References
Ambulance clinician assessment and management of transient loss of consciousness: a retrospective clinical audit
Abstract
Introduction:
Transient loss of consciousness (T-LOC) is thought to be underestimated and under-managed in the pre-hospital setting. This clinical audit aims to assess the compliance of ambulance clinicians against the National Institute of Clinical Excellence guidance on the management of patients with T-LOC.
Method:
Ninety-four patients' clinical records and electrocardiograms (ECGs) were reviewed to determine appropriateness of assessment and patient management.
Results:
In this limited sample, findings show standard assessments and history documented for all patients were equally well recorded for T-LOC patients, but those specific to T-LOC were not. The number of ECGs conducted and interpreted correctly was an additional area of concern.
Conclusions:
Further assessments and history specific to T-LOC are required in the pre-hospital setting to ensure any potentially serious causes are recognised and these patients are taken to hospital.
Transient loss of consciousness (T-LOC) (also known as ‘blackouts’) is a loss of consciousness with complete recovery after the event (National Institute of Clinical Excellence (NICE), 2010). Sometimes there may be a prodromal period in which various symptoms (e.g. light headedness, nausea, sweating, weakness, and visual disturbances) warn that T-LOC is imminent. Often, however, the loss of consciousness occurs without warning (Task Force for the Diagnosis and Management of Syncope et al, 2009).
T-LOC is common, affecting up to 50% of the population at some point in their lives, and there are three major categories of causes: cardiac (which is the most common), neurological (such as epilepsy), and unknown aetiology. As such, T-LOC patients are seen by a multiplicity of health professionals, including ambulance clinicians (NICE, 2010). Lobban (2013) surmises that accurate and timely diagnosis following T-LOC is frequently not achieved and that not all of the potential causes of T-LOC are explored. Patients' symptoms are frequently ignored or dismissed as trivial. For patients, T-LOC can be confusing and cause anxiety or fear (Lobban, 2013), therefore it is also important from a non-clinical perspective that any potentially serious underlying causes are ruled out prior to discharge. Identification of patients most at risk should be possible with a detailed history and electrocardiogram (ECG) (Khoo et al, 2013). Ambulance clinicians can play a pivotal role in ensuring these patients are conveyed appropriately for diagnosis and management.
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