Syncope

Question 1

In syncope, want to rule out ___as soon as possible

Answer 1

Trauma

Question 2

Life threats you want to rule out with syncope

Answer 2

Cardiac, Neurological event, respiratory issue, volume issue, metabolic issue (4 life threats: shock, cardiac, respiratory, neuro)

Question 3

Syncope

Answer 3

Temporary insufficient perfusion of the brain

Temporary loss of consciousness and posture

Question 4

What life threat should you rule out first with the elder population?

Answer 4

Cardiac

Question 5

Reasons for syncope with cardiac issue?

Answer 5

Palpitations (females especially), MI, Dysrhythmias

Question 6

Types of dysrhythmias that may result in syncope?

Answer 6

SVT (supraventricular tachycardia)
VT (ventricular tachycardia)
Bradycardia
Atrial fibrillation

Question 7

“Fluttering in the chest” is associated with what type of dsyrhythmia?

Answer 7

Atrial fibrillation

Question 8

Syncope that may result from a neuro event?

Answer 8

Cerebral vascular accident (CVA)

Transient Ischemic Accident(TIA)

Question 9

What does a stroke most commonly result from?

Answer 9

Thrombosis (occulsive or aneurysm)

Question 10

What type of assessment would you perform on a stroke patient?

Answer 10

FAST ED

Question 11

Respiratory issue associated with syncope?

Answer 11

Pulmonary embolus

Question 12

Syncope from a volume issue?

Answer 12

Hemmorhage

Dehydration

Question 13

You may want to do what to rule out a volume issue?

Answer 13

Orthostatic vital signs

Question 14

Syncope from metabolic issue?

Answer 14

Hypoglyemia

Hormonal-pregnancy

Question 15

What makes something non-life threatening?

Answer 15

Transient and self resolving

Question 16

Non-life threatening syncopal issues?

Answer 16

Vasovagal
Prolonged/sudden standing
Environmental components
Psychogenic

Question 17

Why would prolonged standing result in a syncopal episode?

Answer 17

Mechanism for moving blood up the viens is muscle movement. if not moving for a long period, blood is not making its way up

Question 18

Common pre-syncopal events (these complaints do not throw up a “red flag”)

Answer 18

Dizziness
Unsteady/weakness
Diaphoresis
Greying of peripheral vision
Brief period of seizure activity not unusual (incontinence/post ictal period is rare)

Question 19

Difference between normal seizure patient and syncopal episode?

Answer 19

Presence of incontinence and post ictal period

Question 20

Assessment for syncopal episode?

Answer 20

ABC's
Trauma?
Reliable witness
Vital signs
Postural (if patient seems stable)
PMH: Meds

Question 21

Assessment, life threats:

Answer 21

Cardiac assessment
Respiratory assessment (oximetry)
Neuro assessment (rule out seizure)
Glucometry
Abdominal assessment

Question 22

Red flags for syncopal episode

Answer 22

Elderly
Syncope at rest (without position change)
Syncope without warning (cardiac and hemorrhage in play)
Cardiac symptoms
Prolongued syncope (cardiac or neuro-position change increases bloodflow to the brain, so should change condition. If not, consider cardiac/neuro)
Seizure
Truama

Question 23

Pertinent negatives

Answer 23

Cardiac: SOB pre or post syncope, Chest pain, Palpitations
Seizure: Incontinence
Trauma: head injury pre or post event

Question 24

What should be documented for syncopal episode, especially when considering potential trauama

Answer 24

Need to document whether or not patient has injury and if the patient went to ground

Question 25

Treatment of syncopal episode

Answer 25

O2
Position
Trauma management
Consider ALS