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Syncope Assessment and Management

  1. 1. Assessment of Syncope Registrar Teaching Emergency Department Sir Charles Gairdner Hospital 01.08.2013 Mohamed Gaber Registrar in Emergency Medicine 16.06.2010 M & M Meeting
  2. 2. Talk outline Case Presentations with ECGs. Any question in Italics is for open audience discussion. Some discussion syncope decision rules and interesting ECGs. Feel free to interrupt with remarks and questions.
  3. 3. Case Presentations
  4. 4. Case Presentation A 64 year old man presents to ED, brought in by wife at 20:00. Was dusting shelf before dinner time, fell back onto couch. Wife says was clammy and sweaty, patient remembers passing out. Prior to passing out, he felt palpitations. Nil chest pain, shortness of breath, bowel/bladder control issues. Currently looks well and would like to go home. PMHx – NSTEMI --- on Aspirin, β-blocker and statin. Vitals – pulse 82, BP 142/87, RR 14, SpO2 98% RA, Temp 37.4, BSL 6.2. Unremarkable chest, abdominal, neurological exam. No postural drop, UA negative, CXR normal. Bloods including Troponin normal. Would you send this patient home?
  5. 5. Case A ECG
  6. 6. Case Presentation B 36 year old lady presents to ED from her place of work at 07:20 AM. Was at the gym earlier in the morning, then rushed to work. Feeling lightheaded and flushed on bus during journey to work. Increased BMI noted, has been trying to lose weight. Started exercising recently as GP confirmed hypercholesterol on bloods. Nil other cardiac risk factors, nil contraception. PMHx – hypercholesterol, nil medications. Vitals – pulse 94, BP 110/73, RR 16, SpO2 98% RA, Temp 36.2, BSL 5.8. Unremarkable chest, abdominal, neurological exam, large BMI noted. No postural drop, UA negative, CXR normal. Bloods including Troponin normal. Would you send this patient home?
  7. 7. Case B ECG
  8. 8. Discussion
  9. 9. Differential is wide
  10. 10. Don’t forget drugs
  11. 11. Work up algorithms
  12. 12. San Francisco Syncope Rule (SFSR)
  13. 13. SFSR
  14. 14. Validation of the SFSR
  15. 15. NNT of the SFSR
  16. 16. Oh no
  17. 17. OESIL Epidemiological Observatory on Syncope in Lazio No prodromal symptoms Age > 65 History of cardiac disease Abnormal ECG
  18. 18. ROSE Risk Stratification of Syncope in the ED
  19. 19. BNP... really?
  20. 20. Lets put them all together
  21. 21. This is beautiful
  22. 22. Further reading
  23. 23. Thank you and Questions