A 60 year old diabetic man was admitted following a syncopal episode to the emergency  department.  His GCS is 8. You have been called  to assess  him with a view to taking him to ICU.

a)     Comment on the ECG

b)    List 5 further investigations you will perform

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College Answer

a)     Comment on the ECG

Normal ECG with sinus rhythm

b)    List 5 further investigations you will perform

BSL, troponin, CT head, Head and neck vascular studies, Holter monitoring, Echo, EEG.

Discussion

The question really asks the candidate to generate some differentials for an undifferentiated loss of consciousness, with a normal ECG. Creepily, the patient still has a GCS of 8, which suggests that not all is well intracranially.

References

References

The European Sociaty of Cardiology has a Taskforce on Syncope; and they have produced a guideline statement.

Brignole, Michele, et al. "Guidelines on management (diagnosis and treatment) of syncope–Update 2004 The task force on Syncope, European Society of Cardiology." European Heart Journal 25.22 (2004): 2054-2072.

Table 1 from the above statement seems like a comprehensive list of differentials.