syncope workup
Started by CueDoc
Hell no, waste of money. Only reason its done at all is defensive medicine.
I agree. It's unlikely that an ischemic event would cause syncope. A bleed can (i.e., SAH), but patients almost always complain of headaches. If the patient syncoped and complains of a headache, then yes, I scan. Otherwise, I don't.
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if after they passed out and had a pretty nasty head injury, or if their hx is a little fishy, or if anything in the hx suggests SAH ( usually not ) or if it sounds like a new onset seizure then yes, i've seen these patients get scanned.
If I can't decide if it was syncope or seizure I may lean toward a scan.
I never CT for isolsated syncope with return to normal mental status. If there was head trauma, persisting AMS, if I can't do a neuro exam, or if the syncope was really a seizure then I'll do the CT. In order to loose consciousness from a CNS etiology one must loose function of both cerebral hemispheres or the entire reticular activating system. In both cases that ptient will not return to a normal mental status.
But as I type the above dogma I find myself wondering why I feel compelled to do a complete neuro exam on each syncope patient. Is it just chart dressing?
But as I type the above dogma I find myself wondering why I feel compelled to do a complete neuro exam on each syncope patient. Is it just chart dressing?
No. CT head is not indicated in a pure syncope work up.
A neuor exam is important. Because if it is focal, you need to scan them.
For a good, overall article on syncope:
http://www.emedicine.com/emerg/topic876.htm
A neuor exam is important. Because if it is focal, you need to scan them.
For a good, overall article on syncope:
http://www.emedicine.com/emerg/topic876.htm
