emDocs - Aug 20, 2018 - Authors: Staiert D and McIntosh B
Edited by: Koyfman A and Long B
"Key Points:
- Cause of syncope can often be determined by history and physical alone. Only an ECG is recommended testing in all patients.
- Multiple Risk Assessment tools exist which can guide disposition.
- Admission can often be avoided if patients can have close follow up with their PCP. Hospital admission often does not lead to a more specific diagnosis.
- A troponin should not be obtained routinely in all patients with syncope unless concern for ischemia/ACS is present.
- Positive orthostatic vital signs may cause early closure and are non-specific.
- CT and MRI should be reserved for patients with other risk factors and focal neurologic deficits and shouldn’t be routinely ordered in syncope.
- Pulmonary embolism as a cause of syncope is not as common as previously thought, occurring in less than 1% of patients with syncope.
- Physician judgment is good for identifying patients with low risk syncope. We should apply that same judgment to determining which patients are safe to discharge and which can skip the extensive workup including labs and imaging."