Syncope
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 7 August 2016
⏱️ 10 minutes
🧾️ Download transcript
Summary
6 EKG Findings. 6 Risk Factors. 6 Mimics.
Step 1: Get an EKG
* This is the only “required” test for a patient with syncope* Other common tests* CBC* Evaluate for anemia* hCG* If patient might be pregnant
Step 2: Look For 6 High Risk EKG Patterns
* Mnemonic: QT-BRIDE* QT prolongation* Especially QTc >500* Brugada pattern* Right heart strain* Tachycardia* S1Q3T3* Inverted T waves precordial leads* Ischemic changes* ST segment elevation/depression* T wave inversion* Delta waves* Seen in Wolf-Parkinson White (WPW)* Epsilon waves* Seen in arrhythmogenic right ventricular dysplasia (ARVD)
Step 3: Ask the 6 High Risk Historical Questions
* Mnemonic: CHESS +1* Cardiac history* CHF* Structural heart disease* Hematocrit <30%* “Elderly”* Shortness of Breath* Systolic BP <90* (+1) Family history of sudden cardiac death
Step 4: Consider 6 Deadly Syncope Mimics
* 15% of the following diseases reportedly present as “syncope”* AKA “Rule of 15s”* Subarachnoid hemorrhage* Myocardial infarction* Pulmonary embolism* Aortic dissection* Abdominal aortic aneurysm* Perforated GI* Ulcers* Ectopics
Additional Reading
* QT Intervals (LITFL)* Brugada Syndrome (LITFL)* Right Heart Strain (LITFL)* Delta Wave (LITFL)* Epsilon Wave (LITFL)
Transcript
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| 0:00.0 | Hello, med students. This episode has been sponsored by Freed AI. Do you dread the thought of |
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| 0:34.1 | and you can cancel at any time if you decide it's not right for you. You can learn more at |
| 0:39.3 | www.gitfreed.a.i. Hello, med students. My name is Zach Olson. Thank you for downloading this |
| 0:49.8 | episode of the EM Clerkship Podcast. We're going to be covering some more core topics this month for your clerkship. |
| 0:57.7 | Here's the case. |
| 1:02.4 | University Hospital's Ambulance 48 coming to you with a 40-year-old female. |
| 1:06.9 | Singapore episode while in church, currently conscious, alert, and oriented times three, |
| 1:11.8 | was attending services and fainted from a standing position. |
| 1:15.6 | No trauma suspected, vital signs are normal, nor the complaints at this time. |
| 1:20.2 | Patient denies any medical history or medications. |
| 1:23.2 | We're about seven to eight minutes out to your facility. |
| 1:38.2 | Think. When this patient gets here, what will you do? |
| 1:46.0 | What I want you to remember today about syncope is 666. |
| 1:48.0 | 666. There are six life-threatening EKG patterns. |
| 1:53.0 | There are six additional life-threatening risk factors that you have to look for. |
| 1:59.0 | And there are six life-threatening syncope mimics. |
| 2:04.1 | 666. |
... |
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