Med emergencies Ch6,7 Syncope

Ischemia

O2 deprivation ( not enough oxygen)

Positioning during syncope

Supine (30-45degrees) position with legs slightly elevated

Psychogenic

fright, anxiety, emotional stress, unwelcome news, pain, seeing blood, dental instrument Ex: administering anastesia

Synonyms of syncope

Atrial bradycardia Benign faint Neurogenic syncope Psychogenic syncope Simple faint Swoon Vasopressor syncope Vasovagal syncope

What is definitive management?

Loosening up clothes, respiratory stimulant (Arom. Ammonia), cold towel on pt forehead, if bradycardia persists give atropine (incr. heart rate).

prevention of orthostatic syncope

Med history Physical examination Dental tmt modifications (always ask question about medications, what taking, is there are any side effects)

After Syncope

No more dental treatment May experience second episode Before discharging Dr. should ask pt what what the reason for the syncope so we can make a note in pt med history.

predisposing factors

Administration of drugs, long period of staying in same position, people who forced to stand for a long period of time, venous defect in legs, Addison disease, physical exhaustion, chronic postural hypotension(age depended) .

Precaution of syncope

Control predisposing factors, Make sure pt eaten, normal temp and humidity, stress reduction protocol, sedation, proper positioning +O2

Prevention of syncope

Eliminate factors that may cause syncope, make sure to have good air conditioning, eat a snack before the procedure, make sure they are not experiencing psychological stress

syncope

breathing irregular, gasping pupil dilate, death like appearence bradycardia weak pulse decr. BP (might exp. convulsion, might pee themselves if systolic BP is lower than 70mmHg)

Postural hypotension (orthostatic hypotension)

drop in blood pressure related to change in position (supine/seated to standing) at least 20mmHg systolic, and 10 mmHg diastolic within 3 min.

post syncope

facial pallor, nausea, weakness, and disorientation; BP and HR are normal tendency to second attack if stand up too quickly

syncope definition

fainting or sudden loss of consciousness caused by lack of blood supply to the cerebrum, which is secondary to period of cerebral ischemia

presyncope early symptoms

feeling warm, pale, heavy respiration, complain about feeling bad, nausea, BP is at baseline, tachycardia

presyncope late symptoms

pupillary dilation, yawning, hyperpnea, coldness in hands, hypotension, bradycardia, dizziness, loss of consciousness

Treatment of syncope

stop tmt. looses tight clothing place pt in head low position lower limbs elevated Monitor pulse: if normal (aromatic ammonia, and sprinkle water) if bradycardia Dr. injects atropine If no response support respiration and start O2

Pathophysiology of syncope

stress > release of catecholamine (epineph, and norepineph.) fight or flight response > incr. blood flow to muscle (pooling of blood because muscle are not moving) > therefore decr. in circulatory volume, decr. in cerebral flow. > SYNCOPE >Decr. in BP

Family history that contributes to syncope

unexplained death heart problems of any kind metabolic disorders seizures

non-psychogenic factors

upright or standing position (postural hypotension), hunger, exhaustion, poor physical condition, hot, humid, crowded environment, male sex, age between 16-35 (men more than women)

Dental anxiety, what to consider?

1. Every pt has to be evaluated for dental anxiety 2. written anxiety questionnaire 3. if anxiety is resent supine position is required 4. consider sedation: oral. inhalation( nitrous oxide or O2), IM or IV.

Management of syncope

1. Procedure is stopped, pt in supine position with legs slightly elevated. 2. C>A>B and D (airway, breathing, circulation) + drugs(aromatic ammonia or O2)

Management of vasopressor syncope

1. asses consciousness 2. activate emergency system 3. supine position 4. C>A>B 5. D> definitive care ( O2, monitor vitals, Aromatic Ammonia, Sugar. 6. Administer atropine if bradycardia persists Post syncope recovery, arrange pt escort

Steps of syncope management

1. asses consciousness (lack of response to stimulation) 2. Call for assistance 3. Supine position 4. A -assess open airway (chin-up) 5. Assess breathing (administration of O2 and monitor vitals) 6. provide definitive management

Physical examination (recording vital signs) Change in response to elevation from supine to elevated position for Postural Hypotension

Systolic NORMAL (BP +10 mmHg) postural hypotension (Decrease of >25 mmHg) Diastolic NORMAL (Increase 10 to 20 mmHg) postural hypotension (Decrease of >10 mmHg) Heart Rate NORMAL 5-20 beats per min above baseline postural hypotension Baseline or higher(>30 beats per minute

Management of orthostatic hypotension

- terminate all dental tx activate office emergency - place pt in supine position(Trendelenburg), with legs raised above the level of the head _C>A>B D, administration of O2 -definitive care - monitor vitals

Dental therapy considerations for orthostatic hypotension

Pt should be cautioned from rising too rapidly from dental chair Slowly reposition pt (3 chair positions in 1 minute Be close to pt when she/he stand up

Properties of syncope

Rapid onset, Brief duration, spontaneous and complete recovery. Pt consciousness immediately because of restoration of blood flow to the brain