We noted you are experiencing viewing problems
-
Check with your IT department that JWPlatform, JWPlayer and Amazon AWS & CloudFront are not being blocked by your network. The relevant domains are *.jwplatform.com, *.jwpsrv.com, *.jwpcdn.com, jwpltx.com, jwpsrv.a.ssl.fastly.net, *.amazonaws.com and *.cloudfront.net. The relevant ports are 80 and 443.
-
Check the following talk links to see which ones work correctly:
Auto Mode
HTTP Progressive Download Send us your results from the above test links at access@hstalks.com and we will contact you with further advice on troubleshooting your viewing problems. -
No luck yet? More tips for troubleshooting viewing issues
-
Contact HST Support access@hstalks.com
-
Please review our troubleshooting guide for tips and advice on resolving your viewing problems.
-
For additional help, please don't hesitate to contact HST support access@hstalks.com
We hope you have enjoyed this limited-length demo
This is a limited length demo talk; you may
login or
review methods of
obtaining more access.
Printable Handouts
Navigable Slide Index
- Introduction
- Challenge 4 - using aggressive management
- ER - risk stratification
- The ROSE study
- Do TLOC “experts” help?
- Usual vs. standardized care
- Standardized vs. usual care tests
- Challenge 5 - treating the problem
- Neurocardiogenic syncope - treatment options
- Neurocardiogenic syncope - drugs
- Do pacemakers help? VPS I study
- Do pacemakers help? VPS II study
- Why pacing might help
- Why pacing may not help
- Young woman with syncope
- ACC/AHA guidelines
- Challenge 6 - restricting the patient
- Syncope - restrictions
- 18 yo female - syncope (1)
- 18 yo female - syncope (2)
- Dizziness - 19 yo football player
- A day in the emergency department
- Summary
Topics Covered
- Challenge #4: determining who needs aggressive management
- Challenge #5: treating the problem
- Pacemakers as a treatment
- ACC/AHA guidelines
- Challenge #6: restricting the patient
Talk Citation
Olshansky, B. (2021, January 10). Syncope: finding the cause of the drop 2 [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved December 9, 2024, from https://doi.org/10.69645/VOTG6265.Export Citation (RIS)
Publication History
Financial Disclosures
- Prof. Brian Olshansky has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.
Syncope: finding the cause of the drop 2
A selection of talks on Clinical Practice
Transcript
Please wait while the transcript is being prepared...
0:04
A fourth challenge is to determine
who needs aggressive management.
As you can see from
the previous case,
this individual did require
aggressive management
to prevent life-threatening
ventricular
fibrillation from killing her.
0:20
There are various risk
stratification schemes
and algorithms that
have been developed
to assess which individual
is at highest risk for dying.
This doesn't necessarily
mean ventricular
fibrillation as cause for death.
It may be sudden cardiac death.
It may be death from
some other cause.
So in terms of the
emergency department,
this rule, the San Francisco
Syncope Rule, has been used.
The eponym, I think is
the proper term is CHESS,
and that is congestive heart
failure, hematocrit less than 30%,
abnormal ECG, shortness of
breath, and systolic blood
pressure less than
90 on presentation.
The problem is, when you
use a rule like this,
48% of the individuals who came
into the emergency department
with syncope were
considered high risk,
and therefore, clinical
judgment had similar results
in terms of admission and also
in terms of long term outcome.
Therefore, this rule
really did not add much
in terms of how to evaluate
the individual who comes
into the emergency room,
and then the decision
might be to either admit
the patient to rule out
a life-threatening potential
cause for the syncope,
or to let the patient go home.
This is a critical issue in
the emergency department-
what to do with the patient.
More recently, there have
been other approaches
that have been postulated
as being good approaches.
We'll talk a little
about that in a second.