NICE advises on blackouts, BP in pregnancy and RA

NICE has issued advice on diagnosing blackouts, alongside guidance on hypertension in pregnancy and rheumatoid arthritis.

In assessing transient loss of consciousness (TLoC), the specific circumstances that occurred before, during and after the suspected blackout need to be established, NICE says. Medical history and vital signs should then be recorded.

NICE recommends that, if initial assessment does not reveal concerns and if the blackout is symptomatic of an uncomplicated faint, no immediate management may be required.

But if there are uncertainties, then other tests, including an electrocardiogram, should be offered and patients should be referred to a cardiovascular specialist within 24 hours.

For pregnant women, NICE suggests that GPs advise those with a moderate to high risk of developing pre-eclampsia to take 75mg of aspirin a day from the twelfth week of pregnancy until birth.

For rheumatoid arthritis, after treatment with a tumour necrosis factor inhibitor has failed, NICE recommends rituximab, adalimumab, etanercept, infliximab and abatacept as possible treatments.

NICE has also recommended tocilizumab, under certain circumstances, as an additional option for treatment of rheumatoid arthritis.

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