1. Admit to: Monitored ward
2. Diagnosis: Syncope
3. Condition:
4. Vital Signs: q1h, postural BP and pulse q12h. Call
physician if BP >160/90, <90/60; P >120, <50; R>25,<10
5. Activity: Bed rest.
6. Nursing: Fingerstick glucose.
7. Diet: Regular
8. IV Fluids: Normal saline at TKO.
9. Special medications:
High-grade AV Block with Syncope:
-Atropine 1 mg IV x 2.
-Isoproterenol 0.5-1 mcg/min initially, then slowly titrate
to 10 mcg/min IV infusion (1 mg in 250 mL NS).
-Transthoracic pacing.
Drug-induced Syncope:
-Discontinue vasodilators, centrally acting hypotensive
agents, tranquilizers, antidepressants, and alcohol use.
Vasovagal Syncope:
-Scopolamine 1.5 mg transdermal patch q3 days.
Postural Syncope:
-Midodrine (ProAmatine) 2.5 mg PO tid, then increase
to 5-10 mg PO tid [2.5, 5 mg]; contraindicated in coronary artery disease.
-Fludrocortisone 0.1-1.0 mg PO qd.
10. Symptomatic Medications:
-Acetaminophen (Tylenol) 325-650 mg PO q4-6h prn headache.
-Docusate sodium (Colace) 100-200 mg PO qhs.
11. Extras: CXR, ECG, 24h Holter monitor,
electrophysiologic study, tilt test, CT/MRI, EEG, impedance
cardiography, echocardiogram.
12. Labs: CBC, SMA 7&12, CK-MB, troponin T, Mg,
calcium, drug levels. UA, urine drug screen.
