What is the appropriate management for a fainting adolescent girl?

Management of a Fainting Adolescent Girl

The immediate priority is to assess responsiveness, breathing, and pulse simultaneously within 10 seconds—if the patient is unresponsive with no pulse or only gasping, begin CPR immediately; if responsive with normal breathing and pulse, position supine with legs elevated and monitor vital signs. 1

Initial Assessment Algorithm

Scene Safety and Responsiveness Check:

• Verify the scene is safe before approaching 1
• Check responsiveness by shouting and tapping the patient 1
• Simultaneously assess breathing and pulse within 10 seconds—look for absent breathing or only gasping while palpating for a pulse 1

If Unresponsive Without Pulse (Cardiac Arrest):

• Activate emergency response system immediately and retrieve AED 1
• Begin chest compressions at 100-120 per minute, at least one-third of the anterior-posterior diameter of the chest 2, 3
• Use 30:2 compression-to-ventilation ratio if alone, or 15:2 if two rescuers are present 2, 3
• Apply AED as soon as available and follow prompts for rhythm analysis 1

If Responsive With Normal Breathing and Pulse (Simple Syncope):

• Position the patient supine (flat on back) 1
• Elevate legs if possible to improve venous return
• Monitor vital signs including heart rate, respiratory rate, and oxygen saturation 4
• Continue monitoring until emergency responders arrive or symptoms fully resolve 2

Management of Vasovagal Syncope

For patients with prodromal symptoms (warning signs before fainting):

• Instruct the patient to perform leg crossing combined with muscle tensing for at least 30 seconds at the onset of warning symptoms 5
• This physical counter-maneuver increases systolic blood pressure from approximately 65 to 106 mm Hg and can prevent or postpone syncope 5
• Prodromal symptoms typically disappear during this maneuver, and loss of consciousness can be avoided 5

Critical Pitfalls to Avoid

Do not delay CPR for detailed history-taking:

• If uncertain about pulse presence after 10 seconds, immediately start CPR 1
• The priority is immediate chest compressions in any patient without a definite pulse 1

Do not perform inadequate compressions:

• Compressions must be hard (at least one-third chest depth) and fast (100-120/min) to be effective 1, 3
• Allow complete chest recoil between compressions—leaning on the chest prevents adequate cardiac refilling 1

Do not assume all fainting is benign:

• Adolescent syncope can be the first presentation of cardiac arrhythmias or structural heart disease
• Any patient with syncope during exertion, family history of sudden death, or prolonged loss of consciousness requires cardiac evaluation

Post-Event Considerations

For patients who recover consciousness:

• Keep supine until fully alert and vital signs are stable 1
• Assess for injuries sustained during the fall, particularly head trauma 6
• Provide counseling about injury prevention and recognizing prodromal symptoms 5

For recurrent syncope:

• Teach physical counter-maneuvers (leg crossing with muscle tensing) for use at onset of warning symptoms 5
• This technique has proven beneficial in daily life for patients with recurrent vasovagal syncope 5