Manejo del síncope en la población pediatrica y pacientes ancianos. Dr. Nynke Van Dijk.

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Manejo del síncope en la población pediatrica y pacientes ancianos.

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  • OUderen manoeuvres minder werkzaam ivm stabiliteit
  • Manejo del síncope en la población pediatrica y pacientes ancianos. Dr. Nynke Van Dijk.

    1. 1. Wieling W, et al. Initial diagnostic strategy in the case of transient losses of consciousness: the importance of the medical history. Ned Tijdschr Geneeskd 2003;147:849–854.
    2. 2. Romme JJ, et al. Influence of age and gender on the occurence and presentation of reflex syncope. Clin Aut Res 2008; in press. 1% 0% Metabolic 12% 12% No diagnosis 2% 6% Psychogenic 3% 4% Neurological 20% 1% Cardiac syncope 17% 3% Orthostatic hypotension 0% 2% Other reflex sync 5% 4% Situational syncope 7% 0% Carotid sinus sync. 34% 68% Vasovagal syncope > 60 years < 40 years
    3. 3. Cardiac syncope at young age <ul><li>Cardiac disorder in history </li></ul><ul><li>Syncope during exercise </li></ul><ul><li>Family history sudden cardiac death </li></ul><ul><li>Abnormal ECG (expert). </li></ul>
    4. 4. History suggestive of syncope NR NR NR 2.8 0.66 0.81 Paleness 2.6 0.73 0.73 NR NR NR History pre-syncope 4.7 0.94 0.28 14 0.98 0.28 Nausea 5.9 0.94 0.35 18 0.98 0.36 Sweating (prodromal) 20.4 0.98 0.40 NR NR NR Prolonged standing/ sitting LR+ Spec Sens LR+ Spec Sens Sheldon Hoefnagels
    5. 5. History suggestive of epilepsy 3.0 0.69 0.94 5.0 0.83 0.85 Postictal confusion 5.8 0.94 0.33 16.9 0.98 0.29 Cyanosis NR NR NR 1.5 0.55 0.68 Prolonged LOC (>5 min) 3.4 0.95 0.16 2.6 0.85 0.39 Muscle ache 13.5 0.97 0.43 NR NR NR Turning head 16.5 0.97 0.45 7.3 0.94 0.41 Tongue bite LR+ Spec Sens LR+ Spec Sens Sheldon Hoefnagels
    6. 6. Treatment options: young vs old ++ - Abdominal binders etc ++ (+) Pacing (+) +++ Psychological + + Pharmacological ++ +++ Manoeuvres ++ ++ Explanation and lifestyle advises Older Young

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