Syncope

SYNCOPE

1. SYNCOPE Presented by:- sudha group ‘F’ Roll no. 72

2. CONTENTS DEFINITION SYNONYMS PREDISPOSING FACTORS CLASSIFICATION CLINICAL MENIFESTATION PATHOPHISIOLOGY EVALUATION MANAGEMENT TREATMENT PREVENTION CONCLUSION REFERENCE

3. ‘syncope is a SYMPTOM not a disease’’

4. DEFINITION SYNCOPE is defined as ‘ sudden and transient loss of consciousness which is secondary to period of cerebral ischemia’’ greek :- ‘ to interrupt’’

5. SYNONYMS Artrial bradycardia Benign faint Neurogenic syncope Psychogenic syncope Simple faint Swoon Vasodepressor syncope Vasovagal syncope

6. PREDISPOSING FACTOR PSYCHOGENIC Fright Anxiety Emotional stress Unwelcome news Pain(sudden and unexpected) Sight of blood or of surgical Dental instruments NON PSYCHOGENIC Sitting in an upright position or standing Hunger Exhaustion Poor physical condition Male sex Hot,humid,crowded environment Age b/w16-35

7. CLASSIFICATION VVS CSS AUTONOMIC FAILURE SITUATIONAL DRUG EFFECTS VOLUME DEPLETION NEURALLY MEDIATED ORTHOSTATIC CARDIAC ARRHYTHMIAS CEREBROVASCULAR STRUCTURAL CARDIOPULMANARY DISEASE

8. PREVENTION PROPER POSITIONING OF PATIENT

9. RELIEF OF ANXIETY. Every potential patient must be recognised and evaluated for the presence of dental anxiety MEDICAL HISTORY QUES- TIONNAIRE (USC)

10. CLINICAL MENIFESTATION

11. PRESYNCOPE EARLY SYMPTOMS Feeling of warmth Loss of colour:pale or ashen grey skin tone Heavy perspiration Complaint of feeling bad or faint Nausea Blood pressure aprox . At baseline tachycardia LATE SYMPTOMS Pupillary dilatation Yawning Hyperpnea coldness in hands and feet Hypotension Bradycardia Visual disturbances Dizziness Loss of consciousness

12. SYNCOPE breathing irregular;jerky,gasping Pupil dilate,death like appears Bradycardiya Pulse weak and Decreased blood pressure.

13. POSTSYNCOPE Pallor,nausea,weakness.sweating from few min. to many hrs. Short period of mental confusion Disorientation Blood pressure and heart rate- normal Tendency of second attack if allowed to stand or sit too soon

14. PATHOPHYSIOLOGY stress release of catecholamine change of tissue perfusion ,decrease peripheral vascular resistance,increase blood flow Pooling of blood

15. decrease in circulatory volume decrease in cerebral blood flow SYNCOPE decrease in blood pressure compensatory mechanism are activated

16. FAMILY HISTORY Sudden unexplained death Deafness Arrhythmias Congenital heart disease Seizures Metabolic disorders Myocardial infarction at young age

17. HISTORY Time and day Activities preceding (recurrent/at rest, exercise associated, on standing) Prodromes , associated symptoms Duration of LOC Injuries Medications, ingestions Cardiac History

18. MANAGEMENT

19. PRESYNCOPE Procedure should be stopped P-Patient placed into the supine position with the legs slightly elevated

20. A- airway B- breathing C- circulation D- drugs

21. SYNCOPE Step 1:- Assess consciousness Step 2:-Call for assistence Step 3:-Position the patient:- placing the patient in supine position Step 4:-Assess and open airway Step 5:-Assess airway potency and breathing Step 6:-Assess circulation

22. IF THE PATIENT CONTINUES TO REMAIN UNCONSCIOUS SUMMON MEDICAL ASSISTANCE IMMEDIATELY

23. Step 8:-Administer oxygen Step 9:-Monitor vital signs Step 10:-provide definitive management Step 11:-delay patient recovery

24. DEFINITIVE MANAGEMENT Loosening of clothes Respiratory stimulant:-aromatic ammonia Cold towel on patient’s forehead. Blanket placed If bradycardia persist:- anticholinergics atropine-0.5mg or max 3 mg

25. POSTSYNCOPE Patient should not be subjected to additional dental care. The possibilities of second episode of syncope during this period of time. Prior to dismissal ,the doctor should determine from the patient what the primary precipitating event was and what other factors may have been present such as hunger or fear.

26. PRECAUTION Controlling the predisposing factors Before the patient enters the treatment area It should be made certain that the patient has eaten recently a comfortable enviromental temperature and humidity in the office Stress reduction modalities can be employed Sedation through variety of drugs Reducing anxiety Proper positioning and receiving supplemental oxygen

27. TREATMENT Immediately stop any dental treatment going on Loosen tight clothing Place the patient in head low position With lower limb elevated ( trendelenburg position) monitor pulse If pulse is normal Sprinkle cold water Carry a gauge dipped in aromatic spirit of ammonia close to patients nostrils If bradycardia Injection of atropine 6mg i.v . Injection of mephentramine 10-30 mg i.m . If patient is still not responding support respiration (start oxygen)

28. CONCLUSION Syncope is a common symptom, often with dramatic consequences, which deserves thorough investigation and appropriate treatment of its cause . There are many causes of syncope Be vigilant in ruling out the life-threatening ones! Use the ultrasound machine Take into account the risks of hospitalization

29. REFERENCES MEDICAL EMERGENCIES IN DENTAL CLINIC-STANLEY F. MALAMED 4 th edition www.toothdent.com