SYNCOPE EVALUATION AND MANAGEMENT - Ohio State …：晕厥的评估和管理-俄亥俄州….ppt

SYNCOPEEVALUATION AND MANAGEMENT Jayne Barr, MD Clinical Assistant Professor The Ohio State University Case #1 42 year old female Chief complaint: passing out at work Works in a pharmaceutical lab. Was sitting at her desk, felt nauseated and knew she was going to pass out. Per witnesses, was slump over chair and was unconscious for a few seconds. Case continues No chest pain, palpitations, shortness of breath Similar episodes 10 years ago. No family history of sudden cardiac death No medications. No smoking. No alcohol. No drugs. Case #2 82 year old male. Found unresponsive by his son Past medical history—HTN Medications—HCTZ Exam—BP 160/98. P 70. Now alert and oriented. Facial contusions. Otherwise normal exam. Q: How would you manage these 2 patients? Syncope: Definition Abrupt and self-limited loss of consciousness associated with absence of postural tone Relatively rapid onset. Variable warning symptoms. Followed by rapid and complete recovery. Last only a few minutes. Absence of prolonged confusion Presyncope---prodromal symptom of fainting and typically has the same work up as syncope. Significance of Syncope “The only difference between syncope and sudden death is that in one you wake up”. [1] --anonomymous Syncope: Epidemiology 20-50% of adults experience at least one episode of syncope during their lifetime. Explained 53-62% Infrequent, unexplained 38-47% 500,000 new syncope patients each year. 3-5% of ER visits. 6% of hospital visits. More common in the elderly. Up to 23% in age 70 years. Syncope: Economic Burden Per recent data, the overall cost per hospital admission was estimated to be about $10,600. One study found to be $17,000 of “unnecessary” testing to diagnosis vasovagal syncope Overall cost in US estimated to be in excess of $1 billion. Costs of Test Troponin $78 EKG $221 Telemetry $255/d Head CT $1545 MRI brain $2216 Carotid US $1294 EST $2492 Echocardiogram $809 EEG $1115