Article Figures & Data
Figures
- Figure 1
Classifications of TLoC and syncope. TLoC can be broadly categorized into a traumatic and non-traumatic loss of consciousness, with non-traumatic further subdivided into four groups: syncope, psychogenic pseudo-syncope, epileptic seizures, and rare miscellaneous causes. Syncope is categorized into four types: reflex, cardiac, orthostatic hypotension, and unexplained syncope. Their relative mean frequencies are stated.11 TLoC, transient loss of consciousness.
- Figure 2
Algorithm for the management of falls and syncope evaluation. Credit to ‘Syncope, “mechanical falls”, and the trauma surgeon’ by Biffl et al.16 Consent for image use provided by Wolters Kluwer health (CC-BY-NC). The discussion points A–F and table 1 can be sourced from the original article.
- Figure 3
Venn diagram of the ESC, ACC, and NICE high-risk syncope features. A Venn diagram illustrating which high-risk features indicative of cardiac syncope are recognized by NICE, ACC, and ESC guidance. CHADS-2 estimates stroke risk in patients with atrial fibrillation; ACC, American College of Cardiology; BPM, beats per minute; CAD, coronary artery disease; ED, emergency department; ESC, European Society of Cardiology; GFR, glomerular filtration rate; NICE, National Institute for Health and Care Excellence; SBP, systolic blood pressure; SCD, sudden cardiac death; TLoC, transient loss of consciousness.
- Figure 4
A systematic outline of ATLS principles. ATLS, advanced trauma life support.
Tables
- Table 1
Causes of syncope
Pathophysiological origin Causes Reflex syncope Vasovagal
Situational
Carotid sinus syndrome
Non-classical formsCardiac syncope With obstructive structural heart disease:
Aortic stenosis
Hypertrophic cardiomyopathy
Cardiac masses
Pericardial disease/tamponade
Prosthetic valvular dysfunction
Congenital coronary artery abnormalities
With arrhythmia:
Tachyarrhythmias
Bradyarrhythmias
Cardiopulmonary and great vessels:
Pulmonary embolism
Aortic dissection
Pulmonary hypertensionOrthostatic hypotension Medication induced
Volume depletion
Primary autonomic failure
Secondary autonomic failureThe categorizations and causes of syncope, modified from the European Society of Cardiology.32
- Table 2
Non-syncopal conditions presenting with collapse
Condition Features that distinguish from syncope Cardiac arrest No spontaneous recovery from TLoC Cataplexy Loss of muscular tone and responsive, usually associated with narcolepsy Coma Longer duration of LoC without spontaneous recovery Complex partial seizures, absence epilepsy Unresponsiveness and amnesia without falls, with associated neurological features Falls without TLoC Absence of amnesia and unresponsiveness, clear cause for fall Generalized seizures Aura, flashing lights may trigger, longer duration of LoC, symmetrical rhythmic muscle movements, confusion after LoC lasting minutes (shorter with syncope) Intoxication Longer duration of LoC, consciousness often impaired rather than lost Intracerebral or subarachnoid hemorrhage Severe headache, neurological signs, and progressive LoC Metabolic disorders (hypoglycaemia, hypoxia, hyperventilation with hypocapnia) Longer duration of LoC, consciousness often impaired rather than lost Psychogenic pseudosyncope Increased frequency and longer duration of apparent syncope without true LoC, maintained hemodynamics, normal electroencephalogram Subclavian steal syndrome Upper extremity activity associated with focal neurological signs Transient ischemic attack Focal neurological features usually without TLoC.
If LoC occurs, there is a longer duration of TLoC.Conditions that may be incorrectly diagnosed as syncope are listed, modified from the American College of Cardiology and European Society of Cardiology and syncope guidelines.12 32
LoC, loss of consciousness; TLoC, transient loss of consciousness.
- Table 3
Canadian Syncope Risk Score
Category Risk factors Points Clinical evaluation Predisposition to vasovagal symptoms −1 History of heart disease* 1 Any systolic blood pressure reading <90 or >180 mm Hg 2 Investigations Elevated troponin level (>99th percentile) 2 Abnormal QRS axis (<−30° or >100°) 1 QRS duration >130 ms 1 Corrected QT interval >480 ms 2 Diagnosis in the ED Vasovagal syncope −2 Cardiac syncope 2 Total score Very low risk: −3 to −2 Low risk: −1 to 0 Medium risk: 1–3 High risk: 4–5 Very high risk: 6–11 The risk factors included in the Canadian Syncope Risk Score and their associated points that categorize patients into groups from very low risk to very high risk of serious adverse outcomes after 30 days.
*History of heart disease includes coronary or valvular heart disease, cardiomyopathy, heart failure and non-sinus rhythm on ECG (ECG evidence during index visit or documented history of ventricular or atrial arrhythmias, or device implantation).
ED, emergency department.
- Article
- Abstract
- Introduction
- Syncope and the trauma team
- Definitions
- Causes of syncope
- Assessment of syncope
- Should investigations be protocol driven?
- Which international syncope guideline to follow?
- Risk stratification
- How can trauma be managed differently to prevent recurrent syncope and future trauma?
- Conclusion
- Ethics statements
- Footnotes
- References
- Figures & Data
- eLetters
- Info & Metrics