Department of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
Chief of Pediatric Emergency Medicine Services, Massachusetts General Hospital; Instructor in Pediatrics, Harvard Medical School, Boston, MA
Andrew Dixon, MD, FRCPC
Associate Professor, Faculty of Medicine, Department of Pediatrics, Division of Emergency Medicine, Stollery Children's Hospital, Edmonton, AB, Canada
Sabrina Guse, MD
Attending Physician, Emergency Medicine & Trauma Center, Children's National Health System; Assistant Professor of Pediatrics & Emergency Medicine, The George Washington University School of Medicine, Washington, DC
Timothy Rupp, MD, MBA, FACEP, FAAEM
Emergency Medicine Physician, Dallas, TX
Syncope is a condition that is often seen in the emergency department. Most syncope is benign, but it can be a symptom of a life-threatening condition. While syncope often requires an extensive workup in adults, in the pediatric population, critical questioning and simple, noninvasive testing is usually sufficient to exclude significant or life-threatening causes. For low-risk patients, resource-intensive workups are rarely diagnostic, and add significant cost to medical care. This issue will highlight critical diseases that cause syncope, identify high-risk “red flags,” and enable the emergency clinician to develop a cost-effective, minimally invasive algorithm for the diagnosis and treatment of pediatric syncope.
Excerpt From This Issue
A 10-year-old previously healthy boy presents after “passing out” and experiencing chest pain while playing basketball with friends earlier that evening. The patient reports occasional chest pain with exertion. Today, he also had chest pain while running, collapsed, and had a loss of consciousness for 4 to 5 seconds. He then returned to baseline. He has no prior history of syncope and no recent infections. He denies drug use. On physical examination, there is no evidence of acute distress, and he has normal pulmonary and cardiac examinations. You immediately order an ECG. Do you also need to obtain troponins, D-dimer, or coagulation studies? Does he also need an echocardiogram? You want the patient to see a cardiologist, but does this need to happen in the middle of the night?
A 16-year-old previously healthy adolescent girl presents with multiple episodes of syncope over the last 24 hours. Her preceding symptoms include the sensation that her heart was racing, seeing spots in her visual fields, and feeling short of breath. She had been feeling unwell for 4 days with a dry cough, but no other cold-like symptoms. The first episode of syncope occurred the previous night after getting up from seated position and walking. Her second episode of syncope was this morning, again, after getting up and walking. She had her third episode of syncope today while seated on a couch. This episode was witnessed by friends who state she was unconscious for a few seconds. She denies any pain with these episodes. She currently has no chest pain, but feels short of breath. She has no risk factors for pulmonary embolism and no family history of early cardiac death or clotting disorders. Her last menstrual period was 2 weeks ago. As you order an ECG and a pregnancy test, you think about what else you need to do for this patient.