Abstract
Résumé
Standardized Approaches in the Emergency Department
Emergency department syncope assessment
Emergency department epidemiology
Events following presentation
Risk factors for nonfatal severe outcomes
Major risk factors (Should have urgent cardiac assessment) | |
Abnormal ECG | Any bradyarrhythmia, tachyarrhythmia, or conduction disease |
New ischemia or old infarct | |
History of cardiac disease | Ischemic, arrhythmic, obstructive, valvular |
Hypotension | Systolic BP < 90 mm Hg |
Heart failure | Either past history or current state |
Minor risk factors (Could have urgent cardiac assessment) | |
Age > 60 y | |
Dyspnea | |
Anemia | Hematocrit < 0.30 |
Hypertension | |
Cerebrovascular disease | |
Family history of early sudden death | Age < 50 y |
Specific situations | Syncope while supine, during exercise, or with no prodromal symptoms |
Summary
Emergency department risk rules
Impact of application of guidelines in the emergency department
Summary
Methodologic limitations
Syncope Units
Summary
Standardized Syncope Investigations
Specific investigations
Perform a comprehensive history and physical examination using evidence-based tools |
Routinely obtain an ECG |
Utilize electroencephalography and brain CT or magnetic resonance imaging only with clinical suspicion of focal neurologic deficit or seizure disorder |
Utilize cardiac imaging only with clinical suspicion of structural or valvular heart disease |
Perform invasive electrophysiologic stimulation only with clinical suspicion of a tachyarrhythmia |
Obtain a tilt test only for diagnostic dilemmas, and if it will affect treatment and/or outcome |
Consider Holter monitoring, event recorders, or implantable loop recorders if an arrhythmia is suspected, depending on the frequency of the events |
Putting guidelines into practice
Summary
CCS Positions
References
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Article Info
Footnotes
The disclosure information of the authors and reviewers is available from the CCS on the following Web sites: www.ccs.ca and www.ccsguidelineprograms.ca.
Drs Sheldon, Morillo, Krahn, O'Neill, and Thiruganasambandamoorthy are members of Writing Panel; Drs Parkash, Talajic, Tu, Seifer, Johnstone, and Leather are members of Secondary Panel.
This statement was developed following a thorough consideration of medical literature and the best available evidence and clinical experience. It represents the consensus of a Canadian panel comprised of multidisciplinary experts on this topic with a mandate to formulate disease-specific recommendations. These recommendations are aimed to provide a reasonable and practical approach to care for specialists and allied health professionals obliged with the duty of bestowing optimal care to patients and families, and can be subject to change as scientific knowledge and technology advance and as practice patterns evolve. The statement is not intended to be a substitute for physicians using their individual judgment in managing clinical care in consultation with the patient, with appropriate regard to all the individual circumstances of the patient, diagnostic and treatment options available and available resources. Adherence to these recommendations will not necessarily produce successful outcomes in every case.