Assessment after Transient Loss of Consciousness - Flowchart
Assessment after Transient Loss of Consciousness - Flowchart Assessment after Transient Loss of Consciousness Assessment after Transient Loss of Consciousness
Flowchart

Transient loss of consciousness (TLoC)

Transient loss of consciousness (TLoC)

Transient loss of consciousness (TLoC)

Investigate/treat suspected disease

Investigate/treat suspected disease

Investigate/treat suspected disease

End

End

End

Key observations (Table 1.1)
Focussed assessment (Tables 9.1 and 9.2)
12-lead ECG (Table 9.3)
Consider differential diagnosis (Box 9.1 and 9.2)

Key observations (Table 1.1)
Focussed assessment (Tables 9.1 and 9.2)
12-lead ECG (Table 9.3)
Consider differential diagnosis (Box 9.1 and 9.2)

Key observations (Table 1.1)
Focussed assessment (Tables 9.1 and 9.2)
12-lead ECG (Table 9.3)
Consider differential diagnosis (Box 9.1 and 9.2)

Table 1.1
9.1 9.2
Table 9.3
Box 9.1 9.2

Could TLoC be due to acute disease

Could TLoC be due to acute disease

Could TLoC be due to acute disease

Yes

Yes

Yes

No

No

No

Manage as seizure (Chapter 16)

Manage as seizure (Chapter 16)

Manage as seizure (Chapter 16)

Chapter 16

Was it syncope or seizure (Table 9.2)?

Was it syncope or seizure (Table 9.2)?

Was it syncope or seizure (Table 9.2)?

Table 9.2

Syncope

Syncope

Syncope

Seizure

Seizure

Seizure

Reassurance and advice
Discharge

Reassurance and advice
Discharge

Reassurance and advice
Discharge


History typical of vasovagal/situational syncope, and examination/ECG normal?

History typical of vasovagal/situational syncope, and examination/ECG normal?

History typical of vasovagal/situational syncope, and examination/ECG normal?

Yes

Yes

Yes

No

No

No

Consider differential diagnosis (Box 9.2)
Review medications

Consider differential diagnosis (Box 9.2)
Review medications

Consider differential diagnosis (Box 9.2)
Review medications

Box 9.2

Is there marked postural hypotension (fall in systolic BP >20 mmHg)?

Is there marked postural hypotension (fall in systolic BP >20 mmHg)?

Is there marked postural hypotension (fall in systolic BP >20 mmHg)?

Yes

Yes

Yes

No

No

No

Refer to cardiologist
Consider admission for ECG monitoring/cardiac investigation

Refer to cardiologist
Consider admission for ECG monitoring/cardiac investigation

Refer to cardiologist
Consider admission for ECG monitoring/cardiac investigation


Is heart disease suspected?


Exertional syncope
Sudden syncope (Stokes-Adams attack; Table 9.2)
Abnormal cardiac exam
Abnormal ECG

Is heart disease suspected?


Exertional syncope
Sudden syncope (Stokes-Adams attack; Table 9.2)
Abnormal cardiac exam
Abnormal ECG

Is heart disease suspected?


Exertional syncope
Sudden syncope (Stokes-Adams attack; Table 9.2)
Abnormal cardiac exam
Abnormal ECG


Exertional syncope
Sudden syncope (Stokes-Adams attack; Table 9.2) Table 9.2
Abnormal cardiac exam
Abnormal ECG

Yes

Yes

Yes

No

No

No

No further investigation

No further investigation

No further investigation

Refer to cardiologist
Consider testing for carotid sinus hypersensitivity, tilt-table test and ECG monitoring

Refer to cardiologist
Consider testing for carotid sinus hypersensitivity, tilt-table test and ECG monitoring

Refer to cardiologist
Consider testing for carotid sinus hypersensitivity, tilt-table test and ECG monitoring


First episode
No injury

First episode
No injury


First episode

TLoC with injury or recurrent episodes

TLoC with injury or recurrent episodes

TLoC with injury or recurrent episodes