Posted by Andy Jagoda MD in: Brain Tease , trackback
Syncope is the transient loss of consciousness and postural tone, with spontaneous recovery. It accounts for approximately 1% of all emergency department visits and $5.6 billion in healthcare costs annually.
In a very small subset of patients, syncope may be a warning sign for serious outcomes or death, but identifying these patients is challenging, as the emergency clinician must distinguish between life-threatening causes and the more common, benign etiologies. Low-yield and expensive testing is often performed, even for benign presentations. Much research on syncope is observational, and clinical decision rules frequently perform poorly in validation studies.
Our recent issue Emergency Department Management of Syncope reviews the clinical and diagnostic findings that are useful for safely and efficiently identifying patients presenting to the emergency department with syncope.
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Here are a few key points:
- Syncope is a transient loss of consciousness, typically with associated loss of postural tone, followed by complete, spontaneous recovery.
- Syncope results from global cerebral hypoperfusion from decreased peripheral vascular resistance, decreased cardiac output, or both.
- There are 3 classifications: (1) neurally mediated (reflex) syncope (the most common); (2) orthostatic hypotension (second most common); and (3) cardiac syncope (the least common, but with highest morbidity).
- An ECG should be obtained for all patients who present with syncope, and the patient should be placed on continuous telemetry while in the ED.