Differentials
Cardiac arrest
SIGNS / SYMPTOMS
History of cardiac disease or family history of sudden cardiac death.
INVESTIGATIONS
Elevated cardiac enzymes. However, elevated creatine kinase 5 times normal may suggest compartment syndrome with rhabdomyolysis in patient with electrical injury.
Ventricular arrhythmia
SIGNS / SYMPTOMS
History of cardiac disease, in particular recent cardiac ischaemia.
INVESTIGATIONS
ECG - abnormal rhythm.
Illicit drug use
SIGNS / SYMPTOMS
History of illicit drug use.
Track marks.
Altered mental status.
INVESTIGATIONS
Urine toxicology screen for illicit drugs.
Acute stroke
SIGNS / SYMPTOMS
History of hypertension or vascular disease.
Limb hemiparesis, cranial nerve abnormalities, or speech changes.
INVESTIGATIONS
CT brain - haemorrhage or areas of ischaemia.
Subarachnoid haemorrhage
SIGNS / SYMPTOMS
History of known cerebral aneurysm or risk factors for cerebral aneurysm (e.g., polycystic kidney disease).
Severe headache.
INVESTIGATIONS
CT brain - subarachnoid blood.
Lumbar puncture - elevated RBC count with xanthochromia.
Generalised seizures
SIGNS / SYMPTOMS
History of seizures or risk factors for seizures (e.g., alcohol abuse, intracranial lesion).
Witnessed tonic-clonic movement.
Tongue biting.
Urinary or faecal incontinence.
INVESTIGATIONS
EEG - epileptiform discharges.
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