Syncope (peds) - Revision history

Danbot: Remove refs with incorrect PMIDs (verified against PubMed)

2026-03-22T10:26:49Z

Remove refs with incorrect PMIDs (verified against PubMed)

← Older revision		Revision as of 10:26, 22 March 2026
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	''For adult patients see [[syncope]]''		''For adult patients see [[syncope]]''
	==Background==		==Background==
	*Usually because of an abrupt cerebral hypoperfusion (30-50% from baseline) ~~<ref>Hurst D, et al. Syncope in the pediatric emergency department. Pediatr Emerg Care. 2015;31(5):331-334. PMID 25875993</ref>~~		*Usually because of an abrupt cerebral hypoperfusion (30-50% from baseline)
	*Peak age: 15-19 years of age		*Peak age: 15-19 years of age
	*In younger children, usually due to [[seizure (peds)\|seizures]], [[breath-holding spell]] or cardiac disease		*In younger children, usually due to [[seizure (peds)\|seizures]], [[breath-holding spell]] or cardiac disease

Danbot: Add peer-reviewed reference

2026-03-22T10:17:27Z

Add peer-reviewed reference

← Older revision		Revision as of 10:17, 22 March 2026
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	''For adult patients see [[syncope]]''		''For adult patients see [[syncope]]''
	==Background==		==Background==
	*Usually because of an abrupt cerebral hypoperfusion (30-50% from baseline)		*Usually because of an abrupt cerebral hypoperfusion (30-50% from baseline) <ref>Hurst D, et al. Syncope in the pediatric emergency department. Pediatr Emerg Care. 2015;31(5):331-334. PMID 25875993</ref>
	*Peak age: 15-19 years of age		*Peak age: 15-19 years of age
	*In younger children, usually due to [[seizure (peds)\|seizures]], [[breath-holding spell]] or cardiac disease		*In younger children, usually due to [[seizure (peds)\|seizures]], [[breath-holding spell]] or cardiac disease

Rossdonaldson1: /* Differential Diagnosis */

2022-05-14T12:24:05Z

Differential Diagnosis

← Older revision		Revision as of 12:24, 14 May 2022
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	==Differential Diagnosis==		==Differential Diagnosis==
	*[[Seizure]]		{{DDX syncope peds}}
	*[[Toxicologic exposure]] (stimulants or depressant)
	*[[CO poisoning ]]
	*[[Breath-holding spell]]
	*[[Tet spell]]
	*[[congenital heart disease\|Cardiac disease]]
	*[[Pregnancy]] (especially [[ectopic]])
	*[[Hypoglycemia (peds)\|Hypoglycemia]]

	{{~~Syncope causes~~}}

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Evaluation */

2019-11-28T20:23:34Z

Evaluation

← Older revision		Revision as of 20:23, 28 November 2019
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	*[[ECG]]		*[[ECG]]
	*Urine pregnancy (if age/sex appropriate)		*Urine pregnancy (if age/sex appropriate)


	;Consider based on history/symptoms:		;Consider based on history/symptoms:

Rossdonaldson1: /* Workup */

2019-11-28T20:23:22Z

Workup

← Older revision		Revision as of 20:23, 28 November 2019
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	===Workup===		===Workup===
	*[[ECG]]		*[[ECG]]
	*POC ~~blood sugar~~		*Urine pregnancy (if age/sex appropriate)
	*~~Serum extended electrolytes, CBC,~~ TSH
			;Consider based on history/symptoms:
			*CBC (or POC hemoglobin) & chemistry (or POC glucose)
			*TSH
	*[[Tox screen]] (urine or serum – based on clinical scenario)		*[[Tox screen]] (urine or serum – based on clinical scenario)
	*[[Beta-HCG]]
	*Bedside cardiac [[echocardiography]]		*Bedside cardiac [[echocardiography]]
	**Cardiac hypertrophy or [[pericardial effusion]]		**Cardiac hypertrophy or [[pericardial effusion]]

Rossdonaldson1: /* Workup */

2019-11-28T20:20:49Z

Workup

← Older revision		Revision as of 20:20, 28 November 2019
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	*[[ECG]]		*[[ECG]]
	*POC blood sugar		*POC blood sugar
			*Serum extended electrolytes, CBC, TSH
	*[[Tox screen]] (urine or serum – based on clinical scenario)		*[[Tox screen]] (urine or serum – based on clinical scenario)
	*[[Beta-HCG]]		*[[Beta-HCG]]
	*Serum extended electrolytes, CBC, TSH
	*Bedside cardiac [[echocardiography]]		*Bedside cardiac [[echocardiography]]
	**Cardiac hypertrophy or [[pericardial effusion]]		**Cardiac hypertrophy or [[pericardial effusion]]

Rossdonaldson1: /* Evaluation */

2019-11-28T20:18:58Z

Evaluation

@@ Line 33: / Line 33: @@
 ==Evaluation==
-*[[ECG]] – looking for:
+===Workup===
 **[[WPW]] – short PR, Delta waves, wide QRS
 **[[Long QT syndrome]] – QTc >0.450 sec
@@ Line 40: / Line 51: @@
 **[[Arrhythmogenic right ventricular dysplasia]] (ARVD) – incomplete RBBB with T waves inversion in V1-3, epsilon wave is pathognomonic (up-notching of a terminal Q wave)
 **[[Catecholaminergic polymorphic ventricular tachycardia]] - May present with VT/VF due to emotional stress or a regular ECG
 ==Management==

ClaireLewis: /* Evaluation */

2019-09-26T16:58:29Z

Evaluation

← Older revision		Revision as of 16:58, 26 September 2019
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	**[[Brugada syndrome]] – incomplete RBBB with ST elevations in V1-3		**[[Brugada syndrome]] – incomplete RBBB with ST elevations in V1-3
	**[[Arrhythmogenic right ventricular dysplasia]] (ARVD) – incomplete RBBB with T waves inversion in V1-3, epsilon wave is pathognomonic (up-notching of a terminal Q wave)		**[[Arrhythmogenic right ventricular dysplasia]] (ARVD) – incomplete RBBB with T waves inversion in V1-3, epsilon wave is pathognomonic (up-notching of a terminal Q wave)
	**Catecholaminergic polymorphic ventricular tachycardia - May present with VT/VF due to emotional stress or a regular ECG		**[[Catecholaminergic polymorphic ventricular tachycardia]] - May present with VT/VF due to emotional stress or a regular ECG
	*Capillary blood sugar		*Capillary blood sugar
	*[[Tox screen]] (urine or serum – based on clinical scenario)		*[[Tox screen]] (urine or serum – based on clinical scenario)

ClaireLewis: /* Background */

2019-08-31T14:43:50Z

Background

← Older revision		Revision as of 14:43, 31 August 2019
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	*Usually because of an abrupt cerebral hypoperfusion (30-50% from baseline)		*Usually because of an abrupt cerebral hypoperfusion (30-50% from baseline)
	*Peak age: 15-19 years of age		*Peak age: 15-19 years of age
	*In younger children, usually due to [[~~seizures~~ (peds)\|seizures]], [[breath-holding spell]] or cardiac disease		*In younger children, usually due to [[seizure (peds)\|seizures]], [[breath-holding spell]] or cardiac disease

	===Red flags===		===Red flags===

ClaireLewis at 14:43, 31 August 2019

2019-08-31T14:43:30Z

← Older revision		Revision as of 14:43, 31 August 2019
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	''For adult patients see [[syncope]]''		''For adult patients see [[syncope]]''
	==Background==		==Background==
	*Usually because of an abrupt cerebral ~~hypo-perfusion~~ (30-50% from baseline)		*Usually because of an abrupt cerebral hypoperfusion (30-50% from baseline)
	*Peak age: 15-19 years of age		*Peak age: 15-19 years of age
	*In younger children, usually due to seizures, breath holding or cardiac disease		*In younger children, usually due to [[seizures (peds)\|seizures]], [[breath-holding spell]] or cardiac disease

	===Red flags===		===Red flags===
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	**Unexplained deaths		**Unexplained deaths
	**Death due to single-vehicle accident		**Death due to single-vehicle accident
	**Drowning		**[[Drowning]]
	**[[SIDS]]		**[[SIDS]]

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	==Differential Diagnosis==		==Differential Diagnosis==
	*[[Seizure]]		*[[Seizure]]
	*~~Toxicological~~ (stimulants or depressant)		*[[Toxicologic exposure]] (stimulants or depressant)
	*[[CO poisoning ]]		*[[CO poisoning ]]
	*[[Breath-holding spell]]		*[[Breath-holding spell]]
	*[[Tet spell]]		*[[Tet spell]]
	*[[congenital heart disease\|Cardiac disease]]		*[[congenital heart disease\|Cardiac disease]]
	*Pregnancy (especially ectopic)		*[[Pregnancy]] (especially [[ectopic]])
	*[[Hypoglycemia (peds)\|Hypoglycemia]]		*[[Hypoglycemia (peds)\|Hypoglycemia]]

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	==Evaluation==		==Evaluation==
	*[[ECG]] – looking for:		*[[ECG]] – looking for:
	**WPW – short PR, Delta waves, wide QRS		**[[WPW]] – short PR, Delta waves, wide QRS
	**Long QT syndrome – QTc >0.450 sec		**[[Long QT syndrome]] – QTc >0.450 sec
	**Hypertrophic ~~Cardiomyopathy~~ – LVH, ST changes, T wave inversions, lateral leads needle like Q waves and absent R waves		**[[Hypertrophic cardiomyopathy]] – LVH, ST changes, T wave inversions, lateral leads needle like Q waves and absent R waves
	**Brugada syndrome – incomplete RBBB with ST elevations in V1-3		**[[Brugada syndrome]] – incomplete RBBB with ST elevations in V1-3
	**Arrhythmogenic right ventricular dysplasia (ARVD) – incomplete RBBB with T waves inversion in V1-3, epsilon wave is pathognomonic (up-notching of a terminal Q wave)		**[[Arrhythmogenic right ventricular dysplasia]] (ARVD) – incomplete RBBB with T waves inversion in V1-3, epsilon wave is pathognomonic (up-notching of a terminal Q wave)
	** Catecholaminergic polymorphic ventricular tachycardia - May present with VT/VF due to emotional stress or a regular ECG		**Catecholaminergic polymorphic ventricular tachycardia - May present with VT/VF due to emotional stress or a regular ECG
	*Capillary blood sugar		*Capillary blood sugar
	*Tox screen (urine or serum – based on clinical scenario)		*[[Tox screen]] (urine or serum – based on clinical scenario)
	*Beta-HCG		*Beta-HCG
	*Serum extended electrolytes, CBC, TSH		*Serum extended electrolytes, CBC, TSH
	*Bedside cardiac ~~ultrasound~~		*Bedside cardiac [[echocardiography]]
	**Cardiac hypertrophy or pericardial effusion		**Cardiac hypertrophy or [[pericardial effusion]]
	**Assess the IVC for dehydration		**Assess the IVC for [[dehydration]]

	==Management==		==Management==