Prospective evaluation of syncope in patients presenting to the emergency department

Martin, Guillaume; Sl, Adams; Martin, HG; Mathews, James; Zull, David N.; Pj, Scanlon

doi:10.1016/s0196-0644(84)80185-7

Cited by 19 publications

(2 citation statements)

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“…Although these symptoms may not be particularly useful in identifying the cause of the syncope, ascertaining the duration of the warning period can be helpful because patients with vasovagal syncope almost always have a prolonged, (i.e. 30 s to 2 min) prodrome, whereas patients who have no warning, despite careful questioning, tend to have cardiac causes, orthostatic hypotension, micturition syncope or seizure disorders 11 . Key features in assessment should include orthostatic blood pressure and pulse measurements, taken with the patient standing for 2 min after a supine period of at least 5 min 12 , looking particularly for evidence of bradycardia, or tachyarrhythmias.…”

Section: Management Of Syncopementioning

confidence: 99%

Clinical management of syncope and seizures in GUM clinics

El-Gadi¹,

Richens²

1997

Int J STD AIDS

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A 32-year-old female patient presented to the GUM clinic with a 4-year history of recurrent vulval soreness and irritation, developed generalized tonic± clonic seizure during vaginal speculum examination. She was a known epileptic, but had not had any seizures for 4 years and was not on any anti-epileptic treatment. This event alerted us to look for guidelines on the management of such patients in the genitourinary medicine (GUM) clinic.Although seizures are rare, fainting and syncope in GUM clinic patients are not uncommon. In a telephone survey of the genitourinary physicians in Wales, over a 5-year period there were 350 syncopal episodes and 21 generalized tonic± clonic seizures. Syncope and seizures followed venipuncture and treatment of genital warts in male and female patients, vaginal speculum examination in female patients, urethral swabs and micturition in male patients. All cases resolved spontaneously. Seizures occurred in patients with and without a past history of epilepsy. Although most episodes of syncope in GUM clinics are probably benign vasovagal and selflimited, syncope and seizures are medical emergencies. The doctors in GUM should be aware of the emergency treatment and the necessary documentation of such patients. We discuss the management of syncope and seizures in GUM clinics. SYNCOPESyncope is a state in which there is a generalized weakness of muscles, with loss of postural tone, inability to stand upright, and a loss of consciousness. Faintness, in contrast, refers to lack of strength, with impending loss of consciousness. It occurs commonly in healthy individuals. CAUSES OF SYNCOPESyncope is a common problem; studies indicate that one-third of people have had a syncopal episode sometime in their life time 1 . The causes of syncope range from benign causes such as vasovagal syncope to potentially life threatening causes such as ventricular tachycardia or pulmonary embolism. Although most episodes of syncope are benign and self-limited, yet 5% of patients with sudden cardiac death have had a recent history of prior syncope 2 which makes it necessary to carefully evaluate each patient (Table 1).

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Section: Management Of Syncopementioning

confidence: 99%

Clinical management of syncope and seizures in GUM clinics

El-Gadi¹,

Richens²

1997

Int J STD AIDS

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“…Syncope, defined as a transient loss of consciousness, is a common clinical condition accounting for up to 3% of all emergency department (ED) visits and 6% of hospital admissions [ 1 – 4 ]. The identification of life-threatening conditions is challenging for the emergency physician [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Predictor variables of abnormal imaging findings of syncope in the emergency department

et al. 2018

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BackgroundThis study aimed to describe the pathological findings and to analyze clinical predictors of abnormal imaging findings in patients presenting to the emergency department (ED) with syncope.MethodsThe database was retrospectively reviewed for all patients who underwent cranial computed tomography (CT) or magnetic resonance imaging (MRI), having the symptom of syncope. Patients were included only if they were from the emergency department and excluded if were under 18 years of age, had known recent intracranial pathology, known brain tumor, or having a history of trauma. The primary outcome was assumed as abnormal head CT or MRI including intracranial hemorrhage, acute or subacute stroke, and newly diagnosed brain mass. Univariate and multivariate logistic regression analysis was utilized to determine the association between clinical variables and any significant pathology in either CT or MR scan.ResultsTotal of 1230 syncope (717 men and 513 women; range, 18–92 years; mean, 54.5 years) as presenting symptoms were identified in patients receiving either cranial CT or MR scan in the ED. Abnormal findings related to the syncope were observed in 47 (3.8%) patients. The following predictor variables were found to be significantly correlated with acutely abnormal head CT and MRI: a focal neurologic deficit, history of malignancy, hypertension, and age greater than 60 years.ConclusionsOur data offer that the identification of predictor variables has a potential to decrease the routine use of head CT and MRI in patients admitting to the ED with syncope.

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