Syncope - A Standard Assessment?

[FLdoc2011]

Just saw a syncope consult, with prior significant cardiac history including a prior shock for VT and when I looked at the EMS paperwork the pt's initial glucose was in the 30's. So I guess useful to check.

 

[DesertMedic66]

Same, no specific protocol I'm aware of, but if my index of suspicion calls for it then orthostatic V/S are absolutely within reason. I do them fairly frequently, particularly with the W/D patients who I will find supine somewhere in their house.

@DesertMedic66 is that a county-wide approach, or more specific to PS? Also, do most syncopes in your area get sent to the lobby once the 12-lead clears?

County wide we were told to completely stop courtesy IVs. Unless we are going to use the line we are told not to start one. I think it is the counties way of "punishing" the EDs for long bed delays.

 

[hometownmedic5]

Curious why you all do a BGL on a symple syncope. Provided it's a "they passed out, now they're fine". Do you actually expect to see a BGL of 35 or do you do it because it's expected/protocol?

Not saying it's wrong, but I've never, ever seen a simple syncope not have a normal BGL

Of course, the one outlier will change the rules for everyone.

I take my sugars from the IV, so it's no extra bother.

 

[DrParasite]

Curious why you all do a BGL on a symple syncope. Provided it's a "they passed out, now they're fine". Do you actually expect to see a BGL of 35 or do you do it because it's expected/protocol?

Not saying it's wrong, but I've never, ever seen a simple syncope not have a normal BGL

Of course, the one outlier will change the rules for everyone.

I want to say in basic EMT class, we tell our students that every AMS (and syncope falls into that category) gets a BGL stick.

That being said, 90% of the time it will be normal and a waste of time.....but that 10% of the time, you will want to know.

I would image the same argument could be made for 12 leads on people who are younger than 60 who experience a syncopal episode. Do you do it because you expect to see something abnormal,or just because it's expected/protocol?

 

[EpiEMS]

Well, given that cardiac-related syncope is high risk, it should pay (cost/benefit) to perform a (relatively costless) 12-lead, no? For BGL, again, it is easily performed and can help to rule in/rule out potential causes.

Thinking about potential high-risk causes, a 12-lead can help rule out many of them (or at least push them further down the differential).

 

[hometownmedic5]

Identify the problem.
Establish a treatment plan.
Prioritize the list of actions that go with that plan.
Start at number one, work till you're done or get to the hospital.
Re-evaluate as you go along and rule things in/out.

A CBG might not be high on the list for syncope, but it's on the list. If you get to it, great. If you don't, they probably aren't going to die because of it. This is a pretty basic thought process that works for every call. Put things in the right order, get done what you can and the hospital can do the rest....

 

[zzyzx]

I can share an interesting syncope story

Twenty something guy comes to the ER because he fainted at work and his boss told him to come in. He said he fainted while walking around. Nothing else to it, no prior syncope, no medical history. All vitals normal.

The standard work up in the ER for a young person with this exact story is an ECG only (no labs or imaging). So that's what we did.

Guess what the 12 lead showed? Delta waves and other textbook indications of WPW. Considering that his rate was apparently fast enough to cause syncope, it is possible that he may have had AF associated with the WPW at the time that he fainted, and that can as we know be a fatal combination. His ER visit may have saved his life.