The European Society of Cardiology issued updated syncope guidelines in 2018 which included recommendations for managing syncope in the emergency department (ED) setting. However, these guidelines lack detailed process-oriented instructions regarding the fact that ED syncope patients initially present with a transient loss of consciousness (TLOC), which can have a broad spectrum of causes. This study aims to establish a European consensus on the general process of the workup and care for patients with suspected syncope and provides rules for sufficient and systematic management of the broad group of syncope (initially presenting as TLOC) patients in the ED.

This is a large, prospective, multicentre study to derive a clinical decision tool to identify elderly patients who can safely forgo a CT scan of their head after a ground level fall or out of a bed.
Patients were assess for the following predictors:
age; sex; head impact on falling; loss of consciousness; amnesia; history of previous major bleed; cirrhosis; previous ischemic stroke; chronic renal impairment; Glasgow Coma Scale reduced from baseline; bruise or laceration on the head; new abnormality on neurologic examination; hemoglobin < 10 g/L; platelet count < 80 × 109/L; anticoagulant therapy; antiplatelet therapy; and Clinical Frailty Scale ≥ 5 (impairment of high order IADLs – see scale below)
Clinicians had to fill out these variables before they could view CT head results (if one was ordered). 
Patients were followed up to 42 days (based on expert consensus) by chart review.

The study was conducted at 11 different EDs in Canada and the USA, with 4308 patients enrolled. 

Pacijentkinja u srednjim 60-im se prijavila u bolnicu sa povremenim epizodama bola u grudima koje se javljaju više puta dnevno, često uz napor.

Imala je infarkt miokarda i dve nedelje ranije su joj postavljena dva stenta. Takođe je primljena oko nedelju dana ranije zbog dvočasovne epizode ​​bola u grudima koja se povukla nitroglicerinom. Njeni troponini su u to vreme bili povišeni oko tri puta iznad gornje granice normale, ali su bili u opadanju, tako da je medicinski zbrinuta bez još jedne kateterizacije.