SYNCOPE

2. SYNCOPE
Pr e s e n t e
d b y :-
s u d h a
g r o u p

3. CONTENTS
DEFINITI CLASSI
ON SYNONY PREDISP FICATI
MS OSING ON
FACTORS
MANAGEM
ENT
EVALUAT PATHOP CLINICAL
ION HISIOLO MENIFES
GY TATION
REFERE
CONCLU NCE
SION
PREVENT
ION

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

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

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

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

8. CLASSIFICATION
CARDIAC STRUCTURA
ARRHYTHMIAS L
CARDIOPUL
MANARY
NEURALLY DISEASE
MEDIATED
ORTHOSTATIC
CEREBROVAS
CULAR
• VVS
• CSS AUTONOMIC FAILURE
• SITUATIONAL DRUG EFFECTS
• VOLUME DEPLETION

10. PREVENTION
• PROPER POSITIONING OF PATIENT

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

12. CLINICAL
MENIFESTATION
PRESYNCOPE
SYNCOPE
POSTSYNCOPE

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

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

15. 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

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

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

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

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

20. MA N A G E ME N T

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

22. • A- airway
• B- breathing
• C- circulation
• D- drugs

23. 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

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

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

26. 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

27. 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.

29. 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

30. 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)

31. 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

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