Context and Definition

Question: How would you define syncope?

Answer: Syncope is defined as a transient loss of consciousness due to a temporary reduction in blood flow to the brain with full neurological recovery without the need for medical intervention.

Question: Why do you think syncope is challenging for the emergency physician to diagnose?

Answer: Syncope is a condition which presents the emergency physician with significant diagnostic challenges, not least of which because the patient has, by definition, recovered from the index event.

It is a common presentation which accounts for 3-5% of ED attendances [1]. The incidence is not constant throughout life, but rises sharply over the age of 70 years with further rises over the age of 80 in women. In elderly patients in long term care, the incidence can be as high as 6%.

The Framingham Study found that around 30% of patients with syncope had more than one episode.  For a single episode of syncope, prognosis varies greatly and is related to the underlying cause.

Identification of the underlying cause following a single episode of syncope can be challenging. The role of the Emergency Physician is pivotal in risk stratifying serious from non-serious causes of syncope and ensuring appropriate intervention when required while at the same time avoiding unnecessary investigations.

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