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Syncope: Who Needs Imaging? Who Needs Admission?

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Neurologic Emergencies

Abstract

A 60-year-old man presents to the emergency department (ED) by EMS with a report of sudden collapse while running a road race. It is a hot summer day, and he was at mile 5 of a 10 K race when he suddenly collapsed. He was helped up by bystanders after a report of roughly 1 min of unconsciousness. He has scrapes on his knees and elbows from the fall to pavement but is only complaining of fatigue. He is awake and alert, with mild tachycardia, a normal blood pressure, and a normal neurological exam. His respiratory rate is normal and he is afebrile. His skin is pale and warm, with some mild sweat. He reports that he has a history of hypertension and non-insulin-dependent diabetes. He takes metformin for the latter, but cannot recall his antihypertensive medication name. EMS has started a peripheral IV en route and given him 500 cm3 of normal saline. They report that a 12 lead ECG showed sinus tachycardia without any features concerning for arrhythmia or ischemia.

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Abbreviations

AMI:

Acute myocardial infarction

BNP:

Brain natriuretic peptide

CAD:

Coronary artery disease

CBC:

Complete blood count

CHF:

Congestive heart failure

CNS:

Central nervous system

CT:

Computerized tomography

DBP:

Diastolic blood pressure

ECG:

Electrocardiogram

ED:

Emergency department

EEG:

Electroencephalogram

EMS:

Emergency medical services

GI:

Gastrointestinal

Hct:

Hematocrit

Hgb:

Hemoglobin

IV:

Intravenous

LOC:

Loss of consciousness

OESIL:

Osservatorio Epidemiologico sulla Sincope nel Lazio risk score

PE:

Pulmonary embolism

RA:

Room air

ROSE:

Risk stratification of Syncope in the ED

SBP:

Systolic blood pressure

SFSR:

San Francisco Syncope Rule

TCA:

Tricyclic antidepressants

TIA:

Transient ischemic attack

VS:

Vital signs

WPW:

Wolff-Parkinson-White

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Author information

Authors and Affiliations

  1. Harvard Affiliated Emergency Medicine Residency, Boston, MA, USA

    Ellen Vollmers M.D., Ph.D.

  2. Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Sean Kivlehan M.D., M.P.H.

Authors
  1. Ellen Vollmers M.D., Ph.D.
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  2. Sean Kivlehan M.D., M.P.H.
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Corresponding author

Correspondence to Sean Kivlehan M.D., M.P.H. .

Editor information

Editors and Affiliations

  1. Orlando, Florida, USA

    Latha Ganti

  2. Boston, Massachusetts, USA

    Joshua N. Goldstein

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Vollmers, E., Kivlehan, S. (2018). Syncope: Who Needs Imaging? Who Needs Admission?. In: Ganti, L., Goldstein, J. (eds) Neurologic Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-319-64523-0_5

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  • DOI: https://doi.org/10.1007/978-3-319-64523-0_5

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-64521-6

  • Online ISBN: 978-3-319-64523-0

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