![]() Patients who faint may need specialized follow-up examination, e.g., with a cardiologist, internist, or neurologist. Before the patient is allowed to get up again, vital signs should be checked if they are normal, the patient should be assisted first to a sitting position and then to a standing position before walking independently. A complete blood count, serum electrolytes, blood urea nitrogen, creatinine, and glucose should be checked. An electrocardiogram should be obtained or cardiac monitoring ordered if the patient has a history of cardiac disease, is elderly, or has multiple risk factors for cardiac disease or dysrhythmias. Fluids should be administered by mouth if nausea has resolved, or by vein if the patient cannot take liquids orally and has an intravenous access in place. Blood pressure, pulse, and oxygenation, as well as cardiac rhythm, should be monitored. The carotid arteries should be checked for bruits, and the heart for evidence of arrhythmia or heart murmurs. A brief examination should be performed to make sure the affected person can move all extremities and facial muscles and can speak clearly and understand speech. Placing the patient in a sitting position with the head lowered between the legs or in a horizontal or Trendelenburg position restores blood flow to the brain and promptly aborts the attack. Several convulsive movements of the body may be noted if blood flow to the brain is inadequate but the loss of consciousness is not accompanied by other signs of seizures, e.g., tongue biting, incontinence, or a prolonged postictal period of confusion. During the event, an unusually slow pulse may be present. Witnesses may report profuse sweating or a loss of color in the face. A ringing in the ears may follow, along with inability to maintain an erect posture. The patient, who may have just experienced a stressful or emotionally upsetting event, reports a feeling of wooziness, nausea, and weakness, followed often by a feeling that darkness is closing in on him. A person who refuses hospital evaluation after recovering from a fainting episode should be encouraged to be examined by a physician as soon as possible. If recovery from fainting is not prompt and complete, a prompt assessment of airway, breathing, circulation, and cardiac rhythm is needed assistance should be obtained and the person transported to a hospital. if the collar is tight.įainting (one form of syncope) is usually of short duration and is counteracted by placing the person supine. At the same time, a clear airway should be ensured. Patient careĪny person with sudden loss of consciousness should be placed in a supine position, preferably with the head low to facilitate blood flow to the brain. In most cases, despite thorough evaluation, a precise diagnosis is not determined. Depending on clinical circumstances, further evaluation may include carotid sinus massage, 24-hour ambulatory monitoring, month-long event monitoring, implantable loop monitoring, tilt-table testing, echocardiography, or psychiatric evaluation. Electrocardiographic monitoring after the event may reveal arrhythmias or evidence of ischemia. The examination of the patient may reveal the cause e.g., a loud aortic murmur may point to valvular heart disease, and a pale patient with orthostatic vital signs may be dehydrated or bleeding. The diabetic patient who becomes agitated and sweaty before passing out should be rapidly assessed and treated for low blood sugar. For example, if the patient stood up just before losing consciousness, an orthostatic cause is likely if a patient is confused or disoriented for a long time after losing consciousness, seizures are probable if a young patient passes out while at a wedding or other stressful event, vasovagal syncope is likely. Lacerations, abrasions, or other injuries occasionally result from the fall. The patient typically complains of having suffered a sudden and unexpected fall to the ground, with loss of awareness, and then rapid recovery of orientation. Many medications (such as sedatives, tranquilizers, excessive doses of insulin), food allergies, hypoglycemia, hyperventilation, massive pulmonary embolism, aortic dissection, atrial myxoma, carotid sinus hypersensitivity, coughing, urination, and psychiatric disease can also result in loss of consciousness. arrhythmogenic, valvular, or ischemic), orthostatic (such as due to dehydration or hemorrhage), and neurogenic, e.g., due to seizures. The most frequent causes of syncope are vasovagal (the common fainting spell), cardiogenic (esp. Syncope is a common occurrence, accounting for about 1% to 3% of all hospital admissions in the U.S. ![]() Transient (and usually sudden) loss of consciousness, accompanied by an inability to maintain an upright posture.
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