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Cardiology Corner - Syncope

Rob Orman, MD and Amal Mattu, MD FAAEM
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23:37
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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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02:00

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EM:RAP 2016 March Written Summary 858 KB - PDF

Amal Mattu breaks down his approach to the syncopal patient. What’s the one test he would take when shipwrecked on syncope island? Hint, the abbreviation is EKG.

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Erin M. -

That video was all sorts of amazing! Thank you!

Mario P., MD -

Where I practice about half of the patients will tell me they "almost passed out" when they are describing the symptoms of their viral URI or ankle sprain. By telling us we need to work up near syncope as though it was true syncope I hope you keep that very narrowly focused to only those patients where it is legit. I'm not going to do an EKG and serial troponins and refer for tilt table testing on all these patients who are obviously exaggerating.

Amal M., M.D. -

Mario,
I'm only reporting what the literature says, and in the end it's totally up to the provider about how to incorporate the literature using their own clinical judgment.
I think you and I have the same patients. Most of mine are also lightheaded. And also have subjective fevers, chills, chest pain, headaches, and had their Rx for percocet stolen.

Bridget S. -

While hCG may be considered low-yield in most syncope cases, failing to diagnose pregnancy in an otherwise healthy patient presenting with syncope would likely make the ED provider look like an idiot to the patient (potentially reflected in a patient satisfaction survey) and may delay prenatal care and lifestyle changes. Also, many movies show pregnancy (incorrectly) presenting with syncope, so it may be a primary concern of any pre-menopausal woman who passes out or feels lightheaded. Might as well get this cheap non-invasive test to give that patient an answer.

Joshua A. -

Dr. Mattu,
Do you routinely order troponins on syncope patients?

Amal M., M.D. -

Routinely? No.
If there's something else in the hx that makes me worry about ACS (e.g. chest pain), I will. But syncope purely on it's own is not enough. Some studies have shown that syncope can be associated with a bump in TN, but no clear evidence that the TN predicts ACS beyond what a good hx and ECG would predict.

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Spring Forward Into PE Full episode audio for MD edition 236:48 min - 330 MB - M4AEM:RAP 2016 March Aussie Edition Australian 38:52 min - 53 MB - MP3EM:RAP 2016 Mars Résumé en Francais Français 52:06 min - 72 MB - MP3EM:RAP 2016 March Canadian Edition Canadian 33:43 min - 46 MB - MP3EM:RAP 2016 March German Edition Deutsche 101:18 min - 139 MB - MP3EMRAP 2016 Marzo Resumen Español Español 87:22 min - 120 MB - MP3EM:RAP 2016 March Written Summary 858 KB - PDFEM:RAP 2016 March Board Review Answers 187 KB - PDFEM:RAP 2016 March Board Review Questions 169 KB - PDFEMRAP 2016 March MP3 Files 302 MB - ZIP

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