EMT STANDING ORDERS

• Routine Patient Care.
• Administer oxygen as appropriate with a target of achieving 94 - 98% saturation.
  • Establish IV access.
• Attempt to determine the cause of syncope.
• Acquire and transmit 12-lead EKG, if available. If acute coronary syndrome is suspected, refer to Acute Coronary Syndrome Protocol - Adult (24 Cardiac).
• Obtain blood glucose analysis; refer to Diabetic Emergencies (Hyperglycemia) Protocol - Adult (7 Medical) or Pediatric (8 Medical), or Hypoglycemia Protocol - Adult (3 Medical) & Pediatric (5 Medical) if indicated.
• Patients with ongoing mental status changes or coma should be treated per the Altered Mental Status Protocol - Adult (16 Medical) or Pediatric (18 Medical).
• Perform stroke screening exam (See Stroke Protocol (56 Medical)).
• Assess for trauma either as the cause of the syncope or as a consequence of the syncopal event. Refer to Spinal Motion Restriction Protocol (14 Trauma), Traumatic Emergencies Protocol (27 Trauma) or Traumatic Brain Injury Protocol (20 Trauma) if indicated.
• Prevent and treat for shock; see Shock Protocol - Adult (56 Medical) or Pediatric (60 Medical).
• Consider ALS intercept.

ADVANCED EMT STANDING ORDERS:

• Establish IV access.
• Consider fluids per Shock Protocol - Adult (56 Medical) or Pediatric (60 Medical).

PARAMEDIC STANDING ORDERS

• Perform cardiac monitoring.
• Observe for and treat dysrhythmias as indicated.

PEARLS:

• Syncope is defined as a loss of consciousness accompanied by a loss of postural tone with spontaneous recovery.
• Consider all syncope to be of cardiac origin until proven otherwise.
• While often thought of as benign, syncope can be the sign of a more serious medical emergency. All patients with syncope deserve emergency department evaluation, even if they appear normal with few complaints on scene.
• Syncope that occurs during exercise often indicates an ominous cardiac cause. Patients should be evaluated at the ED. Syncope that occurs following exercise is almost always vasovagal and benign.
• Prolonged QTc (generally > 500ms), Brugada Syndrome (incomplete RBBB pattern in V1/V2 with ST segment elevation), Delta waves and hypertrophic obstructive cardiomyopathy should be considered in all patients.
• There is no evidence that supports acquiring orthostatic vital signs.
• Syncope can be indicative of many medical emergencies including:
  • Myocardial infarction.
  • Pulmonary embolism.
  • Cardiac arrhythmias.
  • Vasovagal reflexes.
  • Diabetic emergencies.
  • Aortic stenosis.
  • TIA.
  • Poisoning/drug effects.
  • Dehydration.
  • Hypovolemia.
  • Seizures.
  • Ectopic pregnancy.
  • Stroke