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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
PRESYNCOPE EARLY SYMPTOMS LATE SYMPTOMS Feeling of warmth Pupillary dilatationLoss 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
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
PATHOPHYSIOLOGY stress release of catecholamine change of tissue perfusion ,decreaseperipheral vascular resistance,increaseblood flow Pooling of blood
decrease in circulatory volume decrease in cerebral blood flow SYNCOPE decrease in blood pressure compensatory mechanism areactivated
FAMILY HISTORY• Sudden unexplained death• Deafness• Arrhythmias• Congenital heart disease• Seizures• Metabolic disorders• Myocardial infarction at young age
HISTORY• Time and day• Activities preceding (recurrent/at rest, exercise associated, on standing)• Prodromes, associated symptoms• Duration of LOC• Injuries• Medications, ingestions• Cardiac History
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
IF THE PATIENT CONTINUES TO REMAIN UNCONSCIOUS SUMMON MEDICAL ASSISTANCE IMMEDIATELY
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
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.
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
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)
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
REFERENCES• MEDICAL EMERGENCIES IN DENTAL CLINIC-STANLEY F. MALAMED 4th edition• www.toothdent.com