INTRODUCTION
Transient loss of consciousness (TLoC) is loss of consciousness with complete recovery. It is commonly described by the patient as a blackout. TLoC is very common and people who experience it may present to GPs during surgery hours or out of hours, or they may be referred from the ambulance services or the emergency department. There are a number of potential causes of TLoC:
uncomplicated faint or situational syncope;
orthostatic hypotension;
dysfunction of the nervous system (epilepsy);
dysfunction of the cardiovascular system (syncope); or
dysfunction of the psyche (psychogenic attacks).
The diagnosis of the underlying cause is often inaccurate, inefficient, and delayed, and misdiagnosis is common. NICE guideline CG1091 aims to define the appropriate pathways for the assessment of patients who experience TLoC, in order to obtain the correct underlying diagnosis quickly, efficiently, and cost-effectively, and to tailor a management plan to suit their true diagnosis. The guideline includes advice on the management of uncomplicated faint/situational syncope and orthostatic hypotension, as well as on detailed testing and assessment of those people considered to have a cardiovascular cause for their TLoC.
GUIDANCE
Initial assessment
The guidance most relevant to GPs is likely to concern those areas related to initial assessment in order to determine whether the person has had TLoC, the possible causes of it, and the appropriate next steps.
History
Ask the person who has had the suspected TLoC, as well as any witnesses, to describe what happened before, during, and after the event. Try to contact, by telephone, any witnesses who are not present at the consultation. Record details about:
circumstances of the event;
person's posture immediately before TLoC;
presence or absence of any prodromal symptoms (such as sweating or feeling warm/hot) and movement during event (for example, jerking of the limbs and duration);
appearance (for example, whether eyes were open or …