[Medline]. 55(5):464-72. The specific group into which the patient is placed directs the rest of the diagnostic evaluation and treatment. Definition. Quinn J, McDermott D. Electrocardiogram findings in emergency department patients with syncope. for: Medscape. Preliminary data suggests that although syncope may recur in this subset of patients, the frequency is reduced by more than 50%. Prolonged loss of consciousness (coma, defined as a Glasgow Coma Score of 8 or less) is seen commonly: (1) following head injury, (2) after an overdose of sedating drugs, and (3) in the situation of ‘nontraumatic coma’, where there are many possible diagnoses, but the most common are postanoxic, postischaemic, systemic infection, and metabolic derangement, e.g. A newer edition of Plum and Posner's Diagnosis of Stupor and Coma is available. Syncope may result in significant morbidity and disability due to falls or accidents that occur as a result. 1,2 Unless the cause of unconsciousness is immediately obvious and reversible, both early senior physician and critical care input are required, especially when the prognosis is poor and decisions regarding ceiling of care … Syncope Evaluation in the Emergency Department Study (SEEDS): a multidisciplinary approach to syncope management. Atkins D, Hanusa B, Sefcik T, Kapoor W. Syncope and orthostatic hypotension. Aging Clin Exp Res. Rangel I, Freitas J, Correia AS, Sousa A, Lebreiro A, de Sousa C, et al. Drugs, 2010 [Medline]. Fortunately, with constant attention to the changing state of consciousness and a willingness to reconsider the situation minute by minute, few mistakes should be made. 51(3):276-83. Supraventricular tachyarrhythmias include supraventricular tachycardia and atrial fibrillation with rapid response. Care of unconscious patients. Copyright © Distinguishing cardiac syncope from vasovagal syncope in a referral population. 2015 Dec. 25 (6):391-8. 2006 Mar 7. [8, 9]  Syncope reoccurs in 3% of affected individuals, and approximately 10% of affected individuals have a cardiac etiology. Acad Emerg Med. [Medline]. The syncope is thought to occur secondary to efferent vasodepressor reflexes by a number of mechanisms, resulting in decreased peripheral vascular resistance. As much as 50% of the population may experience a syncopal event during their lifetime. 2010 May. A clinically significant defect in any one of these systems or subclinical defects in several of them may cause syncope. CO can be diminished secondary to mechanical outflow obstruction, pump failure, hemodynamically significant arrhythmias, or conduction defects. (If the patient is stable, I will usually start with a much lower dose (0.04mg IV) to avoid precipitating rapid opioid withdrawal.) If you have purchased a print title that contains an access token, please see the token for information about how to register your code. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. [Medline]. Associated chest pain or dyspnea may be present. [Medline]. Syncope occurs as a consequence of global cerebral hypoperfusion. 2016 Sep. 18 (9):1427-33. [18]. 2007 Jul. Started By: fammedmd, MD, Family Medicine, 5:36PM Sep 03, 2010. Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency MedicineDisclosure: Nothing to disclose. Syncope is relatively uncommon in pediatric populations. Orthostatic syncope describes a causative relation between orthostatic hypotension and syncope. Assessment of cardiac electrical activity via rapid “rhythm strip” recording can provide a more detailed analysis of the type of cardiac arrest, as well as indicate additional treatment options. Syncope is defined as a transient, self-limited loss of consciousness Circulation. Signs of impending herniation: Intubate; provide analgesia and sedation; elevated the head of the bed; respirate to a target pCO 2 of 35mmHg; Mannitol 0.5-1gram IV or 3% hypertonic saline 2-3ml/kg IV bolus. Often, these patients are on medications that reduce afterload, which may contribute to the cause of syncope. This condition does not increase the mortality, and recurrences are infrequent. [Medline]. 2014 Nov. 134 (5):e1413-21. MAP decreases with all causes of hypovolemia. Syncope in a patient with poor baseline cardiac function portends a poor prognosis, irrespective of etiology. These causes tend to be more benign and do not predict poor outcomes. Syncope in advanced heart failure: high risk of sudden death regardless of origin of syncope. Ventricular arrhythmias, such as ventricular tachycardia and torsade de pointes, tend to occur in older patients with known cardiac disease.
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