What is it?
It is a brief loss of consciousness with inability to maintain postural tone. It has more or less abrupt onset and spontaneous resolution. This event is quite frequent: it makes up almost 3% of all ambulance calls and 1% of all hospital admissions.
Which are the symptoms?
- cold extremities
- general weakness
How is it diagnosed?
Tests to be done to identify the cause:
How is it treated?
In the syncopal episode witnessed, the wrists are checked immediately. If the patient is pulseless, cardiopulmonary resuscitation is initiated. If pulses are present, severe bradycardia is treated with atropine or external transthoracic pacing. Isoproterenol can be used to maintain an adequate heart rate while placing a temporary pacemaker.
Placing the patient in a horizontal position with legs elevated typically ends the syncopal episode if life-threatening conditions are excluded. If the patient transitions from lying to sitting too rapidly, syncope may recur; keeping the patient seated or transporting the patient upright may prolong cerebral hypoperfusion and prevent improvement.
Tachyarrhythmias should be treated; a synchronized DC discharge is faster and safer for unstable patients.
Inadequate venous return is treated by placing the patient supine, elevating the legs, and administering EV saline.
Tamponade is relieved by pericardiocentesis. Hypertensive pneumothorax requires cannula insertion and pleural drainage.
Specific treatment depends on the cause and its pathophysiology. Driving and use of machinery should be prohibited until the cause is determined and treated.
Where do we treat it?
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