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Syncope: Submitted By, Nikketta Nunez Iv Part Ii Bds
Syncope: Submitted By, Nikketta Nunez Iv Part Ii Bds
Submitted by,
Nikketta Nunez
IV Part II BDS
SYNCOPE
PSYCHOGENIC FACTORS
NON PSYCHOGENIC FACTORS
PSYCHOGENIC FACTORS
Fright
Anxiety
Emotional stress
Receipt of unwelcome news
Pain (sudden & unexpected)
Sight of blood or instruments
These factors can lead to the development of the
“ fright or flight “ response in the patient and in the
absence of muscular movement by the patient ,
produce the transient loss of consciousness known
as vasodepressor syncope
NON PSYCHOGENIC
FACTORS
Erect sitting or standing posture
Hunger from dieting or missed meal
Exhaustion
Poor physical condition
Hot, humid, crowded environment
Male gender
Age between 16 and 35 years
Erect sitting and standing decreases cerebral blood flow below critical
levels.
Hunger can lead to decreased level of glucose supply to brain
Exhaustion can develop due to poor physical condition , hot, humid
and crowded environment
Men between the age group of 16 and 35 are mostly affected
CLINICAL
MANIFESTATIONS
Clinical signs and symptoms of vasodepressor syncope usually
develop rapidly in the presence of an appropriate stimulus.
Actual loss of consciousness does not normally occur rapidly.
There is usually sufficient time for them to sit or lie before they lose
consciousness.
The clinical manifestations of vasodepressor syncope can
be grouped into three definite phases. They are;
PRESYNCOPE
SYNCOPE
POSTSYNCOPE
PRESYNCOPE
Feeling of warmth.
Loss of color; pale or ashen skin tone
Heavy perspiration
Feeling “bad” or “faint
Nausea
BP : base line or slightly lower
Late Signs and Symptoms
Pupillary dilation
Yawning
Cold hands and feet
Hypotension
Bradycardia
Visual disturbances
Dizziness
Loss of consciousness
SYNCOPE
STEP 1 P (position)
As soon as presyncopal signs and symptoms occur dental procedure
should be halted
The patient should be placed in the supine position with legs slightly
elevated
Muscle movements help in returning of the blood from the periphery
The position change usually halts the progression of syncope
STEP 2 A-B-C
(airway – breathing – circulation)
Assessment of airway and breathing should be
done
If required oxygen should be administered
using a full face mask
An ammonia ampule may be crushed under the
patients nose for speedy recovery.
STEP 3 D (definitive care)
Following management , attempts should be made
to determine the cause of syncope while the
patient recovers.
The planned dental treatment should be continued
only if both the doctor and patient feel its
appropriate.
SYNCOPE
STEP 3 P (position)
The first and most important step in management of syncope is the
placement of the victim in supine position
Slight elevation of the legs helps increase the return of blood from
the periphery.
Failure to place the patient in supine position can lead to death or
permanent neurologic damage due to prolonged cerebral ischemia
This can occur within 2 – 3 mts if the victim is in erect posture
Females in the latter stages of pregnancy who lose consciousness
is an exception.
Supine Position
STEP 4 A B C
The victim must be assessed immediately and a patent airway is
ensured
Assessment of airway patency and adequacy of breathing is the next
step.
An adequate airway is present when the patient’s chest moves and
exhaled air can be heard and felt
Look ,Listen ,Feel
Technique
Spontaneous respiration is usually evident during
syncope.
Artificial ventilation may be necessary on those in
which spontaneous breathing ceases.
Positioning and establishing patent airway speeds
up recovery
Artificial Ventilation
To assess circulation carotid pulse must be
palpated.
Weak thready pulse is palpable in neck
Heart rate is quite low.
Carotid Pulse Palpation
STEP 5 ( definitive care)