I was in the toilet this morning having a poo when I felt light headed and collapsed just as I was sitting on the toilet bowl. My husband who walked in shortly after said I was on the floor for about 2 minutes. The husband adds: it's like she fell on her buy while trying to sit on the toilet.
Further Hx: Pt states that she has had "dozens of similar episodes in the past" that typically occurred when she was "startled" or "shocked" or emotionally distressed. She gets a bit nauseous as a prodrome and sits down in anticipation. Pt notes that she is currently in dispute with her husband over some domestic issues and has not been sleeping well. The pt does not have a clear recollection of the event since loosing consciousness. Her husband states that she was less responsive than usual for about a minute after coming to her. She does not have a history of dementia or delirium. Denies urinary symptoms. Denies changes in bowel habits.
Medical Records: A half hour search dug up the following details - Past EEGs, ECGs and investigations have all been n.
Ix: All bloods (FBE, U&E, CMP, LFT, CRP, Amylase/Lipase), including cardiac enzymes and inflammatory markers came back normal. ECG n. FWT n.
O/E: Pt looks well but feeling a bit nauseous and holding on to a vomit bag. GCS 15 communicative. Denies pain anywhere. Nil cspine/thoracic midline tenderness. Clears NEXUS. No bruises/bumps/sore spots on her head.
Everything checks out. Sounds like a simple syncopal episode (?vasovagal). We could not get in touch with her GP as it was after-hours. The patient is stable and comfortable. I think she is suitable for discharge and run her quickly by the senior officer.
What Have I Missed?
Consultant: While the history is largely benign, this is still an unconscious collapse. Having a past history of syncopal episodes does not absolve you medico-legally from failing to diagnose an intracerebral haemorrhage.
Lesson:
The patient got her CT Brain and was discharged as soon as it was cleared by a radiologist.
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