Loss of Consciousness History Taking | OSCE Tips
Loss of Consciousness history taking is a crucial skill that is frequently tested in OSCEs. This tutorial offers a methodical way to collect a loss of consciousness history during an OSCE.
Presenting complaint (PC):
What brought you here today?
Can you tell me what happened before you lost consciousness? where there anyone around you? (you might consider collateral history),
History presenting complaint (HPC):
You can adapt SOCRATES to explore skin problems too: Site, Onset, Character, Radiation, Associations, Time course, Exacerbating/Relieving factors and Severity.
Site: did you feel any pain or discomfort before you lost consciousness?
Onset: did it happen suddenly or gradually? any trigger?
Character: what did you experience before and after the event? any warning signs?
Radiation: n/a
Associate symptoms:
Nausea / vomiting
Chest pain or perfused sweating
Headache
Visual disturbance
Tongue biting
Urinary incontinence
Jerky movements
Eye rolling
Timing: how did the episode last for? how long did it take you to recover?
Exacerbating/Relieving factors: does anything make it better or worse?
Severity: from a scale from 1 to 10. with 10 being the worse, how severe were the symptoms?
Ideas, Concerns & Expectations (ICE):
Now is a good idea to ask Ideas, Concerns & Expectations (ICE): do you have an idea what might be causing your symptoms? is there anything that particularly concern you? what were expecting to achieve in this consultation?
Medical history (MH):
Do you have a history of high blood pressure, heart conditions or diabetes?
Past medical history (PMH):
Ask about any previous episodes of loss of consciousness or treatment or investigations?
Any previous surgeries, neurological conditions as epilepsy or seizures?
Drug history (DH):
Are you taking any medication (prescribed or over-the-counter (OTC)? If so, any side effects.
Any recent use of medications that might have caused it?
Note: the following medications might cause LOC: antihypertensive drugs, benzodiazepines, opiods (codeine) or antidepressants.
Allergies:
Are you allergic to any medications?
Family history (FMH):
Is there any family members who have similar symptoms?
Social History (SH):
Ask about living condition, occupation and social support.
Do you smoker? alcohol? recreational drug use?
System review:
Review each body system to check for any other symptoms that might be causing the LOC.
Possible differential diagnosis:
Stroke.
Cardiac causes.
Seizure.
Vasovagal causes.
Brain injury.
Medication or drug overdose.
Hypoglycaemia.
Summaries your findings.
Investigation:
Bloods: full blood count (FBC), Urea and electrolytes (U&E), Hba1c, C-reactive protein (CRP) + Erythrocyte Sedimentation Rate (ESR).
ECG
Imaging: CT or MRI.
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