Episode 58 – Syncope – An Interview With Dr. James Morris

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Episode 58 – Syncope – An Interview With Dr. James Morris

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Syncope- An Interview With Dr. James Morris

See the EB Medicine Article @ https://www.ebmedicine.net/topics/cardiovascular/syncope

1. Why syncope? Prevalence, hospitalizations, etc.
2. Etiology: figure 1 is fantastic. Physiologic basis of syncope
   1. Neurally mediated
   2. Orthostatic – are we still doing orthostatic vitals in the ED?
   3. Cardiac
3. Differentiating syncope from seizure
   1. Features that point to seizure
   2. Urinary incontinence
   3. Number of jerks
   4. Age?
4. Prehospital care is all about details
   1. What did bystanders see?
   2. What do paramedics see?
   3. Any trauma?
   4. Any neuro deficits ?
   5. Glucose
   6. ECG
5. ED  History – table 4
   1. History of similar
   2. Prodrome
   3. Associated symptoms (chest pain, neuro symptoms, etc)
   4. Falls
   5. Pre-syncope ?
6. ED exam
   1. Vitals, vitals, vitals
   2. Orthostatic vitals ?
   3. Carotid sinus massage, why this? Do we do in the ED?
7. ECG
   1. Brugada, blocks, VT, ST changes, etc
8. Labs
   1. BNP, delta bnp ?
   2. Trop
   3. Lactic acid
   4. Pregnancy test
   5. CBC
   6. lutes
   7. Bun/Cr
9. Echo – any role in the ED?
10. CT
    1. Head
    2. PE- get this on everyone ? Is it high prevalence?
11. Risk stratification tools- the bad and the worse
12. Table 7, amazing
13. Controversies
    1. Admitting the elderly
    2. Orthostatic vitals (we discussed already)
14. Disposition

Last Updated on January 25, 2023

Sam Ashoo, MD

Sam Ashoo, MD, FACEP,  is board certified in emergency medicine and clinical informatics. He serves as EB Medicine’s editor-in-chief of interactive clinical pathways and FOAMEd blog, and host of EB Medicine’s EMplify podcast. Follow him below for more…