Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Risk Factors for Death within 30 Days of "Passing Out"

“Syncope” is medical jargon for “passing out” – becoming unconscious for a period of time, then waking up.  This certainly happens to people from time to time when they are outdoors, and is always disconcerting. Sometimes the cause is easily determined, such as when a person with diabetes suffers from an episode of low blood sugar (hypoglycemia). Other times, it takes a detective to determine the cause. Was it a seizure? Is there a medication side effect or overdose? Has someone suffered an abnormal heart rhythm or stroke? Is dehydration the culprit? Fear or anxiety? There are many, many possible causes.

Syncope hasn’t been studied from an epidemiological perspective in the outdoors, so we are obliged to extrapolate trends and approaches to treatment from what we have learned in urban settings. A frequent question related to any medical condition in the outdoors is what to do with regard to continuing the adventure, versus staying put or turning back. Another aspect is when to call for assistance. 

In an article entitled “Patterns and Preexisting Risk Factors of 30-Day Mortality After a Primary Discharge Diagnosis of Syncope or Near Syncope” (Academic Emergency Medicine, 2012;19:488-496), Stephen Derose, MD and colleagues looked retrospectively in an urban setting at adults who were discharged from the emergency department (ED) with a discharge diagnosis of syncope or near-syncope (nearly “passing out”).  The specific outcome with which they were concerned was the incidence of death (mortality) within 30 days of discharge. From this, they attempted to determine patterns and preexisting risk factors.

They identified 23,951 ED visits, which resulted in 307 deaths within 30 days. Preexisting conditions that were associated with increased mortality included heart failure, seizure, and dementia. Being age 60 years or older didn’t appear to be an increased risk of death until after the patients were followed for 3 months or more.

What to make of this? My take-away is that if I am on a trip and someone passes out or nearly passes out, and they have suffered a seizure or suffer from heart failure, they are in a slightly higher risk (for death within 30 days) than others, so I will have a lower threshold for having them guided or evacuated back to civilization for a thorough evaluation. If someone is age 60 years or older, they deserve a particularly watchful eye, and perhaps an elevated degree of caution.  Every patient is evaluated, treated, and receives aftercare on an individualized basis, but its helpful to know special “watch out” situations.

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.