Syncope

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Discussed the need for emergency evaluation today. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Syncope
• History consistent with vasovagal syncope, with a typical trigger and warning symptoms before the event
• No syncope during exercise, syncope without warning, fainting with a sudden loud noise or startle, chest pain or palpitations before the event, prolonged unresponsiveness or seizure activity, or family history of sudden cardiac death, unexplained drowning or car crash, SIDS, a pacemaker or defibrillator before age 50, or inherited heart disease
• Cardiac and neurologic exam reassuring
• Further workup deferred after shared decision making given a typical history and reassuring exam
• Counseled on drinking water throughout the day and eating regular meals
• Counseled to sit or lie down with the legs raised at the first warning signs
• Cardiology or neurology referral if episodes recur
• Follow up if episodes recur

Fainting in children and teens is usually caused by a brief drop in blood flow to the brain and is not dangerous. Recommended supportive care with an emphasis on drinking water throughout the day, regular meals, avoiding long periods of standing in the heat, and lying down with the legs raised at the first warning signs. Return precautions given including fainting during exercise, fainting without warning, chest pain or a racing heartbeat, a seizure, an injury from a fall, fainting that keeps happening, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Likely cause: vasovagal, orthostatic, breath-holding, POTS, cardiac concern
Red flags present or absent (exercise, no warning, palpitations or chest pain, seizure activity, family history)
Workup deferred after shared decision making; ECG normal, ordered, abnormal
CBC, ferritin, glucose, pregnancy test
Hydration and meals; lie down at warning signs
Salt, caffeine, tell teachers and coaches
Hold sports until cardiology vs okay
Paragraph per branch (vasovagal, breath-holding, cardiac)

Return precautions in the template

fainting during exercisefainting without warningchest pain or a racing heartbeata seizurean injury from a fallfainting that keeps happening

Sources

Few formal guidelines cover this topic, so the template also leans on expert opinion.