Syncope
Syncope
Loss of consciousness <10 minutes
EKG done in main ED and
Sinus or Chronic Afib
No new changes from prior
QTc < 480
No High Grade Block
Does not meet criteria for Brugada Syndrome or ARVD
Orthostatics done in main ED
Stable vital signs or unchanged from baseline if on chronic oxygen
No acute neurologic deficits
Normal CT Brain if completed
Safe environment for disposition to home
Cardiac markers negative or at baseline
Normal Blood Sugar
Pulmonary Embolism ruled out or considered very unlikely
No suspicion of seizure
History of CHF with EF < 40%
OR Clinical CHF regardless of history
Patient has AICD or Pacemaker (unless interrogated and interpreted/cleared by cardiology in main ED)
History of Aortic Stenosis, either severe (valve area < 1 cm) or without close recent followup
Systolic Blood Pressure < 90 at time of admission to CDU
Acute mental status change
Abnormal (CT of brain) if completed in the ED
Abnormal electrolytes: EG Na+ < 125, K+ < 2.5 or >5.0
Concern for acute bleeding as cause
Concerning Story for Cardiogenic Syncope (lack of prodrome, immediate loss of consciousness during activity)
Cardiac monitoring, provider to review overnight tele for abnormality
Trend troponins 0, 3, and 6 hours (including initial in ED) and repeat EKG
Neuro checks every 4 hours
Fall precautions
Repeat CBC to screen for blood loss
Obtain orthostatic vital signs. If patient is orthostatic, give IV fluids and recheck orthostatic vital signs.
PT/OT eval as needed
Consider echocardiogram is clinical suspicion for cardiac etiology of syncope
Consider neurology consult if neurological etiology of syncope
Disposition
Stable Vital Signs
Negative Cardiac Markers or at baseline
Benign CDU Course
No arrhythmia or abnormal electrolytes
Clinical deterioration
Unstable Vital Signs
Abnormal studies