Bonner County EMS System Patient Care Treatment Guidelines-Medical Emergencies & OB/GYNNeurologic Emergencies: Syncope -7002

SYNCOPEPrehospital Management of Syncope

SUBJECTIVE Cardiac history, stroke, seizure Occult blood loss (GI, ectopic) Females: LMP, vaginal bleeding Fluid loss: nausea, vomiting,

diarrhea Past medical history Medications

OBJECTIVE Loss of consciousness with recovery Light headedness, dizziness Palpitations, slow or rapid pulse Pulse irregularity Decreased blood pressure

ASSESSMENT Vasovagal Orthostatic hypotension Cardiac syncope Micturation / Defecation

syncope Psychiatric Stroke Hypoglycemia Seizure Shock (see Shock Protocol) Toxicologic (Alcohol) Medication effect

(hypotension)

TREATMENT GUIDELINESR-EMR E – EMT A-AEMT P-PARAMEDIC **M-Medical Control

*****Higher level of providers are responsible for lower level treatments***

Initial Patient Contact (2000). Administer Oxygen 10-15 L via non rebreather mask (9000). Consider Spinal Immobilization (9062). Perform Stroke Scale (A5).

R Assist ALS with Cardiac Monitor and 12-lead EKG if indicated. Transport to receiving facility, with ALS intercept if ALS not already on-scene. E Blood Glucose Analysis (9040); for glucose <60 and awake with patent airway,

administer 1 tube Oral Glucose PO/SL.2

For glucose <60 and no IV access, administer 1 unit (1 mg) Glucagon IM.2

Establish IV with NS, draw labs; do not delay transport for IV access.2

Reevaluate blood glucose and treat if glucose remains <60 (7035) and patent IV, administer 12.5-25 gm of D50 (50% Dextrose) IV.

Consider Naloxone for decreased respirations and glucose >60. Consider measuring orthostatic vital signs. Administer 10-20 cc/kg bolus of NS IV for Hypotension (5003) or orthostasis.2

A

ALS required for continued ALOC, Glucose >250, Stroke, MI or Arrhythmia.

Consider other causes of syncope if patient not responding to above measures. 12-lead EKG; transmit when possible to Medical control if abnormal. Consider alternate causes of syncope including Arrhythmia (5020-5024),

Hypoglycemia (7035), Hypotension (5003), Seizure (7020) or Myocardial Infarction (5000).

P ** Call Medical Control for syncope associated with Stroke or STEMI**. M2EMT and providers may perform these procedures if credentialed with the appropriate OM.Pearls:

_______________________________________________________________________________________________________________________________________BCEMS Medical DirectorEffective: 04/01/14 final 5/8/2023 page 1 of 2

Bonner County EMS System Patient Care Treatment Guidelines-Medical Emergencies & OB/GYNNeurologic Emergencies: Syncope -7002

Assess for signs and symptoms of trauma if possible fall with Syncope. Geriatric Syncope is often associated with Cardiac Arrhythmia.

_______________________________________________________________________________________________________________________________________BCEMS Medical DirectorEffective: 04/01/14 final 5/8/2023 page 2 of 2