Syncope Wall Presentation

1. SYNCOPE is defined as “sudden and transient loss of consciousness which is secondary to period of cerebral ischemia’’
 PATHOPHYSIOLOGY:
Stress & anxiety related to dental treatment or a painful stimulation
Increased secretion of catecholamines
Dilatation of blood vessels in the skeletal muscles
Resulting in peripheral pooling of blood
Decrease in venous return to the heart
Fall in cardiac output
Fall in BP
As the BP falls, compensatory mechanisms are activated which
attempt to maintain Cerebral blood flow. However these
compensatory mechanism fail
Reflex bradycardia
Fall in cardiac output
Cerebral ischemia & loss of consciousness
Clinical Manifestations:
PRESYNCOPE SYNCOPE POSTSYNCOPE
SYNCOPE
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
Hyperpnea
coldness in hands and
feet
Hypotension
Bradycardia
Visual disturbances
Dizziness
Loss of consciousness
breathing
irregular;jerky,
Pupil dilate,death
like appears
Bradycardiya
Pulse weak and
Decreased blood
pressure.
Pallor,nausea,weakness.
sweating for 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
PREVENTION :
Through pre-procedural instruction and making certain the patient has eaten recently
Comfortable environmental temperature, humidity in operating room
Stress reduction modalities
For anxiety reduction-sedation, use of muscle headphones and placing the patient in supine
position with supplemental oxygen
TREATMENT:
Immediately stop any dental treatment going on
Loosen tight clothing
Place the patient in head low position With lower limb
elevated , 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)
Prepared by- Sk Aziz Ikbal
West Bengal University of Health Science

2. TREATMENT:
Immediately stop any dental treatment going on
Loosen tight clothing
Place the patient in head low position With lower limb elevated , 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)