Post-exertional syncope at fun run

Patient Information

Dispatch: You are called to a patient at the finish line of the Perth River Run. A 43YO male (Marcus Webb) has collapsed after crossing the finish line and is now lying on the ground.
Patient: Marcus Webb — 43yr (80kg)
Incident History: Pt crossed the finish line of the 10km fun run and collapsed onto the ground moments later. Bystanders report he was unresponsive for approximately 20–30 seconds before coming around. He is now sitting up but appears pale and sweaty.
Emergency Contact: Sarah Webb (Wife) — 0412 847 193

Initial Rapid Assessment

Response: Alert
Airway: Patent. Nil airway obstructions. Nil swelling or stridor.
Breathing: Adequate. RR elevated post-exertion. Nil audible wheeze or crackles.
Circulation: Pulse rapid but strengthening. Skin pale, cool, and diaphoretic. Nil external bleeding.
Disability: GCS 15 (E4V5M6). Orientated to time, place, and person. Reports brief loss of consciousness at finish line.
Exposure: Nil visible injuries. No rashes. Running attire — no medic alert jewellery noted.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	97% (RA)	Nil	22	108	94/62	2s	15	4 4 ++	37.6	4.8 mmol/L	1
10 mins	98% (RA)	Nil	16	84	112/72	<2s	15	4 4 ++	37.4	4.8 mmol/L	0

History Taking

Treatment Response

Diagnosis

This patient is suffering from vasovagal (post-exertional) syncope — a transient loss of consciousness caused by a sudden drop in blood pressure upon cessation of vigorous exercise, resulting in brief cerebral hypoperfusion.

Facilitator Triggers — if trainees miss a critical step

! (If the trainee does not lay the patient supine within the first 2 minutes, the patient becomes increasingly pale, reports worsening dizziness, and nearly collapses again — prompt: 'Marcus says he feels like he is going to faint again.')
! (If BGL is not checked, the facilitator should prompt: 'Marcus mentions he has been feeling a bit shaky — is there anything else you want to check?')
! (If the trainee does not gather a history of the event including whether Marcus had chest pain or palpitations prior to collapse, prompt: 'What was happening just before you fell, Marcus?' — he should be asked directly; cardiac cause must be excluded)
! (If vital signs are not reassessed after positioning the patient supine and BP remains at 94 systolic without improvement, deteriorate the scenario: pulse increases to 118, patient reports chest tightness — prompt advanced backup consideration)

Treatment Objectives

1 Ensure scene safety and don appropriate PPE on approach.
2 Perform Primary Survey — confirm airway patent, breathing adequate, assess circulation and GCS.
3 Position patient supine immediately to restore cerebral perfusion — do NOT allow patient to remain sitting or standing.
4 Conduct Vital Sign Survey including BP, HR, RR, SpO2, GCS, BGL, and temperature.
5 Perform BGL — confirm 4.8 mmol/L; no hypoglycaemia treatment required.
6 Apply oxygen only if SpO2 falls below 94% — not indicated at 97% on room air.
7 Gather IMISTAMBO history: specifically exclude chest pain, palpitations, and neurological symptoms prior to collapse to rule out cardiac or cerebrovascular cause.
8 Perform Secondary and CNS Survey — assess for any injuries sustained during fall.
9 Reassess vital signs at 10 minutes — expect improvement in BP, HR, and CRT with supine positioning.
10 Maintain continuous reassurance and monitor for recurrence of syncope or any abnormal vital signs.
11 Advise patient not to stand or mobilise until vital signs have normalised and he feels fully recovered.
12 Document time of syncope, duration of loss of consciousness (approximately 20–30 seconds), and all observations.
13 Arrange transport to ED — this is a post-exertional TLOC in an adult with no prior history; transport is indicated for cardiac monitoring and 12-lead ECG.
14 Scenario ends on arrival of ambulance and IMISTAMBO handover.
15 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Transient Loss of Consciousness (Fainting / Syncope) · Primary Survey · Blood Glucose Monitor · Oxygen Delivery · Secondary & CNS Survey

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