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
• Lightheaded, 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

 

• Universal Patient Care Protocol
• Consider Spinal Motion Restriction Protocol
• Complete set of vital signs including SaO2
• Assess Blood Glucose
• Orthostatic Vital Signs
• 12-Lead ECG

 

AT ANY TIME If relevant signs / symptoms found go to appropriate protocol:

 

• • • • Dysrhythmia
      • Altered Mental Status
      • Hypotension

 

Pearls:

 

• Consider examining: 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.
• Consider performing Cincinnati Prehospital Scale
• These patients should be transported.
• More than 25% of geriatric syncope is cardiac dysrhythmia based.