FBC if clinically anaemic or blood loss suspected.
CXR, ECHO if cardiac cause suspected
ED Provocation tests (not routinely done)
Carotid sinus massage
Hyperventilation (psych cause)
Tilt table testing
Treat underlying cause
Consider admission for possible cardiac cause, significant bleeding, unsupervised social situation, or high risk
Syncope CHESS Rule
2004 San Francisco Rules for short term (7-30d) serious outcome (death, MI, arrhythmia, PE, CVA, SAH, transfusion, return ED visit) risk (96% sens, 62% spec) in undifferentiated syncope:
Systolic BP<90mmHg at triage
Some validation studies of CHESS rule have shown considerably less sensitivity & specificity, but other studies have identified (1) age >65 years; (2) history of CCF; (3) an abnormal ECG as consistent high risk factors. So reasonable to stratify as high risk on CHESS criteria and 2 extra factors Elderly and Family Hx of sudden death.