Paediatric syncope – a primer from Don’t Forget the Bubbles #DFTB

I'm sure you all read your bimonthly issue of EMA assiduously, so you undoubtedly have seen some of the useful clinical summaries regularly published. I've mentioned the Clinical Procedures section before, and today I thought I'd highlight the paediatric emergency section -
Don't Forget the Bubbles.

If you haven't had a look, the DFTB blog is worth a look for high quality summaries and explorations of topics relevant to paediatric emergency medicine. And for even more paediatric goodness, consider next year's inaugural DFTB conference, which will include sessions dedicated to emergency medicine, as well as general paediatrics.

Syncope in Children

lawton2016-syncopeheader

This article in the June EMA summarises the assessment of syncope - a relatively common presentation in children. History, examination and ECG will identify ALL sinister causes in kids (if done right!). Any child with syncope and one of these concerning features requires further investigation.

Assessment Red Flags Reassuring Features
History

  • During exercise
  • While supine or during sleep
  • Chest pain or palpitations
  • No prodrome
  • Structural heart disease
  • Family history (sudden death, SIDS, long QT, congenital arrhythmias)

  • Prolonged standing in a warm environment
  • Completion of strenuous exercise
  • Prodrome (eg: nausea, dizziness, sensory changes, blurred vision, muffled hearing, light-headedness, feeling weak)
  • Seen to become pale, sweaty or tremulous
Examination ANY abnormal CVS finding Normal CVS examination
ECG

  • Pre-excitation/Wolf-Parkinson-White
  • Long or short QT syndrome
  • Brugada syndrome
  • Hypertrophic obstructive cardiomyopathy
  • AV nodal block
  • Arrhythmogenic right ventricular dysplasia
Normal ECG

For more info, there are resources referenced on paediatric ECG interpretation and normal values, with examples.

The article also has a quick summary on breath holding spells, so make sure you have a read.

 

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