3BDS: Neurology 2

what could be the causes for blackouts

vasovagal 'faint ', postural hypotension, cardiac arrhythmia, antic stenosis, cardiomyopathy, carotid sinus hypersensitivity

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what is the cause of faints
how does the patient feel

-fear, emotion, heat, prolonged standing, hunger
-fleeing faint, nausea, visual fields closing in
Transient loss of consciousness, pallor and fall to ground- due to low BP and low heart rate (pulse)

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how is faint management

lie flat and elevate legs to increase venous return

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what is postural hypotension
what drugs cause postural hypotension ?
what autonomic dysfunction causes postural hypotension
what kind of intravascular volume depletion causes postural hypotension

-Blood pressure usually rises when we stand. In some conditions, BP falls when standing, reducing cerebral perfusion
-antihypertensives, diuretics, tricyclics
-DM, parkinsons disease
- blood loss, dehydration, shock

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what complications can arise from a head injury and therefore what monitoring is done if someone has a head injury

- Extradural haemorrhage (bleeds outside the dura and pressing on the brain)
- Subdural haemorrhage (under the dura pressing on the cerebral cortex)
- Diffuse axonal in jury and coma (caused by shaking of head)
- Of maxillofacial and skull injuries

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what causes impaired consciousness

-head injury, stoke, tumour/mass lesion, epilepsy (intrinsic brain disorders)
-endocrine disease, drugs/alcohol/poisoning, CNS infection, Sepsis, liver failure, reparatory failure, renal failure (diffuse brain dysfunction)

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in more detail what metabolic causes lead to impaired consciousness

• Hypoglycaemia (always check blood glucose)
• Hypoxia
• Hypercapnia (increased co2)
• Hyponatraemia
• Hypercalcaemia
• Hypothyroidism

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in more detail what infections lead to impaired consciousness

• Brain (encephalitis, meningitis, cerebral abscess, malaria and other tropical illnesses)
• Any other severe bacterial infection causing sepsis (pneumonia, urinary tract, wherever

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what is the clinical approach for impaired consciousness
what is the most common cause?

ABCDE, identify cause, treat cause
Oxygen
Grade- AVPU/GCS

-Commonest cause is airway obstruction
Usually recovery position

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what could be done for someone with impaired consciousness in the dental practice before they are sent to the hospital

Hypoglycaemia (glucagon but if glucogel if conscious)
Hypoxia (high flow o2 15l with ..unless they have copd)
Severe infection
Benzodiazepine overdose (diazepam) ( give Flumazenil, minolxin)

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3BDS: Neurology 2

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