Hi team!
Today, we discussed syncope, which is
defined as an abrupt and transient loss of consciousness, associated with the
loss of postural tone. It is an event that is followed by complete and
generally rapid recovery. In the majority of cases, it is benign, however; it
may be a warning of a more sinister underlying disease process (i.e. a
premonitory sign of cardiac arrest!)...
The
European Society of Cardiologists has excellent guidelines, including one on
Syncope. The tables at the beginning are helpful and I
thought it might be a nice reference to have.
Here is
the link:
Recall that we reviewed the San Francisco Syncope Rule (SFSR)
today. It is a prediction tool, to help risk stratify patients
presenting with syncope and determine whether they ought to be admitted. This
rule should only be applied to those patients that have no obvious or evident
cause for their syncope after their initial evaluation in the emergency
department. Note that if your patient has none of the factors associated with
the SFSR, this does not preclude a thorough diagnostic work-up! When used in
the right clinical context, the SFSR has a negative predictive value of 98% (reference: Saccilotto
R, et al. San Francisco Syncope Rule to predict short-term serious
outcomes: a systematic review. CMAJ 2011; 183: E1116-E1126)
The SFSR components include CHF, Hematocrit <30%, Abnormal ECG findings/or findings on the
monitor (new changes), History of dyspnea (SOB), Systolic BP <90 mm Hg (Memory
aid- "CHESS"-CHF, Hct <30%, ECG changes, SOB, SBP<90 mm Hg)
Check
out the CMAJ article: “San Francisco Syncope Rule to predict short-term serious
outcomes: a systemic review”
Link:
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