Syncope 

Assessment

Pediatric Pearls: Signs & Symptoms: Differential: 
□ Pediatric hypotension is defined as SBP < 70 + (age in years x 2) mmHg

□ Syncope with activity is concerning		□ Loss of consciousness with recovery 
□ Lightheadedness, dizziness 
□ Palpitations, slow or rapid pulse 
□ Pulse irregularity 
□ Decreased blood pressure		□ Vasovagal 
□ Hypotension / Hypoperfusion 
□ Arrhythmia
□ Pulmonary embolism
□ Micturition / Defecation syncope 
□ Stroke 
□ Hypoglycemia 
□ Seizure 
□ Toxicological 
□ Medication effect (hypotension) 
□ Aortic Stenosis / Vascular Disease 

Clinical Management Options

EMT-B
• Oxygen titrated and PRN 
• Blood glucose level
• Basic airway management 
• Assess for injury
• Orthostatic vital sign assessment if appropriate
Paramedic
• Consider vascular access 
• Isotonic Crystalloid as needed for low-volume states, hypotension
• Monitor ECG
Consult Online Medical Control as Needed

Pearls

  • Assess for signs and symptoms of trauma if associated or questionable fall with syncope. 
  • Consider dysrhythmias, GI bleed, ectopic pregnancy, and seizure as a possible cause of syncope. 
  • More than 25% of geriatric syncope is cardiac dysrhythmia based. 
  • Anyone > 65 years old should have continuous cardiac monitoring. 
  • Syncope in the young during activity (passing out while running) is concerning