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:

1. Stroke.

2. Cardiac causes.

3. Seizure.

4. Vasovagal causes.

5. Brain injury.

6. Medication or drug overdose.

7. 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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