Risk Management Pitfall of Urgent Care Approach to the Syncopal Patient (Postscript 3 of 4)

EBUC Postscripts
Urgent Care Approach to the Syncopal Patient | December 2021

“I didn’t order a pregnancy test because her abdominal pain was mild after the vasovagal event. Plus, she told me she had started her period the day before.”

Post syncopal patients with persistent symptoms such as chest pain, shortness of breath, abdominal pain, or significant headache should not be diagnosed with benign, low-risk syncope until more dangerous etiologies are investigated and excluded. The presence of vaginal bleeding should never be used to rule out ectopic pregnancy, as up to 40% of patients with ectopic pregnancy present with vaginal bleeding,1 and almost 10% of patients with ectopic pregnancy present with painless vaginal bleeding.2 If there is any possibility that pregnancy is contributing to the patient’s presentation, order the urine pregnancy test and answer the question definitively.

  1. Alsuleiman SA, Grimes EM. Ectopic pregnancy: a review of 147 cases. J Reprod Med. 1982 Feb. 27(2):101-106.
  2. Kaplan BC, Dart RG, Moskos M, et al. Ectopic pregnancy: prospective study with improved diagnostic accuracy. Ann Emerg Med. 1996 Jul. 28(1):10-17.
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Last Updated on May 10, 2022

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