Management of syncope in the emergency department

In 2018, the European Society of Cardiology (ESC) published guidelines for diagnosis and management of syncope, which for the first time explicitly addressed the emergency department (ED). Syncope is a major health care issue as approximately half of the entire population has at least one episode in life-time. The patient population with syncope in the ED differs relevantly from other settings, as it is of higher risk compared to primary care settings.

From the perspective of emergency medicine (EM), the process of care starts with a patient, who has a transient loss of consciousness (T-LOC). According to EM standards, patients undergo a structured triage process followed by the medical ABCDE-approach. At this step, severe medical conditions like septic shock, bleeding, trauma or physical shock due to other reasons are sorted out. The further work-up of patients is related to specific suspected diagnoses in the diagnostic process and leads to a final disposition into competent medical departments or outpatient care. ED patients with syncope are mostly high-risk according to ESC criteria and not suitable for direct discharge from ED.

Management of syncope in the ED focus on severe underlying conditions and differential diagnoses of transient loss of consciousness.