Syncope
Ingestion of foreign body
DEFINITION Syncope is defined as a form of transient loss of consciousness with or without prodromes, sudden, spontaneous, of short duration, with spontaneous and complete recovery of consciousness
Syncope
2
Ingestion of foreign body
In some subjects it may be preceded by prodromes with non-specific symptoms such as scotomas, nausea, sweating, muscle weakness, blurred vision
Syncope
3
Ingestion of foreign body
Syncope can be due to:
Syncope
•
Cardiac causes: sometimes life-threatening such as valve disease, aortic dissection, pericardial disease, pulmonary embolism, congenital and acquired coronary anomalies, arrhythmias
•
Extracardiac causes: most of the episodes in the pediatric population are due to a usually benign vasovagal reaction
4
Triage methodology
Assessment on the door: • • • • •
Syncope
ABCD Global appearance of the pt Ambulation AVPU Signs and symptoms (drowsiness, irritability, stupor, meningismus signs, hypotonia, fever, headache, vomiting, diarrhea, pallor, distress, profuse sweating, dehydration, amnesia)
5
Triage methodology Data collection: • • • • • • •
Loss of consciousness Presence of prodromal symptoms Duration and modality Secondary traumas Convulsions Any previous episodes of loss of consciousness Concomitant factors (pain, fright, emotional stress…) • Basic pathologies (heart disease, arrhythmias, epilepsy, diabetes, coagulation disorders, recent head trauma) • Recent plaster shower on the lower limbs, surgery • Drugs, substances of abuse
Syncope
6
Triage methodology
Vital signs collection: • • • • • • •
Syncope
Blood pressure Heart rate Breath frequency Oxygen saturation Body temperature Capillary refill Cute complexion
7
Triage decision: assignment of numerical code
The URGENCY is mainly dictated by the presence of critical vital parameters and the triggering causes.
Syncope
8
PEDIATRIC TRIAGE OF SYNCOPE TRIAGE CODE
3
4
5
from code 2
from code 3
from code 4
from code 5
Characteristics of the main symptom/sign
New onset dysrhythmias. Irregular pulse. Suspected or confirmed intoxication. Absence of prodromal symptoms. Appearance during effort.
Presence of prodromal symptoms. By sudden change of position. Hyperventilation.
Symptoms resolved < 24 hours
Symptoms resolved by > 24 hours
Associated symptoms/signs
Chest pain. Abdominal pain. Current neurological symptoms. AVPU: A FLACC/VAS: 4-7
AVPU: A FLACC/VAS: 3-1
Vital parameters
Score assessment TRIAGE PROCEDURES Counseling activation
Pain therapy Revaluation
Syncope
1 from code 1
AVPU: P/U
2
AVPU: A/V FLACC/VAS: 8-10 1
2
3
4
5
Exceeded the 60 minute wait. According to local protocol (cardiologist, neurologist) According to local protocol Direct observation or mediated video with constant monitoring of clinical conditions.
Repetition of part or all of the assessment phases on the decision of the triagist, at the request of the patient, once the maximum recommended waiting time has elapsed. 9
9
Clinical cases
Syncope
10
Clinical case 1
•
16 year old girl
•
Past pathological history: previous hospitalizations for several suicide attempts. Girl followed at the territory Proximate pathological history: ingestion of substances of abuse. Syncope preceded by malaise, chest pain, when sitting Physical examination: discrete general conditions, VAS>4, AVPU: V Vital parameters: P.A. 96/48, FC 122, FR 26, SpO2 97% in ambient air
• • •
Syncope
11
Clinical case 1 PEDIATRIC TRIAGE OF SYNCOPE TRIAGE CODE
3
4
5
from code 2
from code 3
from code 4
from code 5
Characteristics of the main symptom/sign
New onset dysrhythmias. Irregular pulse. Suspected or confirmed intoxication. Absence of prodromal symptoms. Appearance during effort
Presence of prodromal symptoms. By sudden change of position. Hyperventilation.
Symptoms resolved < 24 hours
Symptoms resolved by < 24 hours
Associated symptoms/signs
Chest pain. Abdominal pain. Current neurological symptoms. AVPU: A FLACC/VAS: 4-7
AVPU: A FLACC/VAS: 3-1
Vital parameters
Score assessment TRIAGE PROCEDURES Counseling activation
Pain therapy Revaluation Syncope
1 from code 1
AVPU: P/U
2
AVPU: A/V FLACC/VAS: 8-10 1
2
3
4
5
Exceeded the 60 minute wait. According to local protocol (cardiologist, neurologist) According to local protocol Direct observation or mediated video with constant monitoring of clinical conditions.
Repetition of part or all of the assessment phases on the decision of the triagist, at the request of the patient, once the maximum recommended waiting time has elapsed.
12
12
Clinical case 1
Attribution code Given the presence of chest pain, with VAS > 4, AVPU: V and the safety of a drug abuse, a code 2 will be assigned
Syncope
13
Clinical case 2
•
6 year old girl
•
Past pathological history: no previous hospitalizations, no medications, denies allergies Proximate pathological history: reported loss of consciousness of a few seconds preceded by nausea, dizziness and blurred vision Physical examination: good general condition, alert and responsive Vital parameters: P.A. 112/63, FC 101, FR 22, AVPU: A, VAS 4, SpO2 99% in ambient air
• • •
Syncope
14
Clinical case 2 PEDIATRIC TRIAGE OF SYNCOPE TRIAGE CODE
3
4
5
from code 2
from code 3
from code 4
from code 5
Characteristics of the main symptom/sign
New onset dysrhythmias. Irregular pulse. Suspected or confirmed intoxication. Absence of prodromal symptoms. Appearance during effort.
Presence of Symptoms resolved < prodromal symptoms. 24 hours By sudden change of position. Hyperventilation.
Associated symptoms/signs
Chest pain. Abdominal pain. Current neurological symptoms.
Vital parameters
Score assessment TRIAGE PROCEDURES Counseling activation
Pain therapy Revaluation Syncope
1 from code 1
AVPU: P/U
2
AVPU: A/V FLACC/VAS: 8-10 1
2
AVPU: A FLACC/VAS: 4-7 3
Symptoms resolved by < 24 hours
AVPU: A FLACC/VAS: 3-1 4
5
Exceeded the 60 minute wait. According to local protocol (cardiologist, neurologist) According to local protocol Direct observation or mediated video with constant monitoring of clinical conditions.
Repetition of part or all of the assessment phases on the decision of the triagist, at the request of the patient, once the maximum recommended waiting time has elapsed. 15
15
Clinical case 2
Attribution code Given the presence of prodromal symptoms, a child alert and responsive, with AVPU assessment: A, a code 3 will be assigned
Syncope
16