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Surgical sieve
💫 Collapse / syncope
Cardiac, neurological, or mechanical? A collateral history is worth more than any test.
| Arrhythmia Must exclude | Sudden, no warning, injury on falling, palpitations. Exertional syncope is cardiac until proven otherwise.ECG, telemetry, electrolytes, consider prolonged monitoring. |
|---|---|
| Massive PE Must exclude | Syncope with hypoxia and tachycardia. Syncope is an under-recognised PE presentation.CTPA if suspected. |
| Aortic dissection or ruptured AAA Must exclude | Collapse with pain — chest/back/abdomen. Hypotension.Urgent CT. |
| GI bleed Must exclude | Collapse may precede visible bleeding. Melaena on PR.PR examination, group and save, Blatchford score. |
| Subarachnoid haemorrhage Must exclude | Thunderclap headache before collapse. Neck stiffness.CT head, LP at 12h if CT negative. |
| Aortic stenosis Time-sensitive | Exertional syncope, ejection systolic murmur radiating to carotids, slow-rising pulse.Echo. Exertional syncope needs admission. |
| Seizure Time-sensitive | Tongue biting (lateral), incontinence, prolonged post-ictal confusion. Witness account is key.Glucose, electrolytes, consider CT and EEG. |
| Orthostatic hypotension Common | On standing, warning symptoms. Antihypertensives, diuretics, alpha-blockers.Lying and standing BP — a drop ≥20 systolic. |
| Vasovagal syncope Common | Prodrome — nausea, sweating, tunnel vision. Provoking factor. Rapid full recovery. |
| Hypoglycaemia Time-sensitive | Sweating, tremor, confusion preceding collapse.Glucose in every collapse. |
| Sepsis Time-sensitive | Collapse from vasodilation and hypovolaemia. |
| Mechanical fall Common | No loss of consciousness — trip or slip. Still needs an injury survey and a cause review.Do not accept "mechanical" without checking meds, BP and cognition. |
12 differentials · 10 open a full pathway in the app.