506 | Syncopal event, reported loss of consciousness

Treatment

• Scene – EKG, vitals

• En Route –12 Lead, CBG, TT, oral glucose.

• Hospital – unknown

Disposition

• Response to treatment – CBG came up; pt refused IV en route.

• Disposition – unknown. While en route pt had no complaints. Did not want any IV’s placed, otherwise cooperative.

Authors:

Mark Shelton Paramedic Woodburn Ambulance
Matthew Hansen, MD Oregon Health & Science University

Editors:

David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
Mohamud Daya, MD Oregon Health & Science University

Diagnosis

• Syncope

Differential Diagnosis

• Syncope – many etiologies, including vasovagal

• Seizure

• Anxiety

• CVA

• Pregnancy

• Hypotension

• Arrhythmia

• Hypoglycemia

Patient Workup History

• Pt states – She felt dizzy, weak and tired just prior to syncope.

• Caregiver states – Mom states that patient had similar episode last week and went to PCP on Wednesday to have an EKG done. Results are not yet available.

Physical Exam

• BP – supine = 108/76 sitting = 109/69 standing = 76/45. All taken about 5 minutes apart.

• CBG – initially 64; after oral glucose, 74

• EKG – sinus tach

• Findings: hypotension orthostatic, hypoglycemic.

Editor’s Notes

It is interesting that this patient has a one year known diagnosis of Lupus (SLE). Certain neuropsychiatric conditions are associated with this disease process, including anxiety, CVA and seizures. These are on this patient’s differential dx, although her mental status and conversation with the paramedic are reassuring.

-Dr. David Spiro

Suggested Approach

Syncope in young adults
Syncope in previously healthy young adults is less likely to be a serious emergency than in older patients. It is often due to dehydration or a vasovagal episode triggered by a position change or a stressful event such as a blood draw. Warning signs for syncope in young adults include onset with exertion (eg. running), abnormal vital signs, or previous cardiac problems.

Suggested workup:

Full set of vital signs, 12 lead ECG, blood glucose.

Suggested treatment:

If signs or symptoms of dehydration are present IV fluids are indicate.

Suggested references

Syncope
Lupus(SLE)

Patient

• Gender: Female

• Age: 15 years

• Height: Not Available

• Weight: Not Available

Vitals

• Temperature: 98.1 F/36.7 C

• Blood Pressure: 108/76

• Heart Rate: 113

• Respiratory Rate: 16

• Pulse Oximetry: 100% RA

Signs and Symptoms

Dizziness, syncope; fatigued

History Medical

• PMH: Diagnosed with lupus ~1y ago

• Allergies: None

• Dispatch info: Fainted but has regained consciousness.

Social

• Lives at home with parents and three siblings.

Medications

• Septra, iron, ASA, Cellcept