TLOC/Collapse: The Role of the Emergency Department Observation Unit

This chapter focuses on the importance of the Observation Unit (OU) in management of patients with syncope/collapse. The designation “OU” applies to a dedicated area, generally located near the Emergency Department (EDOU), devoted to the evaluation of patients, including those with transient loss of consciousness (T-LOC) in whom a diagnosis has not been made during the Emergency Department (ED) process but in whom the clinical findings do not suggest an immediate life-threating condition, such as chest pain, severe headache, abdominal pain. In some hospital organizations, the OU can admit patients with diseases that need only a short acute treatment (e.g., acute asthma). In some countries the OU are also termed Short Intensive Observation Unit, meaning that during the observation time an intense and in-depth clinical observation could be done. The OUs dedicated to the management of patients with syncope/collapse are called Syncope Observation Units (SOU). SOU can admit patients with unexplained syncope/collapse at intermediate risk and many of those at high risk and, combined with the in-hospital Syncope Unit (SU), plays a strategic role in the modern efficient management of syncope/collapse patients. The SOU should have a defined syncope management protocol and a well-established organization and essential equipment for an intensive management of unexplained syncope.