Pt with Syncope... what should you do?
1. Obtain 12 lead EKGs on patients of all ages with history of syncope. (Level A Evidence)
2. According to ACEP Clinical Policy on Syncope, Laboratory testing and advanced investigative testing (such as ECHO and CT Head) need NOT be routinely performed unless guided by specific findings in the history or physical exam (Level C evidence).
3. There are multiple Risk Stratification Tools for syncope, including San Francisco, Rose, OESIL, EGSYS, and Boston, which have varying levels of sensitivity and specificity.
The Boston Guidelines are the newest set of guidelines which have highest sensitivity at 100%.
4. ACEP's Clinical Policy of Syncope state the following four criteria for considering patients "high risk" following a syncopal event:
1. Older age with associated co-mordities,
2. Abnormal EKG,
3. Hct < 30,
4. History or presence of heart failure, CAD, structural heart disease