Med Emergency, Altered Consciousness

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Chapter 4
Syncope

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Objectives
• Upon completion of this chapter, you will
be able to:
– Define syncope
– Describe the causes of syncope
– Describe the physiology of syncope
– Explain ways to prevent syncope
– List the signs and symptoms of syncope
– Demonstrate the treatment for syncope
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Syncope
• Syncope: loss of consciousness
– Known as the common faint
– Most common life-threatening emergency that
may be experienced in the dental office
– Caused by decrease in blood flow to the brain
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Syncope (cont’d.)
– Common occurrence, but must be corrected
promptly
– Unconsciousness should be treated as
cardiac arrest until otherwise diagnosed
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Causes
• Caused by some form of stress—physical,
emotional, or both
• Psychogenic causes (psychological)
– Fear, pain, emotional upset, anxiety
– Most common cause of syncope in dental
office
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Causes (cont’d.)
• Nonpsychogenic causes (physical)
– Hunger, poor health, and remaining in an
upright position for a long period
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Physical Changes Resulting in
Syncope
• Body experiences stress
• Vascular bed dilates and blood is pumped
to the extremities (fight or flight)
• Blood is not recirculated adequately and
pools in the arms and legs
• Lack of oxygenated blood flow to the brain
• As a result, unconsciousness occurs
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Signs and Symptoms
• Syncope is a relatively slow-occurring
problem, with two different stages
– First stage: presyncope
• Patient is pale and covered in cold sweat
• May complain of feeling nauseous, dizzy, or hot
• Vital signs: slight decrease in blood pressure and
very rapid increase in pulse
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Signs and Symptoms (cont’d.)
• Second stage: syncope
– Patient exhibits a deathlike appearance
– Breathing may be shallow and gasping
– Slight convulsive movements may be present
– Pupils are dilated
– Vital signs: very low blood pressure and slow,
thready pulse
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Treatment
• Remain calm
• Stop all dental treatment
• Place patient in the Trendelenburg position
– Supine position with feet slightly elevated
• If patient is in the dental chair, elevate feet
• If patient is the hallway or waiting room, place
patient supine on the floor elevating feet with a
chair or your hands
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Signs and Symptoms of
Presyncope and Syncope
Figure 4-1: Trendelenburg position
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Treatment (cont’d.)
• Pregnant patients should not be placed in
the Trendelenburg position
– Place pregnant patient on her side and
elevate her feet
• Once placed in the proper position, patient
should recover rapidly
– If patient does not recover, utilize head
tilt/chin lift techniques to open airway
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Treatment (cont’d.)
• Once patient is properly positioned and
the airway open
– Can crack ammonia capsule and wave under
patient’s nose for one to two seconds
– Do not leave ammonia capsule in place for an
extended period
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Treatment (cont’d.)
– Pure oxygen can be administered
– Help aid patient’s comfort
• Loosen clothing, place cold towel on forehead
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Recovery from a Syncopial
Episode
• Patient may be slightly confused and
upset
• Explain situation in a calm, reassuring
manner
• Important to remove any predisposing
stimuli such as needles
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Recovery from a Syncopial
Episode (cont’d.)
• Do not leave patient unattended
• Document the episode in patient’s chart
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Prevention
• If signs and symptoms of presyncope
are noticed, stop dental treatment and
place patient in Trendelenburg position
• Alleviate patient’s fears
– Make patient comfortable
– Alleviate sounds and smells associated
with a dental office
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Prevention (cont’d.)
– Some patients may need to be premedicated
to alleviate extreme anxieties
• Syncope can also be prevented by
maintaining and updated patient’s health
history
– Patient with a history of syncope is likely to
experience it during a dental visit
– Extra precautions can be taken
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Summary
• The dental auxiliary can help prevent
syncope by:
– Being familiar with a patient’s history
– Making efforts to reduce stress in the office
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Summary (cont’d.)
• When syncope does occur, auxiliary can
prevent an emergency by:
– Placing the patient in the Trendelenburg
position, maintaining an open airway, and
administering oxygen and ammonia
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