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Quick Chart
Introduction
  • Transient loss of consciousness (TLOC)  is often fairly brief with an associated loss of postural tone. There is usually a full recovery after a few minutes. It should not be confused with seizures, shock or any other cause of loss of consciousness. Vasovagal syncope is the most common type of syncope and may be caused by standing for prolonged periods, pain, illness, fatigue, fear or emotional distress.
  • Post-exertional TLOC, even in younger persons, is a worrying sign and prompts thorough examination (including 12 Lead ECG wherever possible)

See medical library article: Syncope

Clinical Presentation
  • Dizziness or light-headedness
  • Brief, but sudden loss of consciousness (from a few seconds to one to two minutes)
  • Vertigo
  • Pallor
  • Diaphoresis (sweaty)
  • Anxiety and/or restlessness
  • Nausea
  • Rapid return of consciousness once lying flat
  • Chest or abdominal pain (as the faint may be precipitated by a sudden internal bleed)
  • Palpitations
  • Full recovery after a few minutes
  • Signs of trauma sustained
Exclusion Criteria
Exclusion Criteria
Risk Assessment

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.

Management
Primary Care
Intermediate Care (EMT / Level 2)
  • Apply cardiac monitor if trained and authorised
  • Acquire 12 lead ECG where available
  • Perform stroke assessment
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
Advanced Care (AP)
  • Apply cardiac monitor
    • Manage cardiac dysrhythmia
    • 12 lead ECG should be acquired in most, if not all these patients
  • Perform stroke assessment
  • Consider establishing vascular access
  • Consider obtaining pre-hospital blood sample
  • Consider fluid therapy as per CPG
  • Monitor patient continuously, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
Critical & Extended Care (CCP, PSO)
  • As per Advanced Care (AP) guidelines
Additional Information
  • Some pre-hospital procedures such as injections may precipitate syncope in susceptible patients. Patient position should be considered to avoid potential injury.

References
References
Key Terms & Links
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