Table 1 Our emergency department's existing syncope guidelines based on the European Society of Cardiology,⁹,¹⁰ American College of Physicians⁶,⁷ and American College of Emergency Physicians guidelines⁸.

High risk (admit)	Medium risk (consider discharge with early outpatient review)
History findings
Palpitations related to syncope	Age >60 years
Associated chest pain	No prodromal symptoms
Associated headache	Previous myocardial infarct
Related to exertion	Known history of valvular heart disease
Family history of sudden death at <60 years	Known angina/coronary artery disease
Previous history of VT/VF/cardiac arrest	Known history of congestive cardiac failure
Examination findings
Systolic heart murmur heard	>20 mm Hg drop on standing
Signs of heart failure present	Diastolic heart murmur heard
Systolic BP <90 mm Hg	Ventricular pause >3 s on carotid sinus massage
Suspicion of pulmonary embolism	Trauma associated with collapse
AAA detected
New neurological signs on examination
Suspicion of CVA or SAH
FOB present on PR
Other suspicions of GI bleed
ECG findings
Mobitz type II heart block	Right bundle branch block
Wenkebach heart block	QRS duration >120ms
Bifascicular block	Old T wave/ST segment changes
Complete heart block	Frequent pre‐excited QRC complexes
Sinus pause >3 s	Q waves unchanged from old ECG
New ST elevation ventricular tachycardia	Atrial fibrillation or flutter
Sinus bradycardia <50	PR >200 ms (first‐degree heart block)
Sinoatrial block
QTc >450 ms	Low risk (consider discharge)
NEW T wave/ST segment changes	None of the above characteristics
Brugadas (ST segment elevation V1–V3)
Arrhythmogenic right ventricular dysplasia

AAA, abdominal aortic aneurysm; BP, blood pressure; CVA, cerebrovascular accident; FOB, faecal occult blood; GI, gastrointestinal; PR, rectal examination; SAH, subarachnoid haemorrhage; VF, ventricular fibrillation; VT, ventricular tachycardia.