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Cardiology Corner - Syncope

Amal Mattu, MD FAAEM and Anand Swaminathan, MD FAAEM
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19:48
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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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02:18

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EM:RAP 2019 November Written Summary 313 KB - PDF

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Brad N., M.D. -

It is mentioned that Dr. Mattu documents the Canadian Syncope Risk Score in patients he sends home, however, the score requires testing of troponin levels to use the rule the way it was intended. This seems to be the major issue with the score as most practitioners do not measure a serum troponin level unless clinically indicated. I am interested in Dr. Mattu's opinion on this. In particular, does he recommend using the Canadian Syncope Risk Score in only a small subset of syncope patients that he is ordering a troponin level on and not the majority of syncope patients?

Amal M., M.D. -

Thanks Brad, great question. Like most other decision aids, I'd suggest that the CSRS should probably only be used when you are in a bit of a quandary about what to do. If a patient is a 'no-brainer discharge home' kind of presentation, I will not use any risk score, but simply document well. And if it's a 'no-brainer admission' (elderly patient with a whopping aortic stenosis murmur who syncopized), I won't use the score. But in the gray area, I will use the score and, therefore, check the TN for the purpose of following the score the way it was intended.
On a related note, I also believe that if you are going to use a validated decision aid, you should use it the way it was intended (in this case, I will get the TN), and not go rogue. Use it correctly or don't use it.

Kaitlyn A. -

Dr. Mattu, you forgot the euphemism DFO'd (done fell out)...classic Baltimore lingo for syncope!

Sid Williamson -

Additional question regarding troponin. We recently moved to a high sensitivity troponin (yes, the real high sensitivity trop, not the 4th generation assay). So we get a lot of low intermediate results. How would you reconcile the troponin aspect of the Canadian Syncope Risk Score in the setting of an intermediate high sensitivity troponin result?

My gut tells me that doing a 2 hour follow up, if it shows no significant change, would be a reasonable strategy.

Amal M., M.D. -

Yes, I'd agree that that's a reasonable strategy.

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EM:RAP 2019 November Full episode audio for MD edition 220:08 min - 306 MB - M4AEM:RAP 2019 November German Edition Deutsche 91:21 min - 126 MB - MP3EM:RAP 2019 November Canadian Edition Canadian 33:22 min - 46 MB - MP3EM:RAP 2019 November Farsi Edition Farsi 168:42 min - 232 MB - MP3EM:RAP 2019 November French Edition Français 36:44 min - 50 MB - MP3EM:RAP 2019 November Aussie Edition Australian 29:14 min - 40 MB - MP3EM:RAP 2019 November Spanish Edition Español 78:58 min - 108 MB - MP3EMRAP 2019 November Board Review Answers 205 KB - PDFEMRAP 2019 November Board Review Questions 497 KB - PDFEM:RAP 2019 November Individual MP3 FIles 285 MB - ZIPEM:RAP 2019 November Written Summary 313 KB - PDF

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