WK1 - Lecture 5 - STUDENT - Syncope - Su24 PDF

DH 410 – Emergencies in Dental Practice Lecture 5: Syncope Objectives Compare & Contrast types of syncope Recognize signs and symptoms of syncope Understand and explain steps in emergency preparation and patient care during a syncopal episode FERR...

DH 410 – Emergencies in Dental Practice Lecture 5: Syncope Objectives Compare & Contrast types of syncope Recognize signs and symptoms of syncope Understand and explain steps in emergency preparation and patient care during a syncopal episode FERRIGNO Syncope  Syncope “Passing out or Fainting” Sudden, transient loss of consciousness and postural tone with spontaneous recovery ◦ Transient Loss of Consciousness (TLoC) ◦ “transient”- not lasting; lasting only a short period on time Often caused by loss of cerebral oxygenation and perfusion (delivery of blood to a capillary bed) ◦ Cerebral Ischemia  Syncope Often sign of another underlying medical condition Often associated with a stressful condition ◦ Vasovagal Syncope (stress related) ◦ Dental visits!  Syncope Predisposing Factors Psychogenic: ◦ Fright ◦ Anxiety ◦ Stress ◦ Pain (sudden/unexpected) ◦ Sight of blood or dental instruments (ex. Local anesthetic syringe) NonPsychogenic ◦ Exhaustion ◦ Hunger ◦ Poor physical condition ◦ Hot, humid, crowded environment ◦ Male gender ◦ Pregnant women ◦ Age between 16-35 years  Syncope Male ◦ Societal expectations “macho” “take it like a man” ◦ Exhibit no emotions ◦ No escape mechanism can lead to fainting Pregnant Women ◦ Postural changes ◦ Orthostatic hypotension ◦ Pressure on lungs and organs from growing fetus ◦ Difficulty for lung expansion ASA Status ◦ Higher ASA status is more likely to develop a life-threatening situation Syncope #1 MOST common dental emergency Syncopal episodes occur DURING or AFTER administering local anesthetic Occurs RARELY when patient is positioned properly, in SUPINE position during administration of local anesthesia  Types of Syncope 1. Neurocardiac Syncope ◦ Most Common Type 2. Cardiac Syncope ◦ 2nd Most Common Type 3. Noncardiac Syncope FERRIGNO  Types of Syncope Neurocardiac Syncope (most common type)  Vasodepressor, Vasovagal, Neurocardiogenic  Cerebral blood flow below a critical level with a sudden drop in BP, slowing of heart rate, leading to syncope  Body overreacts to certain triggers / noxious stimuli Triggers /noxious stimuli:  Pain (unexpected)  Fear  Exhaustion  Presyncope: Use Stress Reduction Techniques  Calm speech, relaxing atmosphere, nitrous oxide sedation  Types of Syncope Neurocardiac Syncope - Pathophysiology  Normally: Stress activates the autonomic nervous system  Fight or flight response  Releases of catecholamine, epinephrine, and norepinephrine to muscle tissues in preparation for movement with blood pumped back to heart, lungs, brain  Dental patients stay seated (no flight, no fight)  Fight or flight with NO muscle movement  In a semi supine position,  Blood does not make its way back to the heart, lungs, brain  Blood pools in extremities (no oxygen to brain)  Decreased cerebral oxygen = Syncope  Types of Syncope Cardiac Syncope 2nd most common type of syncope ◦ Inadequate cardiac output ◦ Usually due to a heart condition ◦ Arrhythmias (tachycardia, bradycardia) ◦ Obstructions of the heart ◦ Potentially fatal ◦ Requires referral to medical professional  Types of Syncope Non-Cardiac Syncope ◦ Seizures ◦ Hyperventilation ◦ Metabolic diseases (ex. Hypoglycemia) ◦ Orthostatic hypotension - Reduction in BP when assuming an upright position - Common in Dental Offices ◦ Situational occurrences (strenuous efforts) - coughing, urination, defecation EX: Valsalva’s maneuver – forced expiratory effort against a closed airway (strenuous efforts)  Figure 5.1 Types and etiologies of syncope Grimes, E. B. (2014). Medical emergencies: Essentials for the Dental Professional. Prentice Hall  Signs and Symptoms of Pre-Syncope Pre-Syncope (Prodromal)  Pallor  Pupil dilation  Diaphoresis (cold sweat)  Excitation of piloerection (goose bumps)  Weakness, Dizziness, Vertigo, Nausea  Yawning or sighing  Heart Palpitations, Chest Pain  Shortness of breath  Increased BP, Increased Pulse rate Slow Onset – Syncope – Decreased heart rate – Weak pulse  Treatment of Syncope  Remove all instruments/object out of mouth & away from patient  (P) position: SUPINE position with feet slightly elevated  C-A-B: Circulation, Airway, Breathing  (D) definitive care: Administer O2 Monitor vital signs Loosen tight clothing (unbutton collars, neck ties)  Treatment of Syncope Try using Ammonia inhalant  Only on patients with no known/suspected history of head injury  Caution with asthma or breathing issues (irritates mucosa)  Caution with eye issues (can be irritant) *See Mayo Clinic Information: uploaded to Canvas * If unconsciousness (more than 1 minute) summon EMS Longer patient in syncope more likely seizure will occur Figure 5.2 Patient in appropriate position for treatment of syncope  Treatment of Syncope Once consciousness returns ◦ Keep in supine position until patient feels well enough to be returned to upright position and pulse returns to normal ◦ Suspend treatment for the day ◦ Emergency contact should escort patient home as syncope can reoccur ◦ High re-occurrence in first 24 hours ◦ If anything other than Neurocardiac syncope is suspected, contact EMS (911) ◦ Thoroughly document syncope episode in chart  Reference Malamed, S. F. (2022). Medical emergencies in the dental office. Elsevier. Little, J. W., Miller, C., & Rhodus, N. L. (2017). Little and Falace’s dental management of the medically compromised patient. Mosby. Grimes, E. B. (2014). Medical emergencies: Essentials for the Dental Professional. Prentice Hall