1. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 4 Syncope

2. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 2

3. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Syncope –Common occurrence, but must be corrected promptly –Unconsciousness should be treated as cardiac arrest until otherwise diagnosed 3

4. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 4

5. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Causes Nonpsychogenic causes (physical) –Hunger, poor health, and remaining in an upright position for a long period 5

6. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 6

7. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 7

8. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Signs and Symptoms 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 8

9. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 9

10. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Signs and Symptoms of Presyncope and Syncope Figure 4-1: Trendelenburg position 10

11. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment 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 11

12. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment Once patient is properly positioned and the airway open –Crack open ammonia capsule and wave under patient’s nose for one to two seconds –Do not leave ammonia capsule in place for an extended period 12

13. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment –Pure oxygen can be administered –Help aid patient’s comfort Loosen clothing, place cold towel on forehead 13

14. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 14

15. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Recovery from a Syncopial Episode Do not leave patient unattended Document the episode in patient’s chart 15

16. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 16

17. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Prevention –Some patients may need to be premedicated to alleviate extreme anxieties –Syncope can also be prevented by maintaining and updating a patient’s health history –Patient with a history of syncope is likely to experience it during a dental visit –Extra precautions can be taken 17

18. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Summary The dental auxiliary can help prevent syncope by: –Being familiar with a patient’s history –Making efforts to reduce stress in the office 18

19. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Summary 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 19