Evaluation of Syncope in the Emergency Department

Authors: Theodore Segarra, MD; Lee Grodin, MD; Taylor Conrad, MD; Raymond Beyda, MD
Editors: Michael C. Bond, MD FAAEM and Kelly Maurelus, MD
Originally Published: Common Sense January/February 2018

As syncope is a common yet nebulous complaint, evaluation of the patient with syncope presents a unique challenge. Syncope is defined as a brief loss of consciousness and postural tone with rapid return to baseline mentation. Yet, rather than having a single underlying cause, syncope itself is a syndrome with many potential etiologies. Some identified causes are arrhythmia, myocardial infarction (MI), cerebrovascular accident (CVA), hemorrhage, and pulmonary embolism (PE).[1] In this edition of RJR, we review the potential etiologies of syncope, the utility of risk stratification tools in the workup of syncope, and the prevalence of atypical causes of syncope.

A Racing Heart and Seeing Stars: Pre-excitation and Syncope in a Young Adult

This post was peer reviewed.
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Author: Eric Sulava, MD
Emergency Medicine Resident
Naval Medical Center Portsmouth
AAEM Education Committee

Author: Hannah Harris MD
Student Naval Flight Surgeon
Naval Aerospace Medical Institute

Author: Katrina Destree, MD
Staff Physician
Naval Medical Center Camp Lejeune

Chief Complaint
“My heart was racing and then everything went grey”

Board Review: Methadone Intoxication

Originally Published: Modern Resident, Jun/Jul 2010

Original Author: Dana Kindermann, MD Georgetown-Washington Hospital Center Dept. of Emergency Medicine

Submitted by: Saadiyah Bilal, Publications Committee, Co-Chair 


Case history:
56 y/o male BIBA, found in apartment by roommate with altered mental status x 24h, found lying in feces. Patient (pt) with multiple substance abuse related admissions and ED visits. On arrival, pt slow to respond, confused, A&O x 2, denies pain, takes 150mg PO methadone daily, denies other med/drug use. Initial EKG: QTc - 500ms, bigeminy. Pt loaded with IV Mg, IV fluids; all initial labs normal and pt transferred to floor. Three hours later, pt develops Torsades de Pointes (TdP).