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You are seeing an adolescent who had a syncopal episode at school. It occurred 10 minutes after P.E. class had finished, when she was in the locker room changing out of her gym clothes.
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September 13, 2023 at 8:06 pm
A) Physical exam in the emergency department will be significant only for a relative bradycardia
Vasovagal syncope is by far the most common cause of syncope seen in the pediatric emergency department, especially for adolescents. Cardioinhibitory and vasodepressor mechanisms lead to bradycardia and/or hypotension which spontaneously resolve, and thus would not be present in the PED. Typically, prodromal symptoms are present, such as those listed in answer B as well as sensation of warmth or coldness, sweating, auditory changes, and pallor. Vasovagal syncope can be triggered by pain, fear, prolonged standing, heat, but also by coughing, urinating, defecating, and even brushing one’s hair. ECG is indicated for patients with syncope to rule out more serious causes such as long QT syndrome or Brugada. Counterpressure maneuvers such as described in Answer E to reduce venous pooling may be taught to patients with recurrent syncope, along with instructions to avoid triggers, maintain good hydration, and consider compression stockings if required to stand for long periods of time.