Recognising Syncope and Near-Syncope for Student Nurses
Learn how to recognise fainting and near-fainting, establish what happened before and after an episode and identify clinical features that require urgent assessment and escalation.
Syncope, near-syncope and collapse
Patients may describe a range of symptoms from feeling faint to completely losing consciousness. Establish exactly what occurred rather than relying on the word “collapse”.
Temporary loss of consciousness
The patient loses consciousness briefly and then recovers spontaneously.
Feels about to faint
The patient may become light-headed, weak, sweaty or visually dimmed without completely losing consciousness.
A description, not a diagnosis
“Collapse” may describe syncope, seizure, a fall or another acute event and needs further clarification.
What happened immediately beforehand?
Standing, sitting or lying?
Establish the patient's position and whether they had recently stood up.
Any warning?
Ask about light-headedness, nausea, sweating, visual dimming, weakness or feeling hot.
Chest pain or palpitations?
Cardiovascular symptoms associated with syncope are important to identify and report.
What was the patient doing?
Syncope during physical exertion or without an obvious trigger requires careful clinical assessment.
Any dehydration or poor intake?
Fluid loss, vomiting, diarrhoea or reduced intake may contribute to circulatory problems.
Consider the medication picture
Medicines affecting blood pressure, heart rate or hydration may be clinically relevant.
Build a clear description of the episode
Loss of consciousness
Establish whether consciousness was actually lost and, if known, approximately how long this lasted.
Fall or injury
Identify whether the patient struck their head or sustained another injury during the episode.
Observed movement
Ask witnesses whether any abnormal movements were seen, but avoid assuming movements automatically confirm a seizure.
Appearance
Witnesses may report pallor, sweating or another obvious change in appearance.
Recovery provides important information
Did consciousness return promptly?
Establish whether the patient quickly returned to their previous level of alertness.
Are they confused afterwards?
Persistent or new confusion after a collapse requires further assessment.
Any new focal signs?
Look for changes in speech, facial movement, limb strength, sensation or coordination.
Any ongoing pain or palpitations?
Persistent cardiovascular symptoms need prompt assessment.
Has respiratory status changed?
Assess respiratory rate, oxygen saturation and work of breathing.
Check for harm from the fall
Head injury or other trauma may become an additional clinical priority.
A clear timeline often gives the clinical team far more useful information than simply reporting that the patient “fainted”.
Assess the patient using ABCDE
Airway
If the patient remains unresponsive, immediately assess airway patency and use the appropriate emergency response.
Breathing
Assess respiratory rate, oxygen saturation, breathing pattern and work of breathing.
Circulation
Assess pulse, blood pressure and perfusion. Consider postural assessment only when clinically appropriate and safe according to local practice.
Disability
Assess consciousness, relevant neurological findings and blood glucose when clinically appropriate.
Exposure
Look for injury, bleeding, signs of illness and other clinical clues while maintaining dignity.
Escalate
Report significant abnormalities, persistent symptoms or an unexplained episode promptly.
Many conditions can cause collapse
Student nurses do not need to diagnose the precise cause. The priority is recognising the event, identifying concerning features and communicating the clinical picture accurately.
Blood pressure may fall
Reduced circulating volume, postural changes and other circulatory factors may contribute to fainting.
Heart rhythm may matter
Some arrhythmias and other cardiac conditions can present with syncope.
Situational triggers can occur
Some episodes occur after pain, emotional stress or other triggers, but concerning features still require assessment.
Check the wider physiology
Glucose abnormalities and other physiological problems may cause altered consciousness or collapse.
Not every collapse is syncope
Seizures and other neurological conditions can cause transient loss of responsiveness.
Consider recent changes
Medication effects can contribute to hypotension, rhythm changes or reduced alertness.
When collapse requires urgent escalation
- The patient does not rapidly regain normal consciousness.
- Airway or breathing is compromised.
- Syncope occurs with chest pain, significant breathlessness or persistent palpitations.
- The episode occurs during exertion.
- There is significant hypotension, an abnormal pulse or other physiological deterioration.
- New focal neurological abnormalities are present.
- There is persistent confusion or reduced consciousness afterwards.
- The patient sustains a significant head injury or other trauma.
- Repeated unexplained episodes occur.
- The patient appears seriously unwell before or after the episode.
Avoid making the diagnosis from one feature
Distinguishing syncope from seizure can sometimes be difficult. A detailed witness account and the patient's recovery are important.
What was actually observed?
Record the duration of unresponsiveness, movements, appearance and sequence of events as accurately as possible.
How quickly did the patient return to baseline?
Persistent altered consciousness or confusion should be clearly reported.
Consider the whole episode
Symptoms before the collapse, injuries, neurological findings and physiological observations all contribute to assessment.
Protect the patient after an episode
Do not rush mobilisation
A patient may remain light-headed or unstable immediately after an episode.
Repeat observations
Continue monitoring according to the patient's condition and local clinical procedures.
Consider ongoing risk
Ensure the patient has appropriate support if another episode could create a risk of injury.
A patient briefly loses consciousness
Example
A patient stands beside the bed and suddenly says they feel light-headed. They become pale and briefly lose consciousness while staff support them safely.
They recover quickly, but you identify that their blood pressure is low and their pulse is faster than earlier in the shift.
You recognise the pattern: brief loss of consciousness + circulatory symptoms + abnormal observations.
You assess the patient using ABCDE, prevent immediate mobilisation, repeat appropriate observations and escalate the episode and physiological change.
Report what happened before, during and after
Example escalation
“I'm concerned about Mr Evans. He stood beside the bed, reported sudden light-headedness and became pale before losing consciousness briefly. He recovered quickly but his blood pressure is lower than earlier and his pulse is now faster. He has not been mobilised again.”
This communicates the trigger, warning symptoms, observed event, recovery and associated physiological changes.
Syncope assessment errors to avoid
- Calling every collapse a simple faint.
- Failing to establish whether consciousness was actually lost.
- Ignoring symptoms immediately before the episode.
- Missing chest pain, palpitations or exertional symptoms.
- Ignoring injury caused by the fall.
- Assuming abnormal movements automatically mean seizure.
- Mobilising the patient again before assessing their stability.
- Failing to compare current observations with baseline.
- Delaying escalation because the patient appears to have recovered.
Protect → assess → reconstruct → escalate
Make the patient safe
Prevent injury, assess responsiveness and avoid unnecessary mobilisation after the episode.
Use ABCDE and build the timeline
Assess physiology and establish what happened before, during and after the event.
Report concerning features
Clearly communicate loss of consciousness, associated symptoms, recovery and abnormal observations.
A collapse is an event to investigate, not a diagnosis
Build confidence by protecting the patient, assessing their current condition and reconstructing exactly what happened before, during and after any episode of transient loss of consciousness.
Explore Clinical Confidence →