A worried couple bring in their 7 yr old boy (Tom) to your ED after he suddenly lost consciousness at the school athletics carnival.
Fainting or loss of consciousness can be an understandable cause for alarm for parents, especially in those with no family history or experience with fainting.
- A detailed history is the most diagnostic part of syncope assessment
- Vasovagal syncope is by far the most common cause in paediatrics
- A baseline ECG can help rule out rare but deadly causes of arrhythmia
They had just seen him run in the 200m final before lunch, and five minutes later he was lining up for food and fell to the ground. He was initially unresponsive but came to after what seemed like a long time. He then collapsed again within a few minutes on the way to the car. An ambulance was called, and by the time QAS arrived he was awake but feeling very tired.
This is the first time this has happened to Tom, who is an only child and is usually quite a fit and active boy. His mother and father do not have a fainting history and there is no history of congenital heart disease known in the extended family. Tom’s maternal grandfather died at 38 in a car accident.
What is syncope?
Syncope is a sudden and transient loss of consciousness with loss of postural tone from which recovery is spontaneous and complete.
15% of children will experience a syncopal event, the majority of which will be benign.
It is a very common presentation to ED and has a huge list of differentials.
Our role as Paediatric ED physicians is to detect the rare fatal or pathological syncope whilst avoiding over-investigating the benign.
How is syncope classified?
Syncope can be classified into three main groups
- Neurally mediated – most common
- Cardiovascular causes – potentially fatal
- Other – epilepsy and psychogenic
In this series of posts by Elayne Forbes, we will look at how to approach a case like Tom’s – next week on Syncope Sunday – reflex syncope.