ALS-1 Syncope — Unresponsive, IV Access + Cardiac Monitor + 12-Lead

Maria Garcia · Female · DOB 1952-04-09

Synthetic Demo

Clinical Narrative

Unit was dispatched emergent to a 74-year-old female found unresponsive in the driveway by a neighbor. On arrival, patient was supine, minimally responsive with GCS of 9 (E2V3M4). Bystanders reported witnessing patient lose consciousness and fall in the driveway approximately 5 minutes prior to EMS arrival. IV access was established in the right antecubital fossa with an 18-gauge catheter and patent IV confirmed with normal saline flush. Cardiac monitoring was initiated immediately revealing sinus bradycardia at 52 bpm. A 12-lead ECG was performed and transmitted to the receiving facility. Patient blood pressure was 88/54 on initial assessment. During transport patient regained consciousness with GCS improving to 14 and blood pressure improving to 102/66. Patient transported emergently to Riverside Medical Center with report called ahead.

Vitals

Initial

BP: 88/54
HR: 52
RR: 16
SpO₂: 96%
GCS: 9

Final

BP: 102/66
HR: 68
RR: 16
SpO₂: 98%
GCS: 14

Procedures

IV access established (18g right antecubital)
Cardiac monitoring — sinus bradycardia identified
12-lead ECG performed and transmitted
Vital signs monitoring

Medications

Normal Saline — 250 mL bolus IV

Crew & Logistics

Crew: 2 personnel, Paramedic
Loaded miles: 5.2
Origin → Dest: R → H
Disposition: transported

Level of Service

ALS-1A0427

›IV access: true | IV med: false | Cardiac monitor: true | 12-lead: true

›ALS-1 criteria met

›Emergency: true → A0427

Inference: 21,170ms · Model: claude-sonnet-4-5

ICD-10 Diagnoses

R55

Syncope and collapse

Primary

95% conf

The witnessed loss of consciousness with fall is the primary presenting problem that prompted the EMS call. This meets criteria for syncope and collapse, which drove all clinical decision-making including IV access, cardiac monitoring, and emergent transport.

R00.1

Bradycardia, unspecified

95% conf

Sinus bradycardia was explicitly documented on cardiac monitoring and is a significant finding that affected clinical assessment and treatment decisions.

W18.30XA

Fall on same level, unspecified, initial encounter

90% conf

A witnessed fall in the driveway is explicitly documented. This is an external cause code appropriate for the mechanism of injury during the syncopal episode.

R41.3

Other amnesia / altered mental status

90% conf

The patient presented with altered mental status documented by GCS of 9, which improved during transport. This affected care decisions and monitoring.

CPT / HCPCS Codes

A0427

ALS-1 emergency transport

90% conf1 transport

IV access: true | IV med: false | Cardiac monitor: true | 12-lead: true → ALS-1 criteria met → Emergency: true → A0427

A0425

Ground mileage per statute mile

100% conf5.2 miles

Loaded miles: 5.2

Modifiers

RH

Residence to Hospital

Modifier