Signs of Syncope

Have been thinking all week of something good to write for blog….. I have been seeing much the same patients but I did have one experience that is worth sharing. One of my day 1 CABG patients post –operatively had some unexplained bleeding and was readmitted to theatre to look for the cause, nothing was found and he was back on pathway the following day.

He tolerated SOOB the next AM in the ICU well and was T/F to the ward in the arvo with no complaints. When I went to see him in the Pm he looked quite unwell, very pale and sweaty. He insisted that he was fine and wanted to get up for a walk as planned.

After speaking to my supervisor and the nurse it was decided that he needed to get up to be weighed anyway so we would go ahead and “see how he felt”. Usual observations were checked and the telemetry was hooked up, nothing out of the ordinary. SOEOB patient begins to feel nauseated, as this is common after anaesthesia we precede, other obs stable.

On standing things really start to look wrong. The patient begins to shake and is sweating so much my glove is wet, he looks very pale/ grey, but says he is feeling fine but is very quite.

We cancelled the walk and T/F him to the weighing chair. He is up 11kg on his pre-op weight, he has drained 1.5l into his subcoastal drain and his sats were down to 80% on 4l of o2. We get him back to bed and onto the venturi FIo2 o.5%, then speak to the cardiothoracic surgeon regarding the patient’s condition. CXR are then taken with two large pleural effusions evident, pulmonary oedema is added to his current status. Although we have learnt the textbook signs of what to look for in syncope and desating, it was quite a different experience for me to see it first hand. Just something to keep in the back of your mind.