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

EMplify – June 2021

Announcements:

  1. The Clinical Decision Making in the Emergency Department conference is June 23-27 live and virtual. More information here: https://clinicaldecisionmaking.com
  2. Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this summer !!

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 April 29, 2022

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