EVALUATION OF SYNCOPE IN THE EMERGENCY DEPARTMENT - 09/09/11
Résumé |
Syncope is defined as a “sudden transient loss of consciousness with concurrent diminution in postural tone followed by spontaneous recovery not requiring cardioversion.”25 Syncope is a symptom rather than a primary disease process. Syncope is distinct from a seizure disorder, vertigo, dizziness, coma, shock, or other states of altered consciousness. Nonetheless, on initial presentation, differentiating syncope from other conditions may be difficult.
Syncope accounts for up to 3% of emergency department (ED) visits and between 1% to 6% of all hospital admissions.9, 21, 22, 33, 37, 42 The frequency of loss of consciousness (reported to vary between 12% to 48% in young adults) often is associated with trauma or alcohol ingestion.24 The annual incidence of syncope in institutionalized patients older than 75 years is 6%.31
Because the unexpected loss of consciousness is a frightening experience, patients often present for initial evaluation and treatment. Although most often the clinical course of syncope is benign, it may cause serious trauma or be an ominous prodrome of sudden cardiac death.8, 17, 19, 34, 36, 37 Unfortunately, the clinical evaluation of syncope is often expensive, time-consuming, and often does not lead to a definitive diagnosis. The clinical approach relies on the careful review of the history of the event, a discerning physical examination, and analysis of the 12-lead electrocardiogram (ECG). Using this clinical information and an ECG, the cause of a syncopal episode is determined in many cases (approximately 50% of cases) and provides a safe and effective disposition plan for those patients in whom the cause is ellusive.29, 30
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| Address reprint requests to Oliver W. Hayes, DO, FACEP, Section of Emergency Medicine, College of Osteopathic Medicine, B-305-C West Fee Hall, Michigan State University, East Lansing, MI 48824–1316 |
Vol 16 - N° 3
P. 601-615 - août 1998 Retour au numéro
Article précédent
- ARRHYTHMIAS ASSOCIATED WITH ACUTE MYOCARDIAL INFARCTION AND THROMBOLYSIS
- Tom P. Aufderheide
- SYNCOPE IN CHILDREN
- Robert J. Prodinger, Earl J. Reisdorff
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