1. what are the causes of syncope and how can you remember them?
    • HEAD-represents central nervous system
    • HEART-cardiac pumping dysfunction
    • VESSELS-loss of vascular tone
  2. what does H.E.A.D. stand for?
    HEAD- loc d/t CNS dysfunction

    • H. Hypoxia, Hypoglycemia
    • E. Epilepsy
    • A. Anxiety, psych
    • D. Dysfunction of brain stem
  3. what does H.E.A.R.T. stand for?
    syncope d/t cardiac pumping dysfunction

    • H. heart attack
    • E. embolism of pulmonary artery
    • A. aortic obstruction
    • R. rhythm disturbance
    • T. tachydysrhythmia
  4. What does V.E.S.S.E.L.S stand for?
    syncope d/t loss of vascular tone

    • V. vasovagal
    • E. exsanguanation (ectopis, ruptured aa, GI bleed
    • S. situational
    • S. subclavian steal
    • E. ENT reasons, glossopharangeal neuralgia
    • L. low systemic vascular resistance
    • S. sensitive carotid sinus
  5. name some life threatening causes of syncope
  6. do strokes cause syncope?
    strokes from carotid artery disease rarely do...there is no rapid return to consiousness and there is usually focal neurologic deficits

    vertebrobasilar insufficiency may cause syncope with signs of brain stem dysfunction...ataxia, diplopia and vertigo
  7. what are the initial concerns for treaing a patient with syncope? 3
    • 1. ABCs
    • 2. start IV, monitor, and o2, glucose
    • 3. treat any injuries d/t fall
  8. what components to syncope hx are most important?
    what was patient doing prior to event/position

    was there any prodrome

    witnesses, abnormal movements

    clues to hypovolemia, bleeding, thirst, vomiting diarrhea, heavy vag bleeding

    family hx of sudden death eg long qt syndrome

    duration of event,prior episodes

    medications/drug use/last meal

    associated sxs-face pain,cp,palp, ha,cough,nausea, dizzy,weakness, diaphoresis

    pmh- cad,valve disease, cerebrovasc dz,
  9. how can i tell the difference between syncope and seizure
    ***slow recovery from seizure..post ictal somnolent and confused


    lateral tongue biting
  10. important things to check on physical exam?
    recal exam in elderly
  11. tests needed for syncope work up
    vs including orthostatic vs



    occasionally head ct, spiral t of chest, echocardiogram, carotid us, cbc
  12. low risk patients with syncope
    <30 years old with no history of syncope and no evid of cardiogenic syncope

    <70 years old with clear vasovagaaal syncope
  13. intermediate risk patients with syncope
  14. high risk paitients with syncope
    must be admitted
    frequent episodes that occur with little reason

    syncope that occurs when pt is recumbent

    syncope w assoc card sxs-e.g. cp, pap,dyspnea

    abnormal ecg

    elderly w unexplained etiology
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