Fainting & Syncope

Now let's talk about situations when a patient passes out. More specifically it's known as a "syncopal episode" Now when a person passes out, it could be from a number of reasons and many of those reasons do not have to be life threatening. What we're really concerned about when a person goes unconscious is that they're unable to protect themselves from the fall. And if they can't protect themselves from the fall there's any number of things that can go wrong. They can hit their head, they can hit their face, and they can even break bones.

So when we come up to a person that has had a syn-cable episode or has passed out, we still want to asses them for life threatening conditions. We want to check them for the potential of having a concussion or neck injury. Once we've ruled out those different possible side effects, we can begin to just see if the patient maybe just has a self-limited issue going on. They need to re-hydrate, maybe they need to eat something, and they don't need to necessarily go into the hospital. So, when I come across somebody who's had a syn-cable episode, and they're awake already, like in the case of this patient, she's beginning to respond, she doesn't necessarily feel all that well, but she's clearly gotten up to a sitting position on her own.

Now, we can kind of interview the patient and see what's going on. Hi ma'am, my name is Roy, I'm trained and I can help you. What's going on today? she then responds back to me: "I Didn't feel well while sitting at the desk and I started getting light-headed. So I wanted to get a sip of water, but as soon as I stood up, everything went black. And that's the last thing I remember and I woke up on the floor." So there was no one in here to be able to watch her, so we have no idea if she hit her head or her face, and it's up to us to become a little bit more detective to find out if there's any potential injuries that need to be treated. So, I want to ask her, did you have any headache or how are you feeling? Do you hurt anywhere? She then shakes her head "No." She says, "I'm feeling okay, other than just feeling weak and dizzy." And so, we then know immediately she's awake, she's responsive, she has a good airway, she's breathing, and she has a pulse.

We're going to look at her skin, see if it's pink or pale, if it's dry, or clammy or sweaty, and that could be a sign that she's still dealing with some of the shocks symptoms, and maybe enough for us to say "You know, under circulation, this might be a bit of a compromise, and she's not feeling all the way well." Now is the time where I'm probably going to decide the air on the side of caution and activate EMS. Send a by-stander, "You in the plaid shirt, go call 911, and come back if you can find an AED, bring it with you." Now why did I say "AED?" Well, we have no idea what really caused her sync-able episode in the first place.

Though, it could be something simple as dehydration or little sugar dip. We also might be dealing with a dysrhythmia of the heart, and we don't want to take that for granted.

And so having an automated external defibrillator available, in case she has another event, or goes fully unresponsive is always a good idea. If she begins to recover, she doesn't have any pain, the concussion doesn't seem to me prevalent, or she seems that she's answering questions all fine, we can kind of work with the patient and allow them to begin to recover at will.

At their own power. But if at any time we know notice that they are decrease level of consciousness, have airway breathing or circulation problems, signs of shock, a long bone fracture, or they might becoming in and out of responsiveness, that's immediately going to be an emergency call. Activate EMS, call a code, or call 911. And now we're going to treat her symptoms accordingly..

Learn here causes of syncope by Dr. Boon Lim