Most children with syncope will be fully recovered by the time they arrive at the emergency department.34 Continued altered level of consciousness should prompt an evaluation for causes other than syncope. Treatment should be tailored to current symptoms. Signs of compromised oxygenation, ventilation, or circulation should be addressed immediately. A cardiac monitor should be applied to the patient while gathering the history and physical findings to document any transient dysrhythmias. Vascular access and blood for laboratory studies should be obtained for all children except those in which a simple vasovagal event explains the symptoms.

Treatment is targeted to specific identified etiologies for the syncopal event. Ongoing cardiac dysrhythmias or seizures should be managed as appropriate. Most patients, however, will have no treatable dysrhythmias in the emergency department.

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