Syncope is a common presenting complaint to emergency departments, and can lead to costly and often fruitless inpatient hospitalizations. Observation units can be particularly helpful in the assessment of an unexplained syncopal event by providing a period of monitoring and a chance to obtain further testing in those patients who are not deemed low risk enough for immediate discharge and outpatient follow-up, nor high risk for adverse events. This chapter will discuss some of the tips and pitfalls in the assessment of the syncope patient and some of the traditional diagnostic options during the patient’s evaluation.