Think 'Head, Heart, Vessels' in determining likely cause

• Brain injury or death can occur if the patient is kept upright
• Abnormal vital signs post faint or symptoms such as exertional onset, chest pain, dyspnoea, severe headache or neurological deficits may indicate causes other than syncope
• Fainting whilst lying down is almost always cardiac related
• Confusion lasting >30 seconds may indicate a post-ictal state favouring a seizure rather than a episode of syncope
• Most fainting is a transient drop in blood pressure, not cardiac related. Lying the patient down should be sufficient.
• Fainting by definition is temporary. If patient still unconscious, treat as such.
• Any patient over 40 with no history of prior episodes, faint may be due to an underlying problem and must be transported.

Serious causes of transient loss of consciousness may include:

• Cardiac arrhythmias; may be transient, treat the patient not the rhythm
• Sudden severe blood loss; external or internal
• Postural hypotension (sometimes due to medication)
• Hypoglycaemia, (diabetic or due to low food intake)
• Cerebro-vascular Accidents (C.V.A.) or Transient Ischaemic Attacks (T.I.A.)
  • T.I.A. resembles a C.V.A. (stroke), but is of short duration; even if recovered, always transport to medical care for assessment.

With a simple faint, on assuming the recumbent position, there is a rapid return to normality, that is:

• Full consciousness is restored.
• The pulse becomes normal.
• The BP returns to normal.

If any of these Vital Signs are abnormal immediately after the fainting episode, this is not a simple faint.