# Syncope



## NJEMT12 (Dec 29, 2013)

BLS dispatched for man down no ALS assigned in initial dispatch.

AOS to a 72 y/o male on the ground. Upon initial patient contact patent is CA&Ox4 yet seems sluggish in answering questions. Patient relates he does not remember falling. RP on location said he witnessed the man walking down the street and collapses, by the time he made his way over to the patient is alert. Patient presents w/ minor abrasion above (L) eye & abrasion on (L) hand. ALS requested via protocol due to the LOC. Patient HX: Diabetes & HTN Unknown Meds NKDA. Loaded into truck & ALS AOS. BGL: 134 BP:122:84 Resp:16 SPO2:98 HR:70. Stroke scale preformed yielded bilaterally equal in all fields however could not assess speech due to heavy asian accent. Patient attempts to deny however we talk him into going to the closest facility (4 minutes away) which is non specialty. ALS does a 4 lead which is unremarkable, establishes IV access and transport is initiated. . . Find out on a later call patent was transported to a speciality hospital for a bleed...

My Clinical director flagged the chart for not providing spinal immobilization. They related although there was only minor trauma noted upon the assessment (2 small abrasions) that it'd be impossible to determine if the patient fell suffered the trauma & had the LOC or if the patient suffered a syncopal episode and then trauma. What are your thoughts on providing C-Spine to this patient whom denies Head/Neck/Back pain and only complaint is us talking him into going to the ED.


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## Anjel (Dec 29, 2013)

I personally don't think he needed a backboard and c-collar. However, I have to pull my protocol card and say that I would of placed him in a collar. 

My protocol states any trauma with a person over the age of 65ish, that has any possibility for a head neck or back Injury gets a collar. Not that it going to help the bleed in the dudes head, but my hands are kind of tied. I would not backboard though.


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## mycrofft (Dec 29, 2013)

Your boss is either just enforcing the protocols you are to work under, or imposing his or her common sense on your situation. _*If it is safe*_, ask what signs and symptoms indicted spinal immobilization was indicted versus the risk of iatrogenic injury (pressure sores), pain or death (orthopneic airway embarrassment). It's ok for the answer to be "That's the protocol"; nod, say thank you and press on.

Someone that age just falls out and gets better when he gets prone or supine, I'd be more afraid of a bum heart valve, hydration or nutrition issues, CNS, CVA, or tripping. And of course eval for potential spinal or cranial insult.


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## ZombieEMT (Dec 31, 2013)

NJEMT12 said:


> They related although there was only minor trauma noted upon the assessment (2 small abrasions) that it'd be impossible to determine if the patient fell suffered the trauma & had the LOC or if the patient suffered a syncopal episode and then trauma. What are your thoughts on providing C-Spine to this patient whom denies Head/Neck/Back pain and only complaint is us talking him into going to the ED.



As an EMT in New Jersey, I was tought to go on the side of caution (whether or not I personally agree is irrelevant). Even if the patient doesn't complain of head/neck/back pain, hes got an injury to his head. That combined with a LOC and age of 72, I would have C-Spined even if only a precautionary act.

Also, I ask, is this a 72 year old that takes any blood thinners, ei Plavix, Coumadin/Warfarin, Aspirin? What what his posture like? Would the longboard cause more harm if used?


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## ZombieEMT (Dec 31, 2013)

Also, once ALS becomes involved, they make the decision. What was your medics point of view on the situation? If you decided not needed in a patient that maybe should have, document why not.


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## Burritomedic1127 (Dec 31, 2013)

Where I work if the pt has a reliable mental status (not altered, ETOH, etc), no distracting injuries with no tenderness or pain on palpation of head, neck, and back then c spine is not necessary.

In your case, I don't think a backboard would help his head bleed, just support care and transport to a trauma center


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## epipusher (Dec 31, 2013)

Collar only for cya due to distracting injury, sluggish response, does not remember falling and over 65. Protocol.


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## mycrofft (Dec 31, 2013)

Collar to follow procotol. That will CYA. 

Don't collar to CYA, THEN follow protocol. TX without premise (following protocol) is malpractice, tort and assault/battery.


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## DrParasite (Jan 2, 2014)

why did your clinical director want c-spine precations taken?


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