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
