Syncope, or fainting as it’s more commonly referred to, is a temporary loss of consciousness that typically involves an insufficient flow of blood to the brain. Having blood pressure that is too low is the most common reason it happens, but there can be various reasons as to why it occurs, with some having the possibility of having an underlying medical condition. In the field of emergency medicine, it’s important that a healthcare provider is able to recognize whether or not someone is suffering from syncope, and how to go about treating it. Read on for a brief guide to evaluating syncope.
Step 1: Ensure it’s Syncope
If a patient is stable after waking up from a loss of consciousness, you’ll want to make sure it’s actually syncope versus what could possibly be a seizure, mechanical fall, or something else entirely. This is important because syncope shares many commonly cited symptoms with other health issues, such as myoclonic jerks which bystanders may view as a seizure, or bladder incontinence which can occur during seizures, severe head trauma or syncope. Tongue biting is also common in syncope, seizures and mechanical falls. A good way to determine if it was a seizure is if they have lateral tongue biting or postical confusion, whereas for a mechanical fall you’ll want to as about prodrome because a preceding prodrome is more likely with syncope.
Step 2: True Vs Symptom Syncope
Now it’s time to figure out if it’s true syncope or symptom syncope. Patients with true syncope typically lack any symptoms and after the syncope occurs. If there are other symptoms to go along with the syncope, it’s instead syncope secondary to another health problem and should be evaluated for the disease that’s associated with the symptoms they’re displaying. For example, if they have abdominal pain and syncope, they may be suffering from a rupturing abdominal aortic aneurysm with syncope as a high-risk symptom. Syncope can occur from practically any dangerous disease, making being able to distinguish between true and symptom syncope a vital skill.
Step 3: Risk Of Dysrhythmia
If a patient has true syncope, the final thing you’ll want to do is determine their risk for dysrhythmia. This usually involves performing an ECG. There are 6 factors that tend to increase the risk of adverse outcomes – family history, age, heart disease, exertion, hypotension, and abnormal ECG. If any of these factors are relevant to a patient, they should be admitted for telemetry monitoring and most likely an echocardiogram.