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Announcements:
The Clinical Decision Making in the Emergency Department conference is June 23-27 live and virtual. More information here: https://clinicaldecisionmaking.com
Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this summer !!
Syncope- An Interview With Dr. James Morris
See the EB Medicine Article @ https://www.ebmedicine.net/topics/cardiovascular/syncope
Why syncope? Prevalence, hospitalizations, etc.
Etiology: figure 1 is fantastic. Physiologic basis of syncope
Neurally mediated
Orthostatic – are we still doing orthostatic vitals in the ED?
Cardiac
Differentiating syncope from seizure
Features that point to seizure
Urinary incontinence
Number of jerks
Age?
Prehospital care is all about details
What did bystanders see?
What do paramedics see?
Any trauma?
Any neuro deficits ?
Glucose
ECG
ED History – table 4
History of similar
Prodrome
Associated symptoms (chest pain, neuro symptoms, etc)
Falls
Pre-syncope ?
ED exam
Vitals, vitals, vitals
Orthostatic vitals ?
Carotid sinus massage, why this? Do we do in the ED?
ECG
Brugada, blocks, VT, ST changes, etc
Labs
BNP, delta bnp ?
Trop
Lactic acid
Pregnancy test
CBC
lutes
Bun/Cr
Echo – any role in the ED?
CT
Head
PE- get this on everyone ? Is it high prevalence?
Risk stratification tools- the bad and the worse
Table 7, amazing
Controversies
Admitting the elderly
Orthostatic vitals (we discussed already)
Disposition
