DESIGNATION OF CONDITION

  Syncope –“fainting”-is defined as a transient loss of consciousness with loss of postural tone of less than 5 minutes duration.  The immediate cause of syncope is sudden, temporary, hypoperfusion of the cerebrum.  Some cases of syncope are preceded by warning symptoms—dimming of vision, roaring in ears, sighing or yawning, weakness, diaphoresis, pallor, nausea.  Common causes include orthostatic hypotension, decreased cardiac output, vasovagal/vasodepressor events, carotid sinus stimulation, diabetes, alcohol, and neuropathies.  Syncope is self-limited and resolves itself once the patient is recumbent and blood flow to the brain is restored.  If the patient experiences prolonged unresponsiveness and requires resuscitation, then the condition is not syncope.  Stroke, hypoglycemia, and seizures may mimic syncope.

EMPHASIS ON PATIENT CARE

Airway management, adequate oxygenation, evaluation for underlying cause.  If the patient may have fallen during the episode, evaluate for head/spinal injury and treat.

FIRST RESPONDER AND BASIC PRE-HOSPITAL MANAGEMENT
1. Initial Management - Assess airway, breathing and circulation and manage as indicated.
2. Focused H&P - History, physical exam, vital signs.

• Rule out (see specific protocols):
  • Diabetic emergency, perform Glucometry.
  • Overdose.
  • CVA.
  • AMI or arrhythmia.
  • Head trauma.
  • Dehydration.

INTERMEDIATE and PARAMEDIC PRE-HOSPITAL MANAGEMENT

3. En-route, initiate an IV of an isotonic solution and infuse at a flow rate to maintain adequate vital signs.
4. Cardiac monitoring.