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Spiel for JMS sent to review patients presenting with loss of consciousness / syncope.

Step 0: Injury Screen
Complete primary and secondary survey
Consider spinal precautions.

Step 1: Check for Causes of Postural Hypotension
Sepsis – WCC CRP FWT UMCS CXR ViralSwabs
Drugs – screen medications. esp thiazides and multiple antihypertensives.
Neurogenic – age related / chronic neuropathy from DM / ETOH / Nangs!

Step 2: Screen for features of epilepsy
Incontinence. Tongue biting. Repetitive movements. Post ictal phase. Epilepsy associated injuries.

Step 3: Screen ECG + order telemetry.

Precordial leads – no coved segments or features of sodium channelopathy (Brugadas)
Normal QTc. No sign of Long QT syndrome.
No STD+TWI in anterior leads (RH strain)
No epsilon waves (V1/2), or slurred S in V1-3. (ARVC)
No delta waves (WPW)
No BBB.
No AV Block.
No LVH voltage criteria (tallest S in V1/2 + R in V5/6 > 35mm)
No LVH non-voltage criteria (RWPT > 50ms in V5/6, STD/TWI in L sided leads)
No dagger Q waves to suggest HCM