The key to understanding syncope is understanding who is at high risk and who can go home. Over the years, numerous different studies have been done looking at this topic. The easy way to remember the approach to syncope is 6-6-6. There are 6 high risk EKG findings. 6 important risk factors, and 6 deadly syncope mimics (aka the “Rule of 15s”). Patients with these are at high risk for sudden death and typically need to be admitted, even if they sound like a “simple” case of “orthostatic” syncope.