Syncope / Near Syncope

 

History:

 

  • Cardiac
  • Stroke
  • Seizure
  • Occult blood loss (GI, ectopic)
  • Females:
  • LMP
  • Vaginal bleeding
  • Fluid loss:
  • nausea
  • vomiting
  • diarrhea
  • Past medical history
  • Medications

 

Signs and Symptoms:

 

  • Loss of consciousness with recovery
  • Lightheadedness, dizziness
  • Palpitations, slow or rapid pulse
  • Pulse irregularity
  • Decreased blood pressure

 

Differential:

 

  • Vasovagal
  • Orthostatic hypotension
  • Cardiac syncope
  • Micturition / Defecation syncope
  • Psychiatric
  • Stroke
  • Hypoglycemia
  • Seizure
  • Shock (see Shock Protocol)
  • Toxicologic (Alcohol)
  • Medication effect (hypotension)

 

Treatment

 

Glucose < 60 with signs of hypoglycemia ?

 

  • Yes

 

 

 

    • Consider Oral Glucose 1-2 tubes if awake and no risk for aspiration

 

 

 

 

 

 

 

 

 

 

AT ANY TIME

If relevant signs / symptoms found go to

appropriate protocol:

 

 

Pearls:

 

  • Recommended Exam: Mental Status, Skin, HEENT, Heart, Lungs, Abdomen, Back, Extremities, Neuro
  • Assess for signs and symptoms of trauma if associated or questionable fall with syncope.
  • Consider dysrhythmias, GI bleed, ectopic pregnancy, and seizure as possible causes of syncope.
  • These patients should be transported.
  • More than 25% of geriatric syncope is cardiac dysrhythmia based.

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NRAEMT

National Registry Advance Emergency Technician

NRP

National Registry Paramedic