Syncope Decision Tool

Syncope triage · ROSE score · ECG interpretation · Cardiac · Reflex · Discharge criteria · ESC 2018 · One-time purchase · Works offline

IMPORTANT: For use by qualified healthcare professionals only.

Syncope Decision Tool is a fast, tap-through clinical decision support app for on-call clinicians managing transient loss of consciousness. Built for ED doctors, acute medicine physicians, cardiologists, neurologists, and GPs. Dark navy with teal accents. Full references and citations throughout.

IS THIS SYNCOPE? ESC 2018 definition: transient LOC due to global cerebral hypoperfusion. Syncope vs seizure vs TIA comparison table: prodrome, posture, skin colour, movements, duration, recovery, lateral tongue bite. Presyncope has equal clinical significance -- same risk stratification applies.

CLASSIFY -- CARDIAC VS REFLEX VS ORTHOSTATIC Three-branch ESC 2018 classification. Initial assessment checklist: 12-lead ECG, lying and standing BP, glucose, troponin, FBC, U+E, witness account, full history.

ROSE SCORE -- RISK STRATIFICATION ROSE score (Reed, Heart 2010): BNP above 300, bradycardia below 50, rectal occult blood, anaemia, chest pain, ECG abnormality, SpO2 below 94%. Score 2 or above: high risk, admit urgently. Score 0-1: low risk, consider discharge. ESC 2018 high-risk criteria. San Francisco Syncope Rule (CHESS, Quinn 2004).

ECG HIGH-RISK FEATURES Arrhythmia: sinus bradycardia below 40, Mobitz II and complete heart block, VT, tachycardia above 150. Channelopathies: Brugada pattern (Brugada JACC 1992), Long QT (QTc above 480ms), Short QT, ARVC epsilon wave, WPW pre-excitation (do not give AV nodal blockers). Ischaemic: new LBBB, ST changes, S1Q3T3 (PE).

CARDIAC SYNCOPE Arrhythmic: telemetry 24 hours, Holter, external loop recorder, implantable loop recorder (ISSUE trial, Krahn 2001), EPS. Structural: aortic stenosis (urgent echo), HCM (exertional, ICD consideration), massive PE, aortic dissection, tamponade. 1-year mortality 18-33% -- admit all suspected cardiac syncope.

REFLEX (VASOVAGAL) SYNCOPE Classic prodrome: nausea, sweating, pallor. Triggered by standing, emotion, pain, heat. Benign -- no increased mortality. Carotid sinus massage protocol. Management: physical counter-pressure manoeuvres, tilt training (Ector 1998). POST trial: beta-blockers ineffective (Sheldon 2006). Fludrocortisone and midodrine if refractory.

ORTHOSTATIC HYPOTENSION 20mmHg systolic or 10mmHg diastolic drop within 3 minutes standing. Drug causes: antihypertensives, diuretics, levodopa, dopamine agonists. Neurogenic: Parkinson disease, MSA, diabetic autonomic neuropathy. Treatment: fluids, salt, compression stockings, fludrocortisone 0.1-0.3mg OD, midodrine (last dose before 6pm).

NEUROLOGICAL -- SYNCOPE VS SEIZURE VS TIA Seizure features: lateral tongue bite (highly specific), post-ictal confusion above 5 minutes, elevated CK. TIA does not cause TLOC in anterior circulation. First seizure: NICE NG217 2022. DVLA driving rules: Group 1 and Group 2 guidance (DVLA 2022) -- document advice in notes.

SAFE DISCHARGE AND SAFETY-NETTING Safe discharge criteria (ESC 2018, NICE NG109). Interactive 7-item checklist: driving advice, return precautions, medication review, vasovagal lifestyle advice, falls risk, follow-up, documentation. Documentation template for medical notes.

REFERENCES 12 cited sources, 21 inline citation badges. ESC 2018; NICE NG109 2021; NICE NG217 2022; DVLA 2022; ROSE (Reed, Heart 2010); CHESS (Quinn 2004); ISSUE trial (Krahn 2001); POST trial (Sheldon 2006); tilt training (Ector 1998); Brugada (JACC 1992).

Font A- / A+ adjustment. No login. No patient data stored.

DISCLAIMER For qualified healthcare professionals only. Does not replace clinical assessment or guidelines. One-time purchase · No subscription · Works fully offline.