Syncope

Question 1

Definition

Answer 1

Loss of consciousness resulting from a brief and reversible loss of normal neurological function due to poor perfusion, a metabolic event, or neurological event

Question 2

Goal of Care

Answer 2

Standard ABC’s, identify and treat reversible causes, transport

Question 3

Causes

Answer 3

Syncope differs from other unconscious collapses in that it most often of limited duration and pts return to a normal level of consciousness quickly

• Vasovagal

Immediately Life Threatening:

• Cardiac disrhythmias w/ or w/o associated ischemia
• Other Heart disease ( Valvular, hypertrophic cardiomyopathy)
• Hypovolemia (GI bleed, occult hemorrhage [etopic, AAA])
• Hypotensive distributive shock (sepsis/anaphylaxis)
• Pulmonary embolus (obstructive shock)
• Hypoglycemia
• Heat exhaustion/stroke
• Subarachnoid hemorrhage (SAH)
• Cerebral Vascular Accident (TIA)
• Seizure
• Drugs: B-blockers/Ca channel blockers/benzodiazepines/narcotics
• Hyperventilation/anxiety

Question 4

Intervention Guidelines

Answer 4

EMR
- Position 
  If symptoms suggest hypotension - lay flat IF this doesnt worsen symptoms
- Supp O2
- Correct hypoglycemia
  Glucogel 1 package

PCP
- Assess for sources of syncope
- Monitor for signs of improvement if pt initially hypo-perfusing
- Correct hypoglycemia
  Glucagon 1mg IM
  Dextrose 10-25mg D10W IV

• IV during transport
• Correct hypoperfusion - hypotension (BP <90mmHg)
  If lung fields clear
  Fluid Challenge
  500 NS - reassessing lung every 200ml
  Target BP - 90mmHg systolic

Facilitate transport