Syncope: a review of emergency department management and disposition

Abstract

Syncope is defined as a transient loss of consciousness due to cerebral hypoperfusion with spontaneous return to baseline function without intervention. It is a common chief complaint of patients presenting to the emergency department. The differential diagnosis for syncope is broad and the management varies significantly depending on the underlying etiology. In the emergency department, determining the cause of a syncopal episode can be difficult. However, a thorough history and certain physical exam findings can assist in evaluating for life-threatening diagnoses. Risk-stratifying patients into low, moderate and high-risk groups can assist in medical decision making and help determine the patient's disposition. Advancements in ambulatory monitoring have made it possible to obtain prolonged cardiac evaluations of patients in the outpatient setting. This review will focus on the diagnosis and management of the various types of syncope.

Keywords: Ambulatory monitoring device; Arrhythmias; Syncope.

Fig. 1.

Algorithm for the approach to patients presenting to the emergency department (ED) with syncope. ^a)High risk criteria: abnormal electrocardiogram, including non-sinus rhythm while in ED; history of or findings of cardiovascular disease, especially congestive heart failure or structural heart disease; absence of prodromal/vagal symptoms; persistent low blood pressure (systolic blood pressure <90 mmHg); family history of sudden cardiac death (especially in younger patients); advanced age.