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Points and Pearls Excerpt
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 of syncope: (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). (See Table 1.)
Date of Original Release: December 1, 2021. Date of most recent review: April 1, 2022. Termination date: April 1, 2025.
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Target Audience: This internet enduring material is designed for urgent care physicians, physician assistants, nurse practitioners, and residents.
Needs Assessment: The need for this educational activity was determined by a practice gap analysis; a survey of medical staff; review of morbidity and mortality data from the CDC, AHA, NCHS, and ACEP; and evaluation responses from prior educational activities for emergency physicians.
Goals: Upon completion of this activity, you should be able to: (1) identify areas in practice that require modification to be consistent with current evidence in order to improve competence and performance; (2) develop strategies to accurately diagnose and treat both common and critical urgent care presentations; and (3) demonstrate informed medical decision-making based on the strongest clinical evidence.
CME Objectives: Upon completion of this activity, you should be able to: (1) describe clinical findings of low-risk and high-risk syncope in the urgent care setting; (2) identify diagnostic studies that safely and cost-effectively lead to improved risk stratification of syncope; and (3) discuss the indications for ED transfer of postsyncopal patients.
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Syncope can be the result of causes ranging from benign to life threatening. A detailed history and physical examination, along with an ECG, are among the most important aspects of the workup for a postsyncopal patient, and must be documented.
Activity before and after the event, exertional activity, prodromal symptoms
Duration of event and time to return to baseline
Past medical history of coronary artery disease, pacemaker, defibrillator, or dysrhythmia
Input from bystander/family
Address any abnormal vital signs, especially persistent bradycardia and tachycardia
New or undiagnosed murmur
Abdominal tenderness, rectal exam, color of conjunctiva
Look for ischemic changes
Mobitz II second- and third-degree atrioventricular block