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Syncope Smart Phrase

Description: Epic smart phrase with syncope differential diagnosis and initial workup plan.

Syncope Dot Phrase

Syncope: evaluating cardiac, neurological, and metabolic syncope

Cardiovascular syncope: Differential diagnosis includes mechanical, electrical, vasovagal, orthostatic
 
Cardiac mechanical (Aortic Stenosis, Hypertrophic cardiomyopathy, Pulmonary Embolism, HTN, Stenosis, Aortic Dissection, Myocardial Infarction)
Plan:
- Echo
- CXR
- D-dimer / CT-PE if hypoxic
- EKG
- CMx2; stress test if negative
- EKG PRN with pain
- Continuous pulse-ox
- tele
 
Cardiac electrical (AV Block, Sick Sinus Syndrome, Arrhythmia, Long QT syndrome)
- EKG
- tele
 
Vasovagal Syncope (Carotid sinus cardioinhibitory, vasodepressor central, Vasovagal cough, micturition defecation, post-prandial valsalva, sneeze)
Orthostatic (Dehydration, Diuretic drugs, Blood Loss, Autonomic insufficiency, Sympathetic nervous system blocker drugs, Adrenal Insufficiency, Vasodilator drugs, Idiopathic)
Plan:
- Measure orthostatic VS
- Daily CBC/BMG
- Review drugs
 
Neurologic syncope: cerebral hypoperfusion due to Transient Ischemic Attack (TIA), Seizure, Takayatsu Arteritis, Intermittent Pressure Hydrocephalus, Subclavian Steel Syndrome, Vertebrobasilar insufficiency.
Plan
- Head CT
- EEG
- MRI/MRA
- Cardiac echo
- Carotid dopplers
 
Metabolic syncope: Hypoglycemia syncope, Hypoxia syncope, Shock, Hyperventilation, Anemia, Alcoholic
Plan
- Blood sugar QAC/HS
- Continuous pulse-ox
- Frequent vitals
- CBC (iron studies if indicated)
- Blood alcohol level; tox screen
- Review medications (hypoglycemic dosing; sulfonylureas and insulin)
 
Psychiatric: panic disorders, depression , hysteria
 

Epic Smart Phrases

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