Syncope

isabellamarie

Forum Ride Along
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What would you guys personally do in this situation

14 Y/O Female
Passed out during a workout
Very slow to answer questions
Seems disoriented
Has passed out before but states that this time feels different.
 

ffemt8978

Forum Vice-Principal
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ABC's, vitals x3, SAMPLE, contact guardian
 

Jim37F

Forum Deputy Chief
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If off duty at the gym as well, call for an ambulance.

If on duty and responding? Get a full set of vitals, determine are they actually alert and orientated, get a full medical history, medication list, allergies, OPQRST, etc, to determine appropriate hospital, hand off to EMS for transport. Oh yeah, 14 year old, get in contact with parent/guardian.

Unless there's something particularly out of left field, this patient will probably get a nice smooth, non-emergent ride to the closest ER with BLS monitoring.
 

MMiz

I put the M in EMTLife
Community Leader
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Off duty: Activate emergency response (911). Have friends/family with patient call the parent/guardian.

On duty: Jim37F covered it.

I see this a lot in my non-EMS job, both with adults and pediatrics. Our policy is to contact 911 for loss of consciousnesses and wait for EMS.

Being slow to answer questions, disorientation, and someone stating that this "feels different" seem to be pretty typical.
 

Peak

ED/Prehospital Registered Nurse
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Do you have a of a bit better description of the syncopal event? Did the patient suddenly lose consciousness, did she lose consciousness shortly after racking a bar after heavy squats, slowly become more and more lightheaded throughout her workout, and so on? Did she have any preceding dizziness, tachycardia/palpitations, chest pain, et cetera? Does she take any supplements or is on any specific diet? Does she present risk factors for hypercoaguable state (birth control, chance of pregnancy, smoking, hormonal supplements, long periods of inactivity)? How much fluid has she taken in during the workout, how much today? Does the patient appear clinically hydrated and/or well perfused. How many times has she urinated today, when was her last urination, what color was it? Does the patient present any focal neurological deficits or only a series of vague symptoms? Diet concerning for anemia? Other general history and physical exam?

EMS: 12 lead. BGL. NIHSS, cerebellar assessment. Serial vitals. Access. Replacement fluids if indicated. Transport depending on clinical assessment.

ED add: CBC, CMP, trop, preg, dimer. Consider CXR or CT. Consider tox. Disposition depending on clinical course.
 

DrParasite

The fire extinguisher is not just for show
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E tank

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yeah... try to justify that MDM in court
had to look that up...but it goes to my point. No clinical insight, no clinical assessment, and no real "MDM"...medical decision making? What medical decision making is there in ordering every test and the kitchen sink for a kid like this? When the only difference in the "MDM" in an adolescent female "syncope" on exertion and say an 80 year old with afib and hypertension being a pregnancy test, you got a real "MDM" issue....
 

Peak

ED/Prehospital Registered Nurse
974
563
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had to look that up...but it goes to my point. No clinical insight, no clinical assessment, and no real "MDM"...medical decision making? What medical decision making is there in ordering every test and the kitchen sink for a kid like this? When the only difference in the "MDM" in an adolescent female "syncope" on exertion and say an 80 year old with afib and hypertension being a pregnancy test, you got a real "MDM" issue....
What are your differential diagnosis?
 

PotatoMedic

Has no idea what I'm doing.
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