Very basic presentation for syncope.pptx

syncope basic ppt

1. Syncope is a general term referring to sudden, transient loss of consciousness that usually occurs secondary to a period of cerebral ischemia. Vasodepressor syncope also known as vasovagal syncope – more often referred to as common faint is potentially life threatening Approx. 53% of all reported emergencies

2. Classified in two groups:

3. Vasodepressor syncope is most commonly precipitated by decrease in cerebral blood flow below a critical level (i.e. 30ml of blood/100gm of brain tissue/min) Presyncope Stress whether emotionally triggered (as with fear) or sensorially triggered (unexpected pain) cause the body to release into the circulatory system increased amount of catecholamines epinephrine and norepinephrine. Their release is a part of body adaptation to stress, commonly called as “ fight or flight ” response.

4. Response to catecholamine release are: Decrease in peripheral vascular resistance Increase in blood flow to many tissues. If anticipated muscular activity occurs Blood volume pumped back to the heart Peripheral pooling of blood does not occur Blood pressure remains at or above the baseline Signs and symptoms of vasodepressor syncope does not occur This happens in normal circumstances

5. If preparation for muscular activity does not occur Diversion of large volumes of blood to the skeletal muscles Pooling of blood in the muscles Decreased venous return to heart Decreased circulatory blood volume Drop in arterial pressure Decrease in cerebral blood flow Presyncopal signs and symtoms are related to decreased cardiac output, diminished cerebral blood flow and other physiologic alteration

6. Blood pools in peripheral vessels Arterial blood pressure begins to fall Compensatory mechanisms are activated Baroreceptors reflexly constrict peripheral blood vessels Carotid & aortic arch reflexes increase heart rate Increase venous return to the heart Increased cardiac output Maintenance of a near-normal blood pressure

7. Compensatory mechanisms soon fatigue Development of reflex bradycardia Slowing of heart rate (<50beats/min) Drop in cardiac output Precipitous fall in blood pressure to levels below critical for maintenance of consciousness Cerebral ischemia Unconsciousness

8. Early Feeling of warmth Loss on color, pale or ashen-gray skin tone Heavy perspiration Complaint of “feeling bad” or “feeling faint” Nausea Blood pressure at baseline or slightly lower T achycardia Presyncopal signs and symptoms Late Pupillary dilation Yawning Hyperpnea Cold hands & feet Hypotension Bradycardia Visual disturbances Dizziness Loss of consciousness

9. Syncope: Breathing may become: I rregularly jerky & gasping Become quiet, shallow and scarcely perceptible Cease entirely Pupils dilated Death like appearance Convulsive movements Muscular twitching of hands, legs and facial muscles Loss of consciousness Brain becomes hypoxic

10. Postsyncope Palor Nausea Weakness Sweating Disorientation Confusion Note : postsyncopal symptoms can last from a few minutes to several hours (even for 24 hrs )

11. Divided into four stages: Presyncope Position Airway Breathing Circulation Definitive care

12. Syncope Step 1:Assessment of consciousness Step 2:Activation of dental office emergency system Step 3: P Placement of the victim in supine position Slight elevation of the legs– increase return of blood from periphery Failure to place victim in supine position can result in death or permanent neurological damage Females in latter stage of pregnancy who lose consciousness are one important exception to this position

13. Step 4: A-B-C (basic life support, as needed) Victim must be assessed immediately Patent airway ensured Head tilt-chin lift procedure successfully establishes a patent airway And adequate airway is present when the patient’s chest moves and exhaled air can be heard and felt Spontaneous respiration is evident during syncope. Artificial ventilation may be necessary on few occasions in which spontaneous breathing ceases

14. To assess circulation, carotid pulse must be palpated Brief periods of ventricular asystole can develop during systole Weak thready pulse is palpable in the neck Heart rate is commonly quite low Patient gains consciousness by this time

15. Step 5: D (definitive care) 5a: administration of O2 5b: monitoring of vital signs Blood pressure, heart rate, respiratory rate should be monitored 5c: performance of additional procedure Loosening of binding clothes such as ties, collars and belts Use of respiratory stimulant such as aromatic ammonia Rescuer should crush an ammonia vaporole between the fingers and allow the patient to inhale it Ammonia stimulates increased breathing and muscular movement

16. 3. Delayed recovery If victim does not regain consciousness after previously mentioned steps or in 15-20 mins , a different cause should be considered EMS system should be activated Doctor should continue performing basic life support while awaiting arrival of EMS team If another cause becomes obvious– definitive treatment If no obvious cause– continue life support and if possible iv infusion

17. Postsyncope After recovery, victim should not undergo additional dental treatment the rest of that day Possibility of a second syncopal episode is greater (body requires upto 24 hrs to rreturn to its normal state) Prior to dismissal, doctor should determine the primary precipitating event & any other factors Arrangements must be made for a friend or family member to take the patient home Drugs used in management: O2, ammonia, atropine

18. Elimination of predisposing factors Adequate air conditioning eliminates heat factor Patient hunger, result of diet and missed meal should be considered Modifications in dental treatment should be considered for medically compromised patient

19. REFERENCES Medical Emergencies in Dental Office Monheim’s Malamed -- Intern

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