Syncope is a brief loss of consciousness from reduced blood flow to the brain, followed by a full and quick recovery. Most causes are harmless, such as a simple faint, yet heart rhythm problems and bleeding can be deadly and must be ruled out.
Key symptoms
- Brief loss of consciousness with a fall and quick recovery
- Warning signs before: nausea, warmth, sweating, tunnel vision
- Fainting when standing up quickly
- Fainting during exercise or without warning
- Palpitations or chest pain before the event
What you find on exam
- Vital signs, including orthostatic vital signs
- Heart rate, rhythm and murmurs
- Injuries from the fall, especially to the head
- Neurologic exam to rule out stroke or seizure
- Signs of bleeding: pale skin, black stools
Tests
- 12-lead ECG for arrhythmia, heart block, long QT, Brugada or WPW
- Blood glucose
- Pregnancy test in women who could be pregnant
- Hospital: blood count, electrolytes; echocardiogram or heart monitor when needed
Treatment basics
- Lay the patient flat and raise the legs
- Treat the cause: fluids for dehydration, stop or change drugs that cause it
- Transport high-risk patients for monitoring
- Teach triggers, hydration and counter-pressure maneuvers for simple faints
- No driving until cleared when the cause is cardiac
Red flags
- Fainting during exercise or while lying down
- Abnormal ECG, chest pain or a family history of sudden death
- Older age, heart disease or signs of bleeding
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Sources: NASEMSO National Model EMS Clinical Guidelines; NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.