Pediatric emergency medicine trisk 1512 1512
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inhalants, and opiates may cause a loss of consciousness, though not true
syncope. Carbon monoxide is an important environmental toxin to consider in
applicable clinical scenarios.
CLINICAL EVALUATION
In children who present with syncope, the history usually offers key information
to assist the clinician in making the diagnosis. However, objective findings are
often absent, which can pose a challenge. An orderly approach to the evaluation
of pediatric syncope is essential and consists of a meticulous history and physical
examination, a 12-lead ECG, and the use of additional testing only in selected
patients ( Fig. 76.1 ). Extensive testing is usually unnecessary.
Determine the sequence of events leading up to the syncopal event and the
position of the patient’s body just before the syncope. It may be necessary to
obtain information from eyewitnesses, as the patient may not recollect all aspects
of the event. Search for precipitating factors, such as exercise, loud noise or a
startle response, rapid postural changes, anxiety or emotional stress, trauma,
dehydration, medication intake, or recreational drug use. Exertion-related
syncope suggests a cardiac cause. Sudden loud sounds or arousal may precipitate
syncope in patients with long QT interval syndromes. In situational syncope,
some specific activities such as stretching, arising suddenly from a recumbent
position, swallowing, coughing, hair brushing, voiding, or defecation may be
associated with loss of consciousness.
