Management of syncope in the emergency department

PURPOSE: 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. RECENT FINDINGS: 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. SUMMARY: Management of syncope in the ED focus on severe underlying conditions and differential diagnoses of transient loss of consciousness.