Urgent Care Approach to the Syncopal Patient | Store

Urgent Care Approach to the Syncopal Patient -

Urgent Care Approach to the Syncopal Patient
Enlarge Image
Delivery Method:

Publication Date: April 2022 (Volume 1, Number 1)

CME Credits: 4 AMA PRA Category 1 Credits™. CME expires 04/01/2025.

Editor-In-Chief and Update Author

Keith Pochick, MD, FACEP
Attending Physician, Novant GoHealth Urgent Care, Charlotte, NC

Urgent Care Content Peer Reviewer

Joseph D. Toscano, MD
Physician and Clinical Chief, Emergency Medicine, San Ramon Regional Medical Center, San Ramon, CA; Urgent Care Physician, John Muir Urgent Care, East San Francisco Bay Area, CA

Charting Commentator

Patrick O’Malley, MD
Attending Physician, Emergency Department, Newberry County Memorial Hospital, Newberry, SC


James Morris, MD, MPH, FACEP
Program Director, Emergency Medicine Residency, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX

Peer Reviewers

Deborah Diercks, MD, MS, FACEP, FACC
Professor and Chair, Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX
Marc A. Probst, MD, MS, FACEP
Assistant Professor, Director of Adult Research, Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY

Case Presentations

CASE 1: A 16-year-old girl is directed to UC after passing out at a pharmacy …
  • History reveals that the patient was getting a flu shot at a local pharmacy when she became lightheaded and diaphoretic and passed out, without striking her head.
  • She was unconscious less than 1 minute and awoke with no confusion.
  • Because she passed out, the pharmacist told the parents that they should “go immediately to UC” for evaluation…
CASE 2: A 40-year-old man presents to UC after what witnesses describe as a “seizure” while he is sitting in a chair…
  • His wife tells you that the man lost consciousness while sitting in a chair. She states that he had generalized jerking of his extremities. He had a prompt return to normal level of consciousness, but was complaining of chest pain and shortness of breath after the event.
  • The patient says that he underwent elective cholecystectomy 3 weeks ago, but denies abdominal pain or vomiting, and he says he has no other medical problems.
  • His vital signs are: blood pressure, 96/54 mm Hg; heart rate, 122 beats/min; respiratory rate, 24 breaths/min; temperature, 37°C; and oxygen saturation, 92%.
  • You wonder what this patient’s major underlying problem is…
CASE 3: A 65-year-old woman presents to UC with complaints of right knee pain after a fall at home…
  • The patient states she was walking to the bathroom when she found herself on the floor with right knee pain, and no recollection of how she got there. She currently has no other complaints.
  • Her vital signs are normal, and her past medical history is significant for diabetes and hypertension.
  • You wonder if a right knee x-ray is all that’s indicated in this case…


Resulting from global cerebral hypoperfusion, syncope is a transient loss of consciousness (TLOC), typically with associated loss of postural tone, followed by complete, spontaneous recovery. Syncope represents approximately 1% of all emergency department (ED) visits in the United States,1 but data on urgent care (UC) visits for syncope are incomplete. Annual expenditures for hospital admissions related to syncope are estimated at up to $5.6 billion in the United States.2 For most patients with syncope, hospitalization has a much smaller impact on mortality than the patient’s underlying morbidities.3

The primary task of the UC clinician is to distinguish syncope as a presentation of ongoing, life-threatening disease (such as subarachnoid hemorrhage, pulmonary embolism, and hypovolemia secondary to bleeding) from syncope that results from benign causes (such as vasovagal syncope), and from high-risk causes that may have resolved at the time of clinic presentation (particularly arrhythmias).4 The most effective tools for evaluating syncope remain the history, physical examination, and electrocardiogram (ECG), as advanced studies have shown vanishingly low yield for most patients with normal examinations and ECGs.5-10 Several clinical decision rules exist, but their utility has been questioned.11,12 This issue of Evidence-Based Urgent Care discusses the best available evidence to identify which patients with syncope can be safely discharged with limited testing, and which patients may benefit from further investigation, including ED transfer.


EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Get A Sample Issue Of Emergency Medicine Practice
Enter your email to get your copy today! Plus receive updates on EB Medicine every month.
Please provide a valid email address.