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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 syncopal episode or has passed out, we still want to assess 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 syncopal 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 bystander, "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 syncopal episode in the first place. Though, it could be something simple as dehydration or a 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 decreased level of consciousness, have airway breathing or circulation problems, signs of shock, a long bone fracture, or they might be coming 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.
This lesson focuses on what to do when you come upon a patient who has just fainted.
Fainting is defined as a temporary loss of consciousness that's usually related to temporary insufficient blood flow to the brain. Fainting is also referred to as syncope, blacking out, or passing out.
There are a number of reasons why a person would pass out and many of those are not at all life-threatening. In fact, when someone faints, the biggest concern is usually the victim's inability to protect themselves as they're falling, which can lead to a number of things going wrong – broken bones, head or face injuries, etc.
In many fainting situations, there is no one around who witnessed the accident. Which means you may need to put on your detective hat to properly discover potential injuries.
How to Assess and Treat a Patient who Faints
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim.
"Hi, my name's _____. I'm a paramedic. I'm going to help you."
Pro Tip #1: The first thing you'll want to do is to assess for life-threatening conditions, including head and neck injuries. After ruling out more serious conditions, begin to see if the patient has a simple problem, like low blood sugar or dehydration that contributed to his or her passing out.
When you come upon a fainting victim, as long as there is nothing more serious going on, they will likely be awake and responsive. They may be sitting up already or are ready to sit up with your help. At this point you'll want to interview the patient to see what's going on.
"Can you tell me what happened here today?"
"Do you hurt anywhere?"
It's common for fainting victims to be weak and dizzy afterward. The important thing is that the patient is awake and responsive enough to answer your questions. However, continue to monitor for:
- Airway issues
- Breathing problems
- Weak or rapid pulse
- Pale, clammy skin
Pale and clammy skin are signs of shock. If you determine the patient to be in shock, that warrants an immediate 911 call and activation of EMS. As always, err on the side of patient welfare.
Pro Tip #2: Just because the situation doesn't appear serious doesn't mean it can't suddenly become serious. If you don't have an AED already, it's a good idea to send someone at the scene to go find one. If, for instance, the fainting was caused by a serious heart dysrhythmia, an AED could be lifesaving.
It's typical for fainting victims to begin to recover under their own powers. As they are coming around, gauge their mental alertness, ask again about the presence of pain, and of course, continue to assess for signs of something more serious:
- Decreased level of consciousness
- Airway, breathing, or circulation problems
- Signs of shock
- Long-bone fractures
- Varying degrees of responsiveness
If you, at any point, notice any of the above, call 911 and activate EMS or call in a code if you're in a healthcare setting. Then treat the patient accordingly.
A Word About Syncope and Presyncope
Syncope, or fainting, is caused due to a temporary reduction in blood flow to the brain. Depriving the brain of its normal blood flow can cause it to momentarily shut down. When this happens, it triggers a fainting episode or syncope.
But what specifically triggers fainting? There are a number of things that trigger it, including:
- Emotional shock
- Pain
- Certain medical conditions
- Overexertion
- In pregnant women and older people – getting up from a seated or lying position
Syncope can occur without warning. Or there could be some early signs, such as dizziness, the feeling of being lightheaded, or feeling like your about to faint. Together, these symptoms have a name – presyncope.
How to Prevent Someone in Presyncope from Fainting
- Help the patient lay down.
- Continue to monitor the patient's breathing and level of consciousness.
- Instruct and help the patient perform physical counter-pressure maneuvers (PCM).
Three Examples of Physical Counter-Pressure Maneuvers
- Have the patient grip one hand at the fingers with the other and try to pull them apart without letting go. They should hold the grip for as long as they can or until their symptoms disappear.
- Have the patient hold a rubber ball or similar object in their dominant hand and then squeeze the object for as long as they can or until their symptoms disappear.
- Have the patient cross one leg over the other and squeeze them together tightly. Have them hold this position for as long as they can or until their symptoms disappear.
Physical counter-pressure maneuvers help raise the patient's blood pressure through skeletal muscle contraction and, in many cases, will resolve symptoms of faintness.
Let the patient know to avoid holding their breath while performing the maneuvers. An easy way to avoid this is to engage the patient and keep him or her talking.