BUMC Basics.pdf - Anesthesia Home

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Start out with aggressive diuretic therapy over first 24 hours,
and reevaluate diuretic therapy every 24 hours. Oxygenation:
start with nasal canula; then may need to advance to BIPAP,
or even intubation if can’t keep adequate oxygenation (PaO2
>60mmHg).
SYNCOPE
Sudden and brief loss of consciousness due to cerebral
hypoperfusion
Causes:
• Neurocardiogenic: “Vasovagal syncope” 2/2 increased
vagal tone
• Orthostatic Hypotension: Hypovolemia, diuretic therapy,
vasodilators, autonomic neuropathy.
• Cardiovascular: Usually has a sudden onset and
recovery
1) Arrhythmias: Bradycardia (AVB, SSS),
Tachycardia (VT, SVT)
2) Mechanical: Endocardial, Myocardial,
Pericardial, or Vascular
• Neurological:Seizure, TIA/CVA (rare), vertebrobasilar
insufficiency, and migraines.
• Misc: Hypoxia, anemia, hypoglycemia.
Work up:
• In this Case H&P are the most important part of work up.
• What was pt. doing prior to episode, how did they feel
(palpitations, flushed, light headed, etc.), was it witnessed,
did they lose consciousness, how long did they lose
consciousness, was there seizure activity, previous
episodes, PMHx important, Meds pt. taking, etc.
• H&P will guide causes, work up and therapy.
• Labs/Studies: EKG, CBC, CMP, check orthostatic vitals,
u/s Doppler lower ext (usually not indicated), u/s carotids,
TTE, CT scan head (usually not indicated but usually done
in ER when pt. first comes in), EEG (if seizure is highly
suspected).
• Admit pt to telemetry bed, hold meds that could cause
syncope.
• A lot of times specific cause will not be found; try to
optimize meds to avoid recurrence.