Transient loss of consciousness—initial assessment, diagnosis, and specialist referral: summary of NICE guidance

The recommendations emphasise elements of the diagnostic algorithm published in the Quick Reference Guide version of the NICE guidance, to which the reader should refer. 4 Evidence levels for the recommendations are given in italic in square brackets Initial assessment At any stage, including initial presentation, if the person has sustained an injury or has not made a full recovery of consciousness, or if transient loss of consciousness is secondary to a condition that needs immediate action, use clinical judgment to determine appropriate management and the urgency of treatment. [Based on the experience and opinion of the GDG] Assess and record: -Details of any previous transient loss of consciousness -Medical history and any family history of cardiac disease -Current medication -Vital signs -Lying and standing blood pressure if appropriate -Other cardiovascular and neurological signs. [Based on moderate, low and very low quality evidence from prospective and retrospective cohort studies and cross sectional studies and on the experience and opinion of the GDG] Important abnormalities in a 12 lead electrocardiogram in patients with transient loss of consciousness Atrial arrhythmia (sustained) Inappropriate persistent bradycardia Conduction abnormality (for example, complete right or left bundle branch block or any degree of heart block) Left or right ventricular hypertrophy Long QT interval (corrected >450 ms) and short QT interval (corrected