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Case 1: Nobody likes the dentist

A 40 year old, previously well man presents following a collapse at the dentist’s office. He rose from the chair following a tooth extraction, then fell down. He was seen to be unconscious for several seconds, and exhibited some jerky movements whilst on the floor. He then woke up, and was immediately oriented and asymptomatic. There was no tongue bite or loss of continence.
The dentist called an ambulance, and the patient has now arrived in your Emergency Department.

His vital signs are:

BP 129/78 mmHg
HR 68 /min
RR 16 /min
SpO2 98% on room air
Temp 36.8 °C

The patient uses no medication, and has no past medical history. No known allergies. He feels completely fine, apart from a mild ache in his jaw.

List your differential diagnosis.

 

The student nurse is asking you to explain to her why you have asked for measurements of the blood pressure lying down and standing up.

What is your response?

 

What are the broad categories of causes of syncope, and how does the history help to differentiate them?

 

What basic investigations do you consider essential?

 

What factors will affect whether this patient can be safely discharged?

What discharge instructions will you give him?

 

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