The diagnosis and management of syncope or TLoC (Transient Loss of Consciousness) can be tricky. Whilst there are very innocent causes of syncope there are also very serious pathologies we can’t miss (the fact that you should ask if a patient has a family history of sudden cardiac death at a young age is a hint here). Sometimes the syncope itself only becomes apparent after an astute history with collateral information – what about that ‘minors’ patient with a nose injury? Not only can the diagnosis and risk stratification be tricky but so can the decision for admission vs follow up and working out if this will effect their ability to drive (see link below)

Be vigilant – Causes of syncope include those that you always think about like ‘vasovagal’, orthostatic e.t.c. but what about massive PE, subarachnoid haemorrhage, Type A Aortic Dissection, Brugada syndrome?

Recommended resource

The St.Emlyn’s team of Natalie May, Simon Carley and Ian Beardsell have put together an excellent Induction post on Syncope, including a podcast, a SEMEP video and some great resources links, including one on Can’t Miss ECGs in Syncope by Amal Mattu (below). Instead of re-inventing the wheel I recommend you check these out.

1. Induction podcast from StEmlyns
2. Induction video from SEMEP
   

Other resources

• NICE have some guidelines you may want to look at – look at pages 27-9 for a suggested algorithm
• RCEM Learning (References are free, RCEM members get full module use)
  • Syncope Module or Syncope Reference
  • Parasyncope Module
  • TLOC (Transient Loss of Consciousness) Module
• Or listen to a paediatric syncope best case ever from Emergency Medical Cases.
• Want to know more about the DVLA driving guidelines for the UK
• What about two podcasts with Dr Andrew Sloas from PEM:ED Pediatric syncope Part I and Part II