Syncope (Fainting) in Adults
Sudden, temporary loss of consciousness with interruption of awareness
⚠️ Treat as cardiac dysrhythmia until proven otherwise!
Initial Assessment
SFA, FR, EMR and up: Full vitals - may reveal dangerous abnormality even if patient now awake
Do postural vitals if patient can tolerate sitting/standing
PCP, RPN, LPN, RN and up: Detailed history, blood glucose, 12-lead ECG if possible, cardiac monitor, consider IV
Postural Vital Signs
- Measure BP and HR lying down - record
- Have patient sit (or stand) for 1-3 minutes
- Repeat BP and HR
- ABNORMAL if:
- Systolic BP drops >20 mmHg (postural drop) OR
- HR increases >20 bpm (postural tachy)
Reasons for Syncope
| Category | Causes |
|---|---|
| Cardiac | HR too fast/slow/long pauses Acute coronary syndrome (ACS) |
| Neural | Vasovagal (pain, fear, nausea, cough, seeing blood, bathroom straining) |
| Orthostatic | Dehydration, hemorrhage, BP meds, psych meds, overdoses, MS, Parkinson's, diabetes, advanced age |
Treatment
Cardiac Causes: Treat HR per ACLS. For ACS, chest pain protocol
Neural (Vasovagal): Watch and wait - expect full recovery
Orthostatic:
- Depletion → Replace volume (oral or IV fluids)
- Drugs → Supportive care
- Disease → Supportive care
Requirements for Patient Release
- ✓ Benign cause identified and corrected
- ✓ Tolerating oral fluids & passes walk test
- ✓ Repeat VS within normal limits x 2
- ✓ No significant postural drop or tachy
- ✓ Blood Glucose >4.0 mmol/L
- ✓ IV removed (if applicable)
- ✓ Care plan post-discharge in place
⚠️ Caution: Be cautious when re-positioning a syncopal patient for transport - they may faint again
Source: Odyssey Medical Consulting
Version: 2023-06-21