16.06.2010 M & M Meeting

Assessment of Syncope

Registrar Teaching Emergency Department

Sir Charles Gairdner

Hospital

01.08.2013

Mohamed GaberRegistrar in Emergency Medicine

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.

Case Presentations

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?

Case A ECG

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?

Case B ECG

Discussion

Differential is wide

Don’t forget drugs

Work up algorithms

San Francisco Syncope Rule (SFSR)

SFSR

Validation of the SFSR

NNT of the SFSR

Oh no

OESIL Epidemiological Observatory on Syncope in Lazio

No prodromal symptoms

Age > 65

History of cardiac disease

Abnormal ECG

ROSE Risk Stratification of Syncope in the ED

BNP... really?

Lets put them all together

This is beautiful

Further reading

Thank you

and

Questions