Thanks to Dr. Joanna Middleton for her summary
Edited by Dr David Lewis
Top tips from this month’s rounds:
Syncopal/Pre-Syncopal Episode – Usually benign, but sometimes serious…….
Red flag symptoms of potentially life-threatening causes of syncope are syncope with exercise, chest pain, dyspnea, severe headache, palpitations, back pain, hematemesis / melena before the syncopal episode. Palpitations before loss of consciousness are a significant predictor of a cardiac cause of syncope. Focal neurologic deficits, diplopia, ataxia, or dysarthria after the syncopal episode.
Syncope Risk Scores
ECG in Syncope
CanadiEM – Medical Concept – ECGs in Syncope
Subarachnoid hemorrhage can present with syncope…
- 97% – sudden, severe headache – “worst”
- 53% – syncope
- 77% – N/V
- 35% – meningismus
How To Be A Clinical Rock Star Managing Subarachnoid Hemorrhage
Abdominal Aorta – Aneurysm vs Dissection
Only 2% of all aortic dissections originate from abdominal aorta. Almost all aortic dissections originate in the thoracic aorta.
The majority of abdominal aortic aneurysms are infrarenal
Management of the Unruptured AAA
- Symptomatic or asymptomatic
- How can an unruptured AAA be symptomatic???
- (rapid expansion of the aortic wall, ischemia from blocking off blood vessels, compression of other structures etc)
- Symptomatic – admit for repair, regardless aneurysm diameter
- Asymptomatic
- <5.5cm – likely outpatient
- “Very large aneurysm” (>6cm) – likely admit for repair
Transfers to and from Major Emergency Departments
- Emergency transfers from referring sites for diagnostic imaging are potentially high risk
- Adverse events have been reported in the medical literature for this group of patients
- A detailed handover between referral and receiving site will reduce risk
- Patient stability must be assessed prior to transfer, on arrival at receiving site and prior to return to referral site.
- The results of the diagnostic imaging should be taken into context with the patient’s condition prior to release for return to referral site.
Hyponatremia – How low is too low?
- All patients with severe (< 120)
- Any patient that is symptomatic from the hyponatremia
LIFL – Hyponatremia – Diagnosis and Management
For the budding critical care physiologist – Deranged Physiology – Hyponatremia
