Date of Original Release: December 1, 2021. Date of most recent review: April 1, 2022. Termination date: April 1, 2025.
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Credit Designation: EB Medicine designates this internet enduring material for a maximum of 4 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Specialty CME: Not applicable. For more information, please call Customer Service at 678-366-7933.
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.
Discussion of Investigational Information: As part of the journal, faculty may be presenting investigational information about pharmaceutical products that is outside Food and Drug Administration approved labeling. Information presented as part of this activity is intended solely as continuing medical education and is not intended to promote off-label use of any pharmaceutical product.
Faculty Disclosure: It is the policy of EB Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME activities. All faculty participating in the planning or implementation of a CME activity are expected to disclose to the participants any relevant financial relationships and to assist in mitigating the relationships. In compliance with all ACCME accreditation requirements and policies, all faculty for this CME activity were asked to complete a full financial disclosure statement. The information received is as follows: Update Contributors (April 2022): the author and Editor-in-Chief, Dr. Keith Pochick; and peer reviewer, Dr. Joseph Toscano, report no relevant financial relationships with ineligible companies. The charting tips author, Dr. Patrick O’Malley, reported receiving royalty payments from Medline Industries. This relationship has been mitigated by attestation and peer review. Original Con¬tributors (June 2021): Dr. Morris, Dr. Diercks, Dr. Probst, Dr. Toscano, Dr. Mishler, Dr. Jagoda, and their related parties report no significant financial interest or other relationship with the manufacturer(s) of any commercial product(s) discussed in this educational presentation.
Commercial Support: This issue of Evidence-Based Urgent Care did not receive any commercial support.
Earning Credit: Go online to www.ebmedicine.net/CME and click on the title of the test you wish to take.When completed, a CME certificate will be emailed to you.
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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