Cough syncope in Heavy Goods Vehicle drivers.
نویسندگان
چکیده
Correspondence Cough syncope in Heavy Goods Vehicle drivers Sir, We have recently become aware of four cases of serious road traffic accidents involving Heavy Goods Vehicle (HGV) drivers, all of whom avoided prosecution from dangerous driving based upon medico-legal reports supporting the diagnosis of cough syncope. One case resulted in the death of two pedestrians. The three other cases involved head-on collisions, two of which resulted in the death of the car drivers involved, one of which resulted in serious injury. All denied previous syncopal episodes with coughing. The accounts given from each of the HGV drivers remained consistent from the time immediately following the accident. The alternative diagnosis of falling asleep at the wheel, secondary to obstructive sleep apnoea, was considered in each case. The classic descriptions of cough syncope from accounts given by the HGV drivers immediately following the incident were felt to be diagnostic and sleep studies were therefore not requested by the physicians. Cough syncope is readily recognizable; syncope follows a series of coughs, or even a single cough. Syncope is generally brief, lasting only seconds and recovery is rapid. We could find only two previous reports of fatal road traffic accidents within the English literature. 4,6 The original descriptions almost exclusively implicated male, middle-aged and overweight chronic bronchitic smokers. There is only one publication in the English literature to follow up a series of cases with cough syncope. 1 Of 45 cases, 43 were male, average age 52, mean weight 96 kg, smoking was implicated in 82%, obstructive lung disease in 86%. Nearly all had pre-syncopal symptoms associated with coughing, but loss of consciousness was rare. They recognized that treatment, in particular stopping smoking, alleviated symptoms in nearly all patients. The occurrence in young asthmatics of both sexes is also now well recognized. 3 Cough syncope was first described by Charcot in 1876 2 using the term laryngeal spasm, but confusion regarding its underlying mechanism has remained until recently. Work by Mattle et al. 5 measuring intracerebral blood flow using the technique of trans-cranial doppler demonstrated that cerebral blood flow can stop and even reverse during a cough in susceptible patients, yet mean arterial pressure does not significantly change. During coughing there is an increase in thoracic and abdominal pressures; this is transmitted via the great veins to the cranial cavity. Intracerebral blood flow is determined by the difference between arterial blood pressure and intracranial …
منابع مشابه
Age related annual crash incidence rate ratios in professional drivers of heavy goods vehicles
Objectives: Evidence concerning crash risk for older heavy vehicle drivers is sparse, making it difficult to assess if it is prudent to encourage older drivers to remain in the workforce in a climate of labour shortages. The objective of this study was to estimate annual crash rate ratios of older male heavy vehicle drivers relative to their middle aged peers. Methods: Data utilized in this stu...
متن کاملBlood Parameters of Drivers and Road Accidents: A Study of Heavy Vehicle Drivers in Tehran, Iran, 2018
Background: Taking the drivers' health into account from different perspectives is important. This study aimed to examine how heavy vehicle drivers' blood parameters are related to their road accident risk. Materials & Methods: A descriptive study was conducted among 200 drivers of heavy vehicles. The blood parameters were determined based on the medical records of drivers, as well as data on ...
متن کاملMedical examinations for public safety.
Driving buses in London is an occupation in which the standards of fitness have been defined and in which the frequency of, and clinical reason for, exclusion from the occupation have been recorded. The criteria of fitness to drive a passenger vehicle are physical capability to handle controls (including good eyesight) and absence of conditions liable to cause sudden collapse or excessive fatig...
متن کاملCough syncope misinterpreted as epileptic seizure.
Cough syncopes are rare but may be one of the cause of sudden loss of consciousness. We recorded under video-EEG monitoring a typical syncope triggered by voluntary coughing (video) and Valsava maneuvre in a patient referred for the diagnosis of generalized tonic-clonic seizures. There were no signs of active epilepsy. The attacks were associated with overweight, obstructive sleep apnea and hea...
متن کاملThe experiences and perceptions of heavy vehicle drivers and train drivers of dangers at railway level crossings.
Heavy vehicle-train collisions have the potential to be catastrophic in terms of fatalities, environmental disaster, delays in the rail network, and extensive damage to property. Heavy vehicles, such as 'Road Trains' and 'B-Doubles', are vulnerable road users due to their size and mass and require specific risk management solutions. The present study aimed to capture the experiences of heavy ve...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- QJM : monthly journal of the Association of Physicians
دوره 97 9 شماره
صفحات -
تاریخ انتشار 2004