[indaemed] Re: Syncope evaluation [was Re: Re: NMS]
- From: Sanjiv Sharma <sanjivshrma@xxxxxxxx>
- To: indaemed@xxxxxxxxxxxxx
- Date: Fri, 19 Mar 2004 21:09:33 +0530
> [ lots snipped ]
> >
> > I would also like to ask the list their views on the following
> > statement. should all cases of syncope reporting to IAM be
> > subjected to hypoxia heat and acceleration stress as part of
> > their evaluation
> >
>
> Rational Reply : Obviously NO ! In most cases of syncope there
> is some history which gives you the necessary clues of the line
> to follow, perhaps hypoglycaemia, heat intolerance, accelera-
> tion induced, observed seizures, ECG abn etc. In cases like
> this where the clues are inconclusive, it is a matter of giving
> the whole battery available ... just to see if we find
> something ... if anything at all. But, if nothing is found it
> would be better to put a diagnosis of "Syncope Inv NAD", rather
> than try and fit some diagnosis.
>
> Diplomatic reply : I do not know ! I'll ask ....
>
> Bish
Dear Sir
indeed there were tell tale signs of syncope: to quote briefly about the
first episode of VVS last year, the History of present illness was something
like this-
He reportedly lost consciousness during pre-flight briefing at 0540 hours.
This happened when he stood up to answer an emergency recall procedure.
After narrating the emergency procedure, he continued to stand still for a
couple of minutes, when he felt dizzy, had blurring of vision and cold
sweating before fainting. He fell flat on the face, sustaining a laceration
wound on his chin. DMO, who was present for the pre-flight medical briefing,
did not observe any jerking movements of limbs, incontinence, tongue bite or
any other suggestive signs of seizures. He found that the patient was
sweating, looked pale and had a pulse rate of 54 beats per min. He regained
consciousness spontaneously in a few minutes and could recollect the events
preceding the faint. However, while being carried on a stretcher he felt
"too tired" to open his eyes or to respond to verbal command. The ambient
temperatures those days were about 22 -25° C.
The patient was feeling unduly fatigued on the day of this episode. He had
woken up at around 0400 hours. He was anxious since he was scheduled to fly
his first solo sortie that day. He had been sleeping for about four to five
hours each night for the past 3 to 4 days instead of his usual seven to
eight hours, busy preparing for Aviation Medicine Final test. He used to
consume about seven to eight cups of coffee daily; except that that morning
he did not have any drinks or food. He had his dinner at about 2030 hours
the previous night.
just for the records...
now we need to put Col Tripathi's and Anuj's findings this time around and
then see: whether or not it was Syncope? If it was syncope, was it VVS? If
it was VVS all three times or one episode of VVS and two of Hypoxia induced
LOC? and finally to decide what is good for his safety and what is good for
his career?
And after this I would reiterate what started this interesting string on the
indaemed list:
Must Hypoxic syncope at 30,000 ft be viewed in isolation, or continuum
of neurologically mediated syncope? After all, at 30,000 ft, he is in the
Critical Stage of Hypoxia, where loss of consciousness is known to
occur, with instant recovery with breathing of 100% oxygen. If all his
investigations remain inconclusive, can he continue his
flying training? After all, even if he is trained in an unpressurised
propeller aircraft, he does not exceed 8,000 ft. And the aerobatic
manoeuvres are short duration of the magnitude of 4-5G. Can he be risked
solo sorties
to complete basic flying training for a military aviation career?
Most of these have been answered and analysed adequately. But just in case
we need a rethink (or start the debate all over again...) or discuss it
further...let the quorum decide.
with warm wishes
Sanjiv
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