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Syncope


Please choose EITHER neurology or cardiac workup



Inclusion Criteria

  • Minimum ED interventions: ECG, monitor, stool guaiac, orthostatics, IV, labs
  • No acute dyspnea or history of CHF
  • No acute EKG changes, bundle branch block, or significant arrhythmias
  • Vital signs normal
  • No new neurologic deficits


Exclusion Criteria

  • Abnormal or unstable vital signs (HR <50 or >100, SBP<100 or >200, pO2<94%, RR>24)
  • ECG: BB blocks {LBBB; RBBB+LAFB; RBBB+LPFB - esp with 1st degree heart block}; Prolonged QTc (>500mS), new *ECG ST/T wave changes
  • Significant cardiac arrhythmias (v. tach, a fib, bradycardia, etc)
  • Serious cause suspected – ACS, PE, GI Bleed, sepsis, AAA, IC bleed, etc
  • History of CHF, major valvular disease, family history of sudden death (<50)
  • Significant injury (eg fracture, subdural). Lacerations acceptable.
  • New CT or lab abnormalities (if done)
  • Unsafe home environment

Potential Interventions

  • Serial vital signs, cardiac and ST segment monitoring take postural BP
  • Serial CBC, cardiac biomarkers
  • Appropriate IV hydration, diet
  • Additional selective workup (based on patient):
  • Cardiac workup – possible 2-D echo, stress imaging, tilt testing, holter event monitor, pacemaker evaluation, EP consult
  • PE work up – possible D-dimer, CT chest, venous doppler
  • Neuro workup – possible serial neuro checks, HCT, neurology consult, EEG

Discharge Criteria

Home

    • Benign CDU course, stable vital signs
    • No arrhythmia documented on review of cardiac monitor history screens
    • Acceptable home environment
    • Follow up with possible, holter event monitor PRN

Admit

    • Deterioration of clinical course
    • Significant testing abnormalities
    • Unsafe home environment

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