What is the initial treatment step for a patient presenting with syncope?

• A. Administer aspirin therapy
• B. Full ALS assessment and treatment, including a 12-lead ECG.
• C. Obtain only vital signs
• D. Observe and recheck later

Answer: (B)

Syncope can mask serious heart problems, such as dangerous arrhythmias or ischemia, so the first step is a comprehensive assessment and treatment under Advanced Life Support principles. This means a full primary survey plus continuous monitoring, establishing IV access, and immediately obtaining a 12-lead ECG. The ECG is essential because it can reveal rhythm disturbances, conduction blocks, or ischemic changes that require urgent actions, guiding next steps in management. Relying only on vital signs or delaying evaluation can miss life-threatening conditions. Aspirin is not automatically given as the initial step in syncope unless there is confirmed or highly suspected acute coronary syndrome; without ECG findings to justify it, it isn’t the appropriate first move.