Syncope

HISTORY:

Syncope ‍ ‍days ago

Event: ‍, following ‍ ‍, ‍witnessed byunwitnessed

Onset: ‍gradualsudden

Preceded by: ‍none

Duration: ‍ ‍secminhoursan unclear duration

Recovery: ‍fastslow with confusion, alleviated by ‍lying down

Associated injury: ‍nonehead injuryneck injury ‍

Similar epiosdes in the past: ‍yesno

‍dizziness

‍blurred vision

‍nausea

‍sweating

‍chest pain, ‍retrosternal, ‍on exertionat restwith deep breath

‍shortness of breath

‍lower extremity edema

‍confusion

‍seizure

Occupation: ‍ ‍lowhigh risk of injury for self or others

Driving license: ‍yesno



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Head: ‍normocephalicatraumaticnormal scalprashlesion

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍

Musculoskeletal: joints ‍ ‍normal, ‍no limited ROM

Neurologic: cranial nerves ‍normal, strength ‍5/5 throughout, sensation ‍normal, reflexes ‍2+ throughout, cerebellar function ‍normal, gait ‍stable

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought process ‍organized, ‍no suicidal ideation, judgment ‍good



ASSESSMENT:

‍Syncope ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍glucose, ‍TSH, ‍calcium, ‍magnesium, ‍albumin, ‍troponin, ‍d-dimers, ‍β-hCG

- ECG

- Cardiac monitoring

- Echocardiogram

- Holter monitor

- Carotid ultrasound

- Tilt table test

- CT scan of the head

- Encourage hydration

- Increase salt intake

- Compression stockings

- Avoid heat and long periods of standing

- If symptoms occur, lie down and elevate legs

- Avoid driving

- Referral to cardiologist

- Referral to neurologist

- Follow-up in ‍ ‍daysweeks

- Return if syncope recurs or if new symptoms develop such as chest pain or shortness of breath