Syncope Evaluation and Management in an Urgent Care Setting Urgent message: When a patient presents to urgent care after a syncopal event, the clinician’s charge is to determine whether the episode was of benign or potentially life-threatening etiology and whether the patient should be transferred for further evaluation. Kenneth V. Iserson, MD, MBA, FACEP, FAAEM, Professor of Emergency Medicine, The University of Arizona, Tucson, AZ Introduction yncope is a sudden, transient loss of consciousness with a loss of postural tone (typically, falling). It results from an abrupt, transient, and diffuse cerebral malfunction and is quickly followed by sponta- neous recovery. The term syncope excludes seizures, coma, shock, or other states of altered consciousness. Many patients will ascribe their syncopal episode to a sit- uationally mediated vasovagal episode. Despite this, the goals in the urgent care setting include the following: Ⅲ Determining whether the patient’s episode was actually a syncopal or presyncopal event, and if it could have a life-threatening etiology Ⅲ Stabilizing the patient Ⅲ Transferring those patients who need further diag- nostic studies or therapeutic interventions © John Bolesky, Artville S Epidemiology Syncope accounts for up to 3% of emergency depart- ment (ED) visits and up to 6% of hospital admissions each year in the United States. 1,2 At some time in their lives, up to about half the population (12% to 48%) of people may experience syncope. 3 Syncope occurs in all age groups, but it is most com- mon in adults. Non-cardiac causes tend to be more w w w. j u c m . c o m common in young adults, while cardiac syncope becomes increasingly more frequent with advancing age. 4 The chance of having at least one syncopal episode in childhood is between 15% and 50%. 5 Though a benign cause is usually found, syncope in children war- rants prompt detailed evaluation. 6 With advancing age comes an increased frequency of The Journal of Urgent Care Medicine | October 2006 13