Urgent Care Approach to the Syncopal Patient | Points and Pearls
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Urgent Care Approach to the Syncopal Patient

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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.)
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Publication Information
Editor in Chief & Update Author

Keith Pochick, MD
Novant GoHealth Urgent Care

Urgent Care Peer Reviewer

Joseph Toscano, MD
John Muir Urgent Care; San Ramon Regional Medical Center

Charting Commentator

Patrick O’Malley, MD
Newberry County Memorial Hospital

Authors

James Morris, MD, MPH, FACEP

Peer Reviewed By

Deborah Diercks, MD, MS, FACEP, FACC; Marc A. Probst, MD, MS, FACEP

Publication Date

April 1, 2022

CME Expiration Date

April 1, 2025

CME Credits

4 AMA PRA Category 1 Credits™.

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CME Information

Charting Tips

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.

History

  • 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
  • Previous episodes
  • Previous workup
  • Input from bystander/family

Physical Examination

  • Address any abnormal vital signs, especially persistent bradycardia and tachycardia
  • New or undiagnosed murmur
  • Abdominal tenderness, rectal exam, color of conjunctiva

Electrocardiogram

  • Look for ischemic changes
  • Mobitz II second- and third-degree atrioventricular block
  • Intraventricular conduction delays
  • Compare to previous ECGs if possible
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