Syncope HISTORY_LIST loss of consciousness: time duration of unconsciousness sudden onset gradual onset was it witnessed? witnessed by who? activity before & after event arm position: reaching neck position: turning to side recumbent or upright position mental status before & after precipitant event (fear, tension, hunger, pain) relationship to meal defecation exertion syncope valsalva hyperventilation chest pain palpitations tonic-clonic movements tongue biting PRODROMAL SYMPTOMS sweating blurred/dimming vision nausea tinnitus aura cough micturation headache SYMPTOMS OF THE EVENT post syncope lethargy confusion lightheadedness vertigo flushing pruritis leg pain pleuritic pain dyspnea vomiting melena hematemesis CHRONIC DISEASE SYSTEMIC DISORDERS past Hx of syncope stroke TIA seizures valvular dz. arrhythmia HTN anemia diabetes anxiety attacks PREVIOUS TESTS carotid Doppler studies 24 hr Holter monitor EEG cardiac testing exercise tolerance SOCIAL HISTORY smoking alcohol caffeine illicit drugs - cocaine MEDS_LAB_TESTS **** MEDS Digoxin Insulin alcohol oral hypoglycemics phenothiazines CNS depressants nitrates quinidine beta blockers calcium channel blockers diuretics antiarrhythmics anticonvulsants sedatives antidepressants marijuana cocaine **** LAB Electrolytes BUN Creatnine CBC LFT's CPK cholesterol triglycerides uric acid UA with microscopic analysis **** TESTS ECG CXR EEG Holter monitor MRI CT scan REVIEW_OF_SYSTEMS_1 GENERAL weight changes appetite changes anorexia difficulty sleeping fever chills polyphagia hypophagia changes in thirst sleeping habit change bowel habit change fatigue hypertension previous physical exams SKIN pigmentation changes texture changes lesions eruptions pruritis easy bruising easy bleeding unusual hair loss changes in hair distribution skin masses finger/toe nail change rashes hives striae skin atrophy uremic frost hirsutism plethora neurofibromatosis lesion HEENT head trauma skull fractures head masses hearing loss vertigo chronic ear infection ear discharge ear pain hearing aid use loss of vision recent change in vision photophobia diplopia (double vision) glaucoma exudates dry eyes eye pain cataracts eye surgery itchy eyes excessive tearing corrective lenses nose bleeds chronic sinusitis nasal fractures nasal drainage polyps changes in sense of smell edentulous (without teeth) partial plate full plate recent dental work oral lesions tonsillitis strep throat tongue problems voice changes chronic hoarseness chronic halitosis NECK neck masses enlarged thyroid gland brachial cleft cysts neck injury REVIEW_OF_SYSTEMS_2 CHEST chronic coughing sputum production hemoptysis wheezing pneumonia bronchitis TB TB exposure SOB (altered by position?) edema chest pains pacemaker HEART MI coronary artery disease heart murmur heart valve disease left ventricular hypertrophy mistral valve stenosis pericarditis palpitations DOE paroxysmal nocturnal dyspnea orthopnea edema hypertension rheumatic fever cardiomyopathy ectopic heart beats arrhythmia exercise intolerance claudication heart medications ABDOMEN abdominal pain nausea vomiting diarrhea constipation hematochezia hematemesis hemorrhoids GI x-rays GI scopings rectal bleeding ulcers bowel polyps bowel incontinence gall bladder disease gall stones hepatitis cirrhosis hepatomegaly splenomegaly GU renal insufficiency renal failure dialysis kidney stones kidney disease kidney cyst flank pain hematuria pyuria dysuria chronic cystitis nocturia anuria hesitancy enuresis change in urine color prostatitis epididymitis scrotal problems TURP pain on intercourse genital lesions genital discharge REVIEW_OF_SYSTEMS_3 OB/GYN metorrhagia menorrhagia irregular menses problems in pregnancy use of contraception breast masses nipple discharge breast skin changes changes in axillary nodes monthly breast exam breast feeding children EXTREMITIES difficulty with gait weakness joint swelling joint stiffness muscle pain muscle swelling muscle injuries sagittal plan scoliosis coronal plane scoliosis fractured bones SLE osteoarthritis rheumatoid arthritis fibromyalgia NEURO seizures head injury LOC loss of coordination difficulty in balance sciatica difficulty: fine motor skills difficulty speaking CVA (stroke) weakness in arms weakness in legs tingling in legs and feet tingling in arms PSYCHIATRIC depression bipolar disorder suicide attempts hospitalization for psychiatric problems personality disorders ENDOCRINE goiter exophthalmos dry skin dry hair intolerance to heat intolerance to cold changes in growth sterility impotence decreased libido LYMPHATIC AND HEMATOLOGICAL lymphadenopathy transfusion anemia PHYSICAL_EVAL_1 VITALS supine BP #1 = supine Pulse #1 = supine Heart rate #1 = supine BP #2 = supine Pulse #2 = supine Heart rate #2 = up right BP #1 = upright Pulse #1 = upright Heart rate #1 = up right BP #2 = upright Pulse #2 = upright Heart rate #2 = Temp = GENERAL pallor level of alertness HEENT pupil size and reactivity extraocular movements retinal subhyloid hemorrhages tongue or buccal lacerations PHYSICAL_EVAL_2 SKIN turgor capillary refill NECK jugular vein volume depletion jugular cannon A waves carotid pulse amplitude carotid duration carotid bruits neck rigidity CHEST breath sounds crackles rhonchi HEART "irregular rhythm accentuated S2 accentuated S3 accentuated S4 systolic ejection murmur cardiac rub irregular, dyskinetic pulse ABDOMEN abdominal bruits abdominal tenderness pulsatile mass GU occult blood urinary incontinence EXTREMITIES trauma to extremities NEURO cranial nerves: 2 - 12 grossly intact Babinski's sign strength gait coordination sensory memory DTR's mental status nystagmus facial paralysis head turned side to side head moved up and down reaching above head bend at waist & pick up object resist push DIFF_DIAGNOSIS Vasovagal Postural hypotension Autonomic insufficiency Medication related syncope Stroke Stokes-Adams attack (AV block, sinus bradycardia, sinoatrial block, sinus arrest, sick-sinus syndrome, SVT) Ventricular tachycardia Carotid sinus hypersensitivity PE MI Basilar artery insufficiency Carotid steal syndrome Hypovolemia (GI blood loss) Valsalva, cough defecation/micturition syncope Aortic stenosis Hypoxia Hyperventilation Anemia Addison's dz. Hypoglycemia TIA Hypertensive encephalopathy Anxiety attack Psychogenic