3. MEDICAL EMERGENCIES
3.12 SYNCOPE (FAINTING) OF UNKNOWN ETIOLOGY
Syncope is a brief loss of consciousness caused by inadequate perfusion of the brain. If the patient remains unconscious, they should be treated according to the "Altered Mental Status" protocol. Syncope may be caused by any mechanism that results in decreased blood flow to the brain: vasovagal (simple faint, hypovolemia (orthostatic), cerebrovascular disease (TIA/CVA), cardiac dysrhythmia, pulmonary embolism, carotid sinus sensitivity, metabolic causes (intoxication, COPD, suffocation, hypoglycemia), neuropsychologic (seizure, hyperventilation, hysteria), and medications (nitroglycerin, thorazine, quinidine, isosorbide dinitrate, captopril).
ASSESSMENT / TREATMENT PRIORITIES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. Assume spinal injury when appropriate and treat accordingly.
3. Administer high concentration oxygen via non-rebreather mask.
4. Determine patient's hemodynamic stability and symptoms. Continually assess Level of Consciousness, ABCs and Vital Signs.
5. Obtain appropriate history related to event, including Past Medical History, Medications, Drug Allergies, Substance abuse or Trauma. Question all witnesses or bystanders as to the actual event.
TREATMENT
BASIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration of oxygen by non-rebreather mask.
4. In cases of suspected head/neck injury, assure cervical spine stabilization/immobilization.
5. If suspected hypovolemia etiology (i.e. GI bleed, ectopic pregnancy) place patient supine and elevate legs.
6. Activate ALS intercept, if deemed necessary and if available.
7. Initiate transport as soon as possible with or without ALS.
8. Notify receiving hospital.
INTERMEDIATE PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration of oxygen by non-rebreather mask.
4. In cases of suspected head/neck injury, assure cervical spine stabilization/immobilization.
5. If suspected hypovolemia etiology (i.e. GI bleed, ectopic pregnancy) place patient supine and elevate legs.
6. Activate Paramedic intercept, if deemed necessary and if available.
7. ALS STANDING ORDERS
a. Provide advanced airway management (if indicated).
b. Initiate IV Normal Saline/Lactated Ringers while in transport.
8. Contact MEDICAL CONTROL. The following may be ordered:
a. Fluid bolus of Normal Saline or Lactated Ringers
9. Initiate transport as soon as possible with or without paramedic ALS.
10. Notify receiving hospital.
PARAMEDIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration of oxygen by non-rebreather mask.
4. In cases of suspected head/neck injury, assure cervical spine stabilization/immobilization.
5. If suspected hypovolemia etiology (i.e. GI bleed, ectopic pregnancy) place patient supine and elevate legs.
6. ALS STANDING ORDERS
a. Provide advanced airway management, if indicated.
b. Initiate IV Normal Saline. If suspect hypovolemic etiology, titrate IV to patient’s hemodynamic status.
c. Cardiac monitoring: manage dysrhythmias per protocol
d. Determine Blood Glucose level with Dextrose stick and draw red top blood sample.
- If glucose is greater than 100 mg/dL, glucose administration unnecessary.
- If glucose is less than 100 mg/dL: administer Thiamine 100 mg IV Push or IM. Followed with 50% Dextrose (25 gm)* IV Push. A second dose of 50% Dextrose may be necessary.
- * NOTE: If cerebrovascular accident is suspected, contact Medical Control prior to administration.
- If no IV access, administer Glucagon 1 mg-2 mg IM for suspected/known hypoglycemia.
e. If suspected/known narcotic overdose: Narcan 0.4-2.0 mg. IV Push or IM. May repeat as necessary.
7. Initiate transport as soon as possible.
8. Contact MEDICAL CONTROL. The following may be ordered.
a. additional 50% Dextrose IV Push
b. Narcan 0.4-2.0 mg IV Push or IM
c. Further Normal Saline bolus.
d. Calcium Chloride 10% 2-4 mg/Kg IV slowly over 5 minutes for suspected calcium channel blocker toxicity.
e. Sodium Bicarbonate 0.5 - 1.0 mEq/Kg IV Push
f. Atropine 0.5 - 1.0 mg IV Push for bradycardia to total dose of 0.0 4 mg/kg
g. Glucagon 1.0 to 5.0 mg IM, SC, or IV for suspected beta blocker toxicity.
9. Notify receiving hospital.
MoonDragon's EMS Index Page
HELPFUL PRODUCTS & FURTHER EDUCATION
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
-- by Phyllis A. Balch, James F. Balch - 4th Edition
-- by Phyllis A. Balch
This is only a small sample of educational materials and products available through Amazon.com. Use the search box provided below to search for a particular item.
HERBS, OILS, & SUPPLIES
MoonDragon's Health & Wellness: Manufacturers & Distributors
Mountain Rose Aromatherapy Oils
 
Click Here To Visit Herbal Remedies Product Page |
A Source For Medicinal & Ritual Herbs & Supplies  |
MoonDragon's Nutrition Information Index
MoonDragon's Health & Wellness: Nutrition Basics Index
MoonDragon's Health & Wellness: Therapy Index
MoonDragon's Nutrition Therapy Index
MoonDragon's Alternative Health Information Index
MoonDragon's Aromatherapy Information Index
MoonDragon's Health & Wellness Index
MoonDragon's ObGyn Information Index by Subject Order
MoonDragon's ObGyn Information Index by Alphabetical Order
MoonDragon's Main Indexlisting
MoonDragon's Home Page