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Medical

SYNCOPE

Signs and Symptoms: Differential Diagnosis:
• Loss of Consciousness with Recovery • Vasovagal Episode
• Lightheadedness/Dizziness • Orthostatic Hypotension
• Nausea/Vomiting • Cardiac Etiology
• Palpitations/Chest Pain • Psychiatric
• Shortness of Breath • Stroke
• Decreased Pulse Pressure • Hypoglycemia
• Seizure
• Shock
• Toxicologic/Medication
Universal Patient Care Guideline If patient unresponsive or mental status is altered
Continued from: O2 (if Hypoxemic) upon arrival of MEDEVAC to patient pick-up site.
Tactical Evacuation Guideline IV/IO Guideline GO To:
Cardiac Monitor AMS Guideline
True Syncope is a brief self-resolving event.
Consider Spinal Immobilization If the patient is still altered upon your arrival it’s
Guideline
NOT Syncope!
O2 Sat <94%?
Evidence of Alcohol Abuse? GCS <8? YES AIRWAY Guideline
NO YES Unable to protect Airway? (maintain stable airway)
Thiamine 100mg IV/IM NO
Tachycardia/Hypotension? YES 1000mL IVF IV
50% Dextrose 25g IV
or D10 drip NO
OR YES Blood Glucose <60?

Glucagon 1mg IV/IM If no improvement after
1000mL Bolus:
NO
12-lead ECG Hypotension/Shock
Guideline
NO Glucose 60-250? YES
Continuous Monitoring When appropriate, return to:
OR
Move to Appropriate Protocol as needed Tactical Evacuation Guideline
Stroke/TIA Guideline Seizure Guideline
Altered Mental Status Guideline Hypotension Guideline
Cardiac Arrest
Bradycardia Tachycardia
with Pulse (VF/Pulseless VT or with Pulse
Asystole/PEA)
Pearls:
• Assess every patient for signs of trauma if suspected with syncopal event.
• Consider occult bleeding in all cases of syncope: GI bleeding, ruptured ectopic pregnancy, and seizure.
• Prodromal symptoms (e.g., flushing, lightheadedness, diaphoresis, tunnel vision) are often associated
with more innocent etiologies, especially if temporally related to standing / rising. Absence of prodrome
should raise concern for cardiac/CNS (emergent) etiologies.
• It is uncommon for stroke to cause syncopal episode.
• Patients who sustain trauma to the temporal region of the skull and are now lucid may experience a
precipitous loss of consciousness/degeneration due to epidural hematoma.
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