes of collapse.

This episode covers Chapter 15 of Rosen's Emergency Medicine.

Episode Overview:

1. What are 12 critical causes of syncope?
2. List common medications that can cause syncope
3. Describe the San Francisco Syncope Rule
4. What are red flags that require admission in syncope?

This episode covers Chapter 15 of Rosen's Emergency Medicine.

Episode Overview:

1. What are 12 critical causes of syncope?
2. List common medications that can cause syncope
3. Describe the San Francisco Syncope Rule
4. What are red flags that require admission in syncope?

Syncope (or "passing out") is a chief complaint that we deal with a lot in the emergency department. While most causes of syncope are benign and need nothing more than reassurance, we need to be on the lookout for the serious causes of syncope. This episode will focus on the definition of syncope, how to get a complete history, catch the red flags, perform a targeted workup that doesn't keep the patient in the ED forever, and how to scrutinize an EKG for the deadly arrhythmias that we can't miss.

In addition, per a request from a podcast listener, there is a bonus section on how to effectively rehydrate patients in the ED. You may be surprised that there are other options besides putting an IV in everyone.