syncopal episodes

[skyemt]

i am finding syncopal episodes to be among the more difficult to assess, particularly for the elderly, with underlying causes ranging from simple vasavagal fainting, to an MI...

initial assessments and ABC's aside, i am looking for help in devising a systematic approach to gathering a history on these patients...in my district, we have our fair share of syncope.

suggestions please...

 

[VentMedic]

Cardiac arrhythmias.

Check for cardiac medications or a cardiac history.

This may be new for them as an electrical conduction problem or some combination of medications that may be producing the cardiac arrhythmia. Check the pulse for at least one minute for any irregularity and check the rate apically if the pulse is thready or to compare perfusion rate.

Often the elderly will have Sick Sinus Syndrome, heart blocks, period of sinus arrest, short bursts of PSVT and electronic Pacemaker malfunction. Any of these can cause a quick change in BP. Many people are diagnosed by wearing a Holter Monitor for 24 hours.

 

[skyemt]

thank you vent... very useful...
however... before i even get to the cardiac history, such as when i arrive at the scene, my chief concern is whether or not the syncopal episode is cardiac in nature... systematically speaking, what do you try to find out that leads you to say, vasavagal perhaps, or cardiac potential, and then proceeding down you line of questioning about meds, etc..

 

[VentMedic]

Also, any changes in diet and the dreaded words for prehospital people, bowel movements. Diarrhea and constipation both bring about problems. Elderly people are often dehydrated; check skin turgor and mucus membranes. This also brings about electrolyte imbalances.

http://www.emedicine.com/emerg/topic876.htm

 

[Guardian]

my first thought on these types of calls is AEIOU TIPS and v/s, to help rule out big stuff. I just wanted to throw that out there.

 

[Ridryder911]

As Guardian described: .."The mnemonic AEIOU-TIPS—alcohol/anemia, epilepsy, insulin, overdose, uremia/unknown, trauma, infections, psychosis and stroke".... as well as vasovagal

R/r 911

 

[VentMedic]

Try the mnemonic VITAMINS C & D in elderly patients that present with weakness, paralysis and/or syncope. This mnemonic includes some of the chronic and acute but more centered toward the elderly person. It may not be as easy to remember as AEIOU TIPS, but it may be something to keep in mind when looking various medications and gathering history. You may also not find it in your typical BLS or even ALS texts but if you take one of the Geriatric Seminars or CEU classes you may come across it.

Geriatric medicine is a whole science in itself. Many elderly people have one, two or many chronic illnesses that are complicated by acute conditions.

V: vascular; stroke, brain, embolism
I: Inflammation of the blood vessels in the brain
T: Toxins, Trauma, Tumors
A: Autoimmune: lupus, MS
M: Metabolic: liver or renal failure, hypoglycemia, hyperglycemia
I: Infection: menningitis
N: Narcotics and other drugs
S: Systemic: sepsis, hypoxia

C: Congenital: seizures
D: Degenerative: Alzheimer's, Parkinson's, dementias.

 

[Gbro]

Also, any changes in diet and the dreaded words for prehospital people, bowel movements. Diarrhea and constipation both bring about problems. Elderly people are often dehydrated; check skin turgor and mucus membranes. This also brings about electrolyte imbalances.

http://www.emedicine.com/emerg/topic876.htm

Had a rather large Pt. Vagal'ed on the Biff. Pt. went Rear over tea-kettle and hooked the large knob on the vanity. Once under the the skin, the knob peeled away tissue until IT exited the anus.
What a mess!
One of those calls that really makes one cringe.