- Witnessed? Determine whether patient experienced tonic-clonic activity while unconscious: Consider Seizure.
- Post-ictal state 20-30 minutes of confusion once regained consciousness: Consider Seizure.
- Tongue biting and/or diffusely sore muscles, generalized weakness: Consider seizure.
San Francisco Syncope Rule:
- Defines high-risk criteria for patients with syncope.
- Telemetry: Assess for arrhythmia. Patient may need to go home with Holter monitor.
- Carotid Doppler US: Look for stenosis of carotid arteries.
- CT of head: Look for intracerebral hemorrhage or mass as etiology of syncope.
- In vs out patient MRI: Further evaluation
- Echocardiogram with Bubble study: Assess cardiac function, look for thrombus within heart, and Bubble study assess for PFO (patent foramen ovale) or other opening between chambers of the heart).
- Neuro checks q4hrs: Monitor patient closely for changes in neurological status.
- IV fluids – possible etiology is dehydration.
- Measure orthostatic vitals qShift to assess for orthostatic hypotension as etiology.
- Fall precautions.
Also consider: UDS (urine drug screen).
Syncope: Nursing perform Neuro checks q4. Fall precautions. IV fluids.
- Orthostatic hypotension: (dehydration vs. medication side effect)
- Consider checking orthostatic vitals measurements. Encourage drinking more fluid and taking more time when going from lying down to sitting up to standing.
- Vasovagal: (causes: emotional stress, prolonged standing, syncope when standing to micturate)
- Avoid standing for long periods of time.
- Hypoglycemic episode
- Eat regular meals and snack throughout the day.
- Rule out Insulinoma: fasting glucose, insulin, c-peptide, and beta-hydroxybutyrate, fasting 3hr GTT (glucose tolerance test)
- EKG – screen for arrhythmia
- Bradycardia: Assess medications (beta-blockers, may need to decrease dose or D/C)
- Echocardiogram, Carotid Doppler US, Telemetry
- Holter monitor: Consider future referral to Cardiology: possible future EP study