Read on Twitter
1/Patient admitted to your service with “syncope” after losing consciousness. You notice this on the right side of his tongue.
What caused him to lose consciousness?
(Posted with permission)
#physicalexam #TipsForNewDocs #medtwitter
What caused him to lose consciousness?
(Posted with permission)
#physicalexam #TipsForNewDocs #medtwitter
2/You will likely see a lot of people billed to you as “syncope”. I would counsel you to take a step back and frame them as loss of consciousness.
Recall that to have true syncope one needs loss of consciousness + postural tone due to
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Pfeil nach unten" aria-label="Emoji: Pfeil nach unten"> CNS perfusion.
Recall that to have true syncope one needs loss of consciousness + postural tone due to
3/Before landing on true syncope, you need to rule out mimics such as seizure and https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Pfeil nach unten" aria-label="Emoji: Pfeil nach unten">gluc that don’t mess with the https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧠" title="Gehirn" aria-label="Emoji: Gehirn"> plumbing.
I love syncope/LOC because the diagnosis is almost exclusively in history. However every once in a while exam gives it away
I love syncope/LOC because the diagnosis is almost exclusively in history. However every once in a while exam gives it away
4/In a patient who loses consciousness, finding of lateral tongue fighting has been found to be BANANAS specific for:
5/If you said seizure, you are correct! A small study documented the incidence of lat tongue lacs in pts admitted for EEG monitoring and used a retrospec syncope cohort for comparison
Lateral tongue biting ~100% spec, 24% sens for seizure https://pubmed.ncbi.nlm.nih.gov/7487261/ ">https://pubmed.ncbi.nlm.nih.gov/7487261/&...
Lateral tongue biting ~100% spec, 24% sens for seizure https://pubmed.ncbi.nlm.nih.gov/7487261/ ">https://pubmed.ncbi.nlm.nih.gov/7487261/&...
6/Key takeaways:
https://abs.twimg.com/emoji/v2/... draggable="false" alt="1️⃣" title="Tastenkappe Ziffer 1" aria-label="Emoji: Tastenkappe Ziffer 1">Start with LOC before calling it syncope. Check out @StephVSherman and @CPSolvers schema!
https://abs.twimg.com/emoji/v2/... draggable="false" alt="2️⃣" title="Tastenkappe Ziffer 2" aria-label="Emoji: Tastenkappe Ziffer 2">Look in pt’s mouths who lose consciousness. It’s free, takes 2 seconds and may massively move the needle diagnostically.
Thanks for tuning in!
@mghmedres
Thanks for tuning in!
@mghmedres
