Loss of Consciousness/Syncope

Loss of Consciousness (LOC)

  • DDX:
  • Physical Exam:
    • VS: State (or WNL or WNL except…) (no orthostatic changes)
    • General: Patient is in no acute distress
    • HEENT: Inspect head, mouth, carotid auscultation and palpation, thyroid exam
      • – NC/AT, PERRLA, EOMI without nystagmus, no papilledema, no cerumen, TMs normal, mouth and oropharynx normal
    • Neck Exam: Carotid auscultation
      • – Supple, No carotid bruits, 2+ carotid pulses with good upstroke bilaterally, thyroid normal
    • Chest Exam: Auscultation
      • – Clear breath sounds bilaterally
    • Heart Exam: Palpation, Auscultation (orthostatic vital signs)
      • – Apical impulse not displaced, RRR, S1, S2 wnl, No murmurs, rubs, or gallops heard
    • Extremities: Palpated peripheral Pulses Symmetric, brachial, radial, and dorsalis pedis pulses bilaterally
    • Neuro Exam: Cranial nerves (including fundoscopic exam), Motor exam, DTRs, cerebellar, Romberg sign, gait, sensory exam
      • – CN 2-12 intact grossly; Motor: Strength 5/5 in all muscle groups; Sensation: Intact to pinprick and soft touch; DTRs, symmetric 2+ in upper and lower extremities, (-) babinski bilaterally; Cerebellar: (-) Romberg, finger to nose normal; Gait: Normal
  • Work-up:

Aortic Stenosis

Cardiac Arrhythmia

Convulsive Syncope

Drug-Induced Orthostatic Hypotension 

Hypertrophic Cardiomyopathy

Orthostatic Hypotension


Vasovagal Syncope