Clinical case · Syncope
Blacked out on the way to the bathroom
An 83-year-old man lost consciousness after getting up at night to pass urine. Work through the emergency assessment, interpret his ECG and standing blood pressures, and find the medicines and habits behind it.
Intermediate 15 minNeeds clinical review
You will learn to
- Follow the emergency pathway for transient loss of consciousness: injuries and shock, vital signs, ECG within 10 minutes, minimum blood tests
- Diagnose orthostatic hypotension from a standing test and tell neurogenic from non-neurogenic causes
- Treat orthostatic hypotension in steps, starting with medicines and fluids
Presentation
Step 1 of 10An 83-year-old man is brought in at 02:30. He got up to pass urine, felt light-headed and "everything went grey", and his wife heard him fall in the hallway. He was unresponsive for under a minute and then fully alert.
He has a grazed elbow and a sore left hip.
References
- Möckel M, Janssens KAC, Pudasaini S, et al. The syncope core management process in the emergency department: a consensus statement of the EUSEM syncope group. Eur J Emerg Med. 2024;31(4):250–259. doi:10.1097/MEJ.0000000000001146 · PubMed 38874507
- Gibbons CH, Schmidt P, Biaggioni I, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol. 2017;264(8):1567–1582. doi:10.1007/s00415-016-8375-x · PubMed 28050656
Last updated 2026-10-22.
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