Near syncopal event, feels “weak” attending funeral


Mark Shelton Paramedic Woodburn Ambulance


David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Near-syncope
• Dehydration

Differential Diagnosis

• Syncope (consider the many etiologies of syncope)
• Myocardial infarction
• Arrhythmia
• CVA/Stroke
• Dehydration
• Anxiety
• Metabolic (eg, electrolyte abnormality)

Patient Workup

• Patient states – she has been working all day cooking for a funeral and has not drank very many fluids today. She been eating ok though. Pt says that she remembers everything and did not pass out,her friends were able to help her sit down in chair. Pt initially refused transport.
• Caregiver states- Physical findings- 12 lead showed NSR, Clammy then less-clammy en-route, weakness

Suggested Approach Notes

• Always consider cervical spinal injury and immobilization when someone falls and hits their head. • It is important to think about both what may have caused the fall, as well as injuries that may have resulted from a fall.
• Even seemingly mechanical falls should have a glucose, a stroke scale and an EKG checked.
• Find out if they are on aspirin (salycilate), Plavix (clopidogrel), Coumadin (warfarin), Pradaxa (dabigatran), or other blood thinners, as these medications increase the risk of intracranial bleeds. Intracranial bleeds are one of the big concerns that could kill a patient.
• Keep in mind that the elderly are already at increased risk of intracranial injury with even minor mechanism, even if they’re not on blood thinners.
• It is important to consider how long the patient was down for, what their functional status prior to the fall was, and what their body temperature is. Many older people fall and can’t get up for prolonged periods, resulting in hypothermia and muscle and skin breakdown from being down for so long. • Whenever someone injures an extremity, check if they have strong distal pulses, motor strength, and sensation. If any of those details are missing, they need immediate evaluation at the hospital. If there is an obvious deformity, a cardboard splint can sometimes help with circulation/nervous/motor problems and pain control.
• Consider treating pain as appropriate per local protocol

Suggested references

Falls in the elderly
Failure to Thrive in Elderly Adults Syncope: Beyond the basics Syncope


• Gender: Female
• Age: Not Available
• Height: Not Available


• Temperature: Not Available
• Heart Rate: 77
• Respiratory Rate: 14
• Pulse Oximetry: 95% RA
• Blood Pressure: 119/78

Signs and Symptoms

Felt weak, poor po liquids today; preparing food for a funeral when event occurred.

History Medical

• Atrial fibrillation Social
• Was cooking for a funeral before this event occurred.
• Lives alone


• No medications

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