Emergency Department Management of Syncope

Show Notes

Announcements:

1. The Clinical Decision Making in the Emergency Department conference is June 23-27 live and virtual.
2. Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this summer.

Why syncope? Prevalence, hospitalizations, etc.

Etiology: Physiologic basis of syncope

1. Neurally mediated
2. Orthostatic - are we still doing orthostatic vitals in the ED?
3. Cardiac 

Differentiating syncope from seizure

1. Features that point to seizure
2. Urinary incontinence
3. Number of jerks
4. Age?

Prehospital care is all about details

1. What did bystanders see?
2. What do paramedics see?
3. Any trauma?
4. Any neuro deficits ?
5. Glucose 
6. ECG

ED History - Table 4

1. History of similar
2. Prodrome
3. Associated symptoms (chest pain, neuro symptoms, etc)
4. Falls
5. Pre-syncope ?

ED exam

1. Vitals, vitals, vitals
2. Orthostatic vitals ?
3. Carotid sinus massage, why this? Do we do in the ED?

ECG

1. Brugada, blocks, VT, ST changes, etc

Labs

1. BNP, delta bnp ?
2. Trop
3. Lactic acid
4. Pregnancy test
5. CBC
6. lutes
7. Bun/Cr

Echo - any role in the ED?

CT

1. Head
2. PE - Get this on everyone ? Is it high prevalence?

Risk stratification tools- the bad and the worse

Table 7

Controversies

1. Admitting the elderly 
2. Orthostatic vitals (we discussed already)

Disposition 

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