Uploaded bySk Aziz Ikbal
Syncope
Syncope is defined as a sudden, transient loss of consciousness caused by a temporary decrease in blood flow to the brain. The pathophysiology involves increased catecholamines during stress or pain, which causes blood vessels to dilate in the muscles and pool blood in the periphery. This decreases venous return to the heart and cardiac output, lowering blood pressure and cerebral blood flow. Compensatory mechanisms attempt to maintain brain blood flow but can fail, resulting in reflex bradycardia, further drops in cardiac output and cerebral ischemia, causing loss of consciousness. Prevention focuses on reducing stress, maintaining proper temperature and positioning, while treatment involves stopping any stimuli, loosening clothes, placing the patient head-low with legs elevated, and administering
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Syncope
- 1. SYNCOPE is definedas “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 anydental 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)