Syncope Algo v1

  • 8y-22y with syncope or presyncope
    • Examinations
      • Perform H+P
      • Obtain 12 lead EKG
      • Obtain urine hCG for post-pubertal females
      • OPTIONAL: Place on CR monitor
      • Additional testing not indicated unless concerning H+P
      • Formal orthostatics NOT recommended
    • Presence of any of the following:
      • Symptoms
        • Syncope with CHEST PAIN, exertion, rapid palpitations, or while swimming
        • Increasing frequency of events
        • 3/6 or other non-innocent murmur
        • More than occasional PAC or more than occasional PVC on CR monitor
        • Abnormal EKG (See Checklist)
      • Yes
        • Cardiology Consult
          • Abnormal Neurological exam or severe headache
            • Yes
              • Neurology Consult
                • Borderline EKG (see table) or FH of SIDS, LQTS, congenital deafness, HCM, sudden cardiac arrest < 40y or sudden unexplained death < 40y
                  • Yes
                    • Outpatient Cardiology referral within 2 weeks: 617-355-2079
                      • Symptoms have resolved and exam is reassuring
                        • Yes
                          • Discharge home with syncope handout
                        • No
                          • Consider further testing, admission or longer observation
                  • No
                    • Symptoms have resolved and exam is reassuring
                      • Yes
                        • Discharge home with syncope handout
                      • No
                        • Consider further testing, admission or longer observation
            • No
              • Borderline EKG (see table) or FH of SIDS, LQTS, congenital deafness, HCM, sudden cardiac arrest < 40y or sudden unexplained death < 40y
                • Yes
                  • Outpatient Cardiology referral within 2 weeks: 617-355-2079
                    • Symptoms have resolved and exam is reassuring
                      • Yes
                        • Discharge home with syncope handout
                      • No
                        • Consider further testing, admission or longer observation
                • No
                  • Symptoms have resolved and exam is reassuring
                    • Yes
                      • Discharge home with syncope handout
                    • No
                      • Consider further testing, admission or longer observation
      • No
        • Abnormal Neurological exam or severe headache
          • Yes
            • Neurology Consult
              • Borderline EKG (see table) or FH of SIDS, LQTS, congenital deafness, HCM, sudden cardiac arrest < 40y or sudden unexplained death < 40y
                • Yes
                  • Outpatient Cardiology referral within 2 weeks: 617-355-2079
                    • Symptoms have resolved and exam is reassuring
                      • Yes
                        • Discharge home with syncope handout
                      • No
                        • Consider further testing, admission or longer observation
                • No
                  • Symptoms have resolved and exam is reassuring
                    • Yes
                      • Discharge home with syncope handout
                    • No
                      • Consider further testing, admission or longer observation
          • No
            • Borderline EKG (see table) or FH of SIDS, LQTS, congenital deafness, HCM, sudden cardiac arrest < 40y or sudden unexplained death < 40y
              • Yes
                • Outpatient Cardiology referral within 2 weeks: 617-355-2079
                  • Symptoms have resolved and exam is reassuring
                    • Yes
                      • Discharge home with syncope handout
                    • No
                      • Consider further testing, admission or longer observation
              • No
                • Symptoms have resolved and exam is reassuring
                  • Yes
                    • Discharge home with syncope handout
                  • No
                    • Consider further testing, admission or longer observation

 

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