Momentary black out

Austin carawan

Austin carawan

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I'm having trouble recalling what these symptoms suggest, I keep leaning toward stroke, but not sure, let's say like a mid 50 male patient, he blacks out and hit a parked car while he was out, he feels no pain, but he puts a lot of effort into forming his words, my thoughts steer away from trauma, as the topic is medical patient. But what caused the black out??
 
Could be hypoglycemia, could be stroke. Those are the two most likely causes.
 
That's really all I got, disregarding the scenario, is there a way that you could rule one out?
 
By checking a BGL...
 
Except performing a stroke scale (especially the standard Cincinatti) doesn't rule a stroke out. Maybe less likely, but not a R/O
 
I had a call like this for a gentleman who was confused all day, had a headache for six hours and ended up driving past his exit on the freeway 35 miles only to get off, go up on a curb and hit a tree at low speed. The hand-off was hyperglycemia (~300) but I wasn't buying it. He seemed like he was out of his element and confused in his surroundings but if you asked him a direct question he was able to answer perfectly. He had decent motor control except for the fact that if you asked him to raise his arms he would only raise the right. Then if you looked at him and said "how about that one", he would look at his left arm and then raise it with good strength. When asked to unbutton his shirt, he also only used R side unless directed to use both (which he did fine)... basically, it was like he forgot he had a left side.
When the CPSS was performed, he technically passed it. Took him to a Stroke Center and confirmed that he had two small bleeds.
 
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Any seizure history?
BGL?
 
Keep in mind this could also be a cardiac issue - he could have had an arrhythmia which caused the syncopal episode, crashed the car into something and bonked his head, now he has a concussion too.
 
On the BGL, remember that a glucose in the normal range may be much lower than some patients are typically at. There is potential to see hypoglycemia symptoms with a BGL that most people would be fine at.
 
Austin carawan said:
I'm having trouble recalling what these symptoms suggest, I keep leaning toward stroke, but not sure, let's say like a mid 50 male patient, he blacks out and hit a parked car while he was out, he feels no pain, but he puts a lot of effort into forming his words, my thoughts steer away from trauma, as the topic is medical patient. But what caused the black out??
Click to expand...

If you haven't already, learn how to conduct a MEND (Miami Emergency Neurological Deficit) exam. It will give you a LOT of insight into scenarios like this. Also, could be blood sugar. Simple check (make sure you calibrate your meters, though). Could be some sort of fainting diminished level of consciousness due to a medication interaction, something like low BP caused by medications reacting. Could be narcotics or alcohol, even if you don't see signs of it. Could be a new onset seizure disorder, patient doesn't remember seizure and isn't post-ictal by the time you arrive.

You could learn a lot, rule out a lot from the MEND exam.
 
joshrunkle35 said:
Could be a new onset seizure disorder, patient doesn't remember seizure and isn't post-ictal by the time you arrive.
Click to expand...


Or they are just altered because they are still postictal... :D


If they weren't postictal as you stated, they probably wouldn't be altered.
 
joshrunkle35 said:
If you haven't already, learn how to conduct a MEND (Miami Emergency Neurological Deficit) exam. It will give you a LOT of insight into scenarios like this. Also, could be blood sugar. Simple check (make sure you calibrate your meters, though). Could be some sort of fainting diminished level of consciousness due to a medication interaction, something like low BP caused by medications reacting. Could be narcotics or alcohol, even if you don't see signs of it. Could be a new onset seizure disorder, patient doesn't remember seizure and isn't post-ictal by the time you arrive.

You could learn a lot, rule out a lot from the MEND exam.
Click to expand...
okay, that is actually the first time I have heard of that, I will look into it. This is a field teeming with mnemonics!!!
 
It's not a mnemonic , it's a type of stroke exam. I'm a bit skeptical of its utility if the hospital you report to does not use it. I have gone through ASLS but still typically use the cincinati stroke scale prehospitally.
 
I had a guy like this once, had a dissecting AAA with a false lumen that occassionally flapped over and occluded the aorta. Really interesting to watch what in essence was a repetitive CVA.
 
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