Causes of Syncope
History Rate of onset Position at onset Duration, rate of recovery Preceding features Obstruction: associated with exertion Neurocardiogenic: associated with emotion, micturition, bowel movement, emesis, neck movement Following features Seizure: Postictal confusion Hypotension: Initial VS Associated trauma Physical Examination VS: rhythm, BP, temperature HEENT: mucous membranes (laceration, dry), trauma, papilledema CV: murmur (AS), rub (pericarditis), bruit (cerebrovascular disease), JVD (obstruction) Lungs: crackles (CHF) Abdomen: pulsatile mass (AAA) Extremities: pulse discrepancy (dissection) Neuro: focal findings (stroke, mass, seizure) Evaluation ECG: arrhythmia (PR, QT, Brugada, unanticipated hypertrophy, RV strain, pericarditis) Orthostatic VS CBC: anemia BMP: electrolyte abnormalities (hyponatremia, hyper/hypokalemia) Glucose: hypoglycemia Troponin: ischemia B-hCG: ectopic Utox: drugs CXR: dissection CT head: focal neurological findings CT PA: concern for PE US abdomen: AAA San Francisco Syncope Rules (CHESS) CHF Hematocrit <30% ECG abnormality SBP <90mmHg SOB References De Lorenzo, R. (2013). Syncope. In Rosen’s Emergency Medicine – Concepts and Clinical Practice (8th ed., Vol. 1, pp. 135-141). Elsevier Health Sciences.
