Syncope Flashcards
Categories of Syncope
Neurally mediated/Vaso-Vagal syncope,
Orthostatic Syncope,
Cerebrovascular,
Cardiopulmonary
Pathophysiology
Occurs d/t global cerebral hypo-perfusion.
3-5 sec when upright.
15 sec when recumbent.
PE for Syncope Eval
- Vital signs with pulse oximetry
- Orthostatics
- Cardiac exam: murmurs, bruits, displaced apex
- Neuro: exclude focal deficit
- Careful head/skeletal assessment to exclude fall trauma.
Labs/Diagnostics for syncope eval
ECG,
Cardiac monitor,
Urine pregnancy
Initial Intervention
IV access,
Crystalloid IV fluids if warrented by fluid status
Features of Seizures
Onset unrelated to postural changes or activity,
Preceding aura,
Tonic-clonic movements,
Incontinence,
Post-ictal period/syptoms–>confusion, drowsiness, paresis, myalgias,
LOC often >5 min
Pathophysiology of Vaso-vagal syncope
reflex tone causes bradycardia & vasodilation
Triggers/History Clues to vaso-vagal syncope
usually standing or sitting;
Pain, cough, micturation, defecation, pregnancy & situational;
Typically Young
PE of vaso-vagal syncope
pale, diaphoresis, dilated pupils & bradycardia
Disposition for vaso-vagal syncope
Reassurance & DC
Pathophysiology of orthostatic syncope
arterial hypotension in upright position
Triggers/history clues to orthostatic syncope
Rapid change to upright position;
Preceding light-headedness, weakness or vision change;
GI Blood loss, dehydration, or autonomic dysfunction
PE for orthostatic syncope
+symptoms, or HR increase by 30, BP decreased by 20, or SBP <90
Dispoition for orthostatic syncope
DC unless uncorrectable with fluids
Causes of Cerebro-vascular syncope
Migraine,
Carotid sinus syncope,
Subclavian steal syndrome,
Basilar artery insufficiency