Adult and Pediatric Syncope and Presyncope

Table of Contents

Aliases

Loss of consciousness, passed out, fainted

Patient Care Goals

  1. Stabilize and resuscitate when necessary
  2. Initiate monitoring and diagnostic procedures
  3. Transfer for further evaluation

Patient Presentation

Syncope is heralded by both the loss of consciousness and the loss of postural tone and resolves spontaneously without medical interventions. Syncope typically is abrupt in onset and resolves equally quickly. EMS providers may find the patient awake and alert on initial evaluation. Presyncope is defined as the prodromal symptoms of syncope. It usually lasts for seconds to minutes and may be described by the patient as “nearly blacking out” or “nearly fainting.”

Inclusion Criteria

  1. Abrupt loss of consciousness with loss of postural tone
  2. Prodromal symptoms of syncope

Exclusion Criteria
Conditions other than the above, including patients:

  1. Patients with alternate and obvious cause of loss of consciousness (e.g. trauma – go to Head Injury guideline)
  2. Patients with ongoing mental status changes or coma should be treated per the Altered Mental Status guideline

Patient Management

Assessment

  1. Pertinent History
    1. Review the patient’s past medical history, including a history of:
      1. Cardiovascular disease (e.g. cardiac disease/stroke)
      2. Seizure
      3. Recent trauma
      4. Anticoagulation
      5. Dysrhythmia
      6. Congestive heart failure (CHF)
      7. Syncope
    2. History of Present Illness, including:
      1. Conditions leading to the event
      2. Patient complaints before or after the event including prodromal symptoms
      3. Syncope that occurs during exercise often indicates an ominous cardiac cause. Patients should be evaluated in the emergency department
      4. History from others on scene, including seizures or shaking, presence of pulse/breathing (if noted), duration of the event, events that lead to the resolution of the event
    3. Review of Systems:
      1. Occult blood loss (GI/GU)
      2. Fluid losses (nausea/vomiting/diarrhea) and fluid intake
      3. Current Medications
  2. Pertinent Physical Exam Including:
    1. Attention to vital signs as well as evaluation for trauma
    2. Detailed neurologic exam (including stroke screening and mental status)
    3. Heart, lung, abdominal and extremity exam
    4. Additional Evaluation:
      1. Cardiac monitoring
      2. Ongoing vital signs
      3. 12-lead EKG

Treatment and Interventions:

  1. Should be directed at abnormalities discovered in the physical exam or on additional examination and may include management of cardiac dysrhythmias, cardiac ischemia/infarct, hemorrhage, shock, and the like
    1. Manage airway as indicated
    2. Oxygen as appropriate
    3. Evaluate for hemorrhage and treat for shock if indicated
    4. Establish IV access
    5. Fluid bolus if appropriate
    6. Cardiac monitor
    7. 12-lead EKG
    8. Monitor for and treat arrhythmias (if present refer to appropriate guideline)

Notes – Adult and Pediatric Syncope and Presyncope