Syncope

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:

-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. Extras: CXR, ECG, 24h Holter monitor, electrophysiologic study, tilt test, CT/MRI, EEG, echocardiogram.

11. Labs: CBC, SMA 7&12, CK-MB, troponin T, Mg, calcium, drug levels. UA, urine drug screen.

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