Managing Syncope/Collapse in the Emergency Department

Abstract

This chapter focuses on the management of syncope and collapse in the Emergency Department (ED). Syncope/collapse is a common reason for ED attendance and it presents a major management challenge with regard to the appropriate workup and disposition. Initially a diagnosis of syncope/collapse should be made considering other syncope mimics that can present with transient loss of consciousness (TLoC), especially seizure, and other causes of collapse such as presyncope, lightheadedness, vertigo, disequilibrium, and mechanical fall. Once the presenting syndrome of syncope is established, the current suggested approach to the syncope/collapse patient as advocated by the 2018 European Society of Cardiology (ESC) syncope guidelines should be followed. If no obvious underlying cause for the event is found, risk stratification should be undertaken to determine which patients likely have benign causes of syncope and which are at high risk of short-term and long-term adverse outcome. Red flag symptoms should be checked and driving, working, and avocational implications should be fully considered according to local protocols. The benefits of a hospital syncope clinical decision unit and a rapid access syncope clinic include reduced admissions, reduced length of hospital stay, and reduced hospital costs.