Syncope | Hypotension |

Syncope is a temporary loss of consciousness usually related to insufficient blood flow to the brain. It's also called fainting or "passing out." It most often occurs when blood pressure is too low (hypotension) and the heart doesn't pump enough oxygen to the brain.
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1. SYNCOPE

2. How to deal with SYNCOPE in the dental clinic? Medical emergencies that occur in dental offices can vary from minor to life-threatening.  All dental team members need to be prepared to take an active role in handling any emergency. Every dental office should have an emergency management plan in place.

3. Each staff person should be able to perform basic life support services competently in order to keep patients alive until advanced help arrives. The most prepared dental offices routinely practice various scenarios and employ a team approach to handle any acute emergency.

4. Syncope (fainting) is the most common emergency seen in dental offices (50% to 60% of all emergencies). Although it occurs predominately in Adults .

5. Syncope occurs as a result of a “ Fight or Flight ” response and the absence of patient muscular movement, leading to a transient loss of consciousness. It is most common in young adults, most commonly between the ages of 16 to 35 years , and in men more than women.

6. Pediatric patients rarely develop syncope because they do not hide their fears and readily react emotionally and physically during a stressful situation. If a pediatric patient or an adult older than 40 years exhibits syncope without predisposing factors, they should be sent for medical consultation.

7. The basic algorithm should be followed for the management of all medical emergencies that is access Airway (A), Breathing ( B) and Circulation (C). The American Heart Association recently changed the order of this algorithm to CAB—Circulation, Airway, and Breathing—for Cardiac arrest cases only.

8. The original ABC should be followed for basic medical emergencies. All patients should undergo a thorough medical history review and have their vital signs recorded before the treatment begins. Promptly recognizing an emergency followed by quick response are imperative to successful outcomes.  

9. There is this main position that patients can be placed in when they are experiencing syncope. If the patient loses consciousness, he or she should be placed supine or in the head down/feet up (Trendelenburg) position .

10. Low blood pressure in the brain is the cause of almost all medical emergencies where the patient loses consciousness. Placing the patient in supine position increases blood pressure in the brain and will help the patient regain consciousness in most of the cases .

11. Medical emergency care should be administered by the dental team members based on their training and ability. However, all dental personnel must be familiar with the basic emergency kit and common medical emergencies. Keeping up-to-date with continuing education courses, literature, and basic life support training is critical for proper preparation.

12.   There are several different types of syncope. The type depends on the cause of the problem . Vasovagal syncope (also called cardio- neurogenic syncope). Vasovagal syncope is the most common type of syncope. It is caused by a sudden drop in blood pressure, which causes a drop in blood flow to the brain.

13. When you stand up, gravity causes blood to settle down in the lower part of your body, below the diaphragm. When that happens, the heart and autonomic nervous system (ANS) works to keep the blood pressure stable.

14. Typical triggers include: • Prolonged standing • Emotional stress • Pain • The sight of blood • Time varying magnetic field

15. Some patients with vasovagal syncope have a condition called O rthostatic hypotension . This condition keeps the blood vessels from getting smaller (as they should) when the patient stands. This causes blood to collect in the legs and leads to a quick drop in blood pressure.

16. When a patient experiences syncope, he or she should be placed in a head down/feet upside position and the ABCs must be assessed. Most patients with syncope have a patent airway, have breathing, demonstrate an adequate pulse, and respond to positional changes within 30-60 seconds.

17. If the patient does not respond in this time frame, he or she did not simply faint and the dental team must consider a complete differential diagnosis for loss of consciousness. Although many possible explanations exist, the more common reasons include low glucose levels, stroke, or cardiac arrest.

18. The initial management of the emergency situation is the same. The dentist should access the condition, call for help and use the emergency kit, and place the patient in a head down/feet up position. The patient's airway should be opened with a head-tilt/ chin lift and breathing assessed.

19. If the patient is breathing, the next step is to check circulation and record the patient's vital signs. Do the patient have a palpable pulse at the carotid artery? What is the patient's pulse rate and blood pressure? If he or she does not respond within 1 minute, the clinician probably may rule out vasovagal syncope.  

20.   SITUATIONAL SYNCOPE Situational syncope is a type of vasovagal syncope. It happens only during certain situations that affect the nervous system and leads to syncope. Some of these situations are : Dehydration Intense emotional stress Anxiety Fear Pain

21. Hunger Use of alcohol or drugs Hyperventilation (breathing in too much oxygen and getting rid of too much carbon dioxide too quickly) Coughing forcefully, turning the neck, or wearing a tight collar (carotid sinus hypersensitivity) Urinating (mic turition syncope)

22. POSTURAL SYNCOPE(also called postural hypotension) Postural syncope is caused by a sudden drop in blood pressure due to a quick change in position, such as from lying down to standing. Certain medications and dehydration can lead to this condition.

23. Patients with this type of syncope usually have changes in their blood pressure that cause it to drop by at least 20 mmHg (systolic/top number) and at least 10 mmHg (diastolic/bottom number) when they stand. Cardiac syncope is caused by a heart or blood vessel condition that affects the blood flow to the brain.

24. These conditions includes an Abnormal heart rhythm (arrhythmia), Obstructed blood flow in the heart due to structural heart disease (the way the heart is formed), Blockage in the cardiac blood vessels (myocardial ischemia), Valve disease, Aortic stenosis, Blood clot, or Heart failure. If you have Cardiac syncope, it is important to see a Cardiologist for proper treatment.

25. NEUROLOGIC SYNCOPE Neurologic syncope is caused by a neurological condition such as seizure, stroke or Transient I schemic Attack (TIA). Other less common conditions that lead to neurologic syncope include migraines and normal pressure hydrocephalus.

26. POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME (POTS) Postural-Orthostatic Tachycardia Syndrome is caused by a very fast heart rate (tachycardia) that happens when a person stands after sitting or lying down. The heart rate can speed up by 30 beats per minute or more. The increase usually happens within 10 minutes of standing. The condition is most common in women but it can also occur in men.

27. Unknown Causes of Syncope The cause of syncope is unknown in about one-third of patients. However, an increased risk of syncope is from the side effects of some medications. Equipments that should be part of medical emergency Portable, full and functional oxygen cylinder tank. Oxygen delivery devices (nasal cannula, face mask etc). Stethoscope and sphygmomanometer to check blood pressure. Glucometer, Flashlight.

28. To book an appointment contact : Dr.Rajat Sachdeva Director & Mentor Dr Sachdeva ’s Dental Aesthetic And Implant Institute I 101, Ashok Vihar Phase 1, Delhi- 110052 Contact us at Phone : [phone]

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