2-24 SYNCOPE

Syncope is defined as a temporary loss of consciousness with recovery.

Syncope may be caused by:  Cardiac Arrythmia, Hypoglycemia, Seizure, Toxicological, Medication Effect (hypotension), Heat Exposure/Dehydration, Vasovagal Response, Hypotension/Septic shock, etc.

Any patient requiring ACLS care should have an ALS intercept if logistically possible.

EMR - Emergency Medical Responder

1. Begin initial medical care
2. Attempt to clarify recent medical history and details surrounding the syncopal episode:
   1. Pre-syncopal symptoms? (Palpitations, lightheaded, overheated, chest pain, shortness of breath, etc).
   2. GI bleeding?  (Bloody/black emesis or stools)?
   3. Vaginal bleeding
   4. Nausea, vomiting, diarrhea
   5. Ongoing Symptoms? Chest pain/palpitations Shortness of breath
   6. Relevant Past Medical History?  Cardiac, CVA, Seizure
   7. New medications?
3. Administer oxygen if indicated
4. Assist ventilations if RR < 8 or > 35
5. Assess for hypotension/ shock (HR >130, cap refill > 2 seconds) & follow shock protocol
6. Perform an initial Trauma Examination to evaluate for potential traumatic injuries if there was a fall or other traumatic mechanism associated with the syncope.
   1. If there is concern for possible traumatic injury, follow Initial Trauma Care protocol, including spinal protective measures.
7. Call for ALS intercept

EMT- Emergency Medical Technician  perform/confirm all above interventions

1. Assure ALS intercept is en route
2. Transport as early as possible
3. Measure blood sugar, follow hypoglycemia protocol if indicated (Glucose < 60).
4. Follow Symptomatic Bradycardia protocol if indicated (HR < 60 with cardio-respiratory compromise).
5. Reassess VS often during transport
6. Apply ECG monitor & run strip (if trained, if time allows and after all other interventions are completed)
7. Perform 12-lead ECG (if trained) as indicated

CONTACT MEDICAL CONTROL

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Start IV/IO access en route, NS TKO (do not delay transport)
2. Administer additional NS fluid bolus, as directed

CONTACT MEDICAL CONTROL

Intermediate perform/confirm all above interventions

1. Attach cardiac monitor if not already done, confirm rhythm in more than 1 lead
2. Treat dysrhythmia primarily; Heart rates > 150 or < 50 are often unstable and/ or symptomatic
3. Administer NS fluid bolus up to a total of 500 mL -IF-
   1. Symptomatic, no dysrhythmia & lungs are clear
4. Reassess VS, lung sounds & rhythm frequently

CONTACT MEDICAL CONTROL

Paramedic perform/confirm all above interventions

1. Follow Cardiac Dysrhythmia (Tachycardia or Bradycardia) protocol if indicated.
2. Follow Hypoglycemia protocol if indicated.
3. Follow Medical Hypotension/Shock protocol if indicated.
4. Follow Seizure protocol if indicated.
5. Follow Hyperthermia protocol if indicated.