SYNCOPE. DEFINITION Syncope is defined as sudden and transient loss of consciousness which is secondary to period of cerebral ischemia CAUSES

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Margery Gilmore
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1 SYNCOPE INTRODUCTION Syncope is a symptom not a disease Syncope is the abrupt and transient loss of consciousness associated with absence of postural tone, followed by complete and usually rapid spontaneous recovery. The underlying mechanism is global hypoperfusion of both the cerebral cortices or focal hypoperfusion of the reticular activating system. DEFINITION Syncope is defined as sudden and transient loss of consciousness which is secondary to period of cerebral ischemia CAUSES Migraine* Acute hypoxemia* Hyperventilation* Somatization disorder (psychogenic syncope) Acute Intoxication (e.g., alcohol) Seizures Hypoglycemia Sleep disorders CLINICAL MANIFESTATIONS Presyncope : feeling of warmth, pupillary dilatation, loss of colour:pale or ashen, yawning, grey skin tone, hyperpnea, heavy perspiration, coldness in hands and feet, complaint of feeling bad or hypotension, fainting, bradycardia, nausea, visual disturbances, at dizziness baseline loss of consciousness, tachycardia

2 Syncope: breathing irregular, jerky,gasping, pupil dilate,death like appears, bradycardiya, pulse weak, decreased blood pressure. Postsyncope: Pallor,nausea,weakness.sweating from 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 PATHOPHYSIOLOGY Stress Release of catecholamine Change of tissue perfusion Decrease peripheral vascular resistance Increaseblood flow Pooling of blood Decrease in circulatory volume Decrease in cerebral blood flow Syncope Decrease in blood pressure Compensatory mechanism are activated

3 DIAGNOSIS Detailed history Physical examination 12-lead ECG Echocardiogram (as available) Ambulatory ECG Head-up Tilt Test (HUT) HISTORY COLLECTION Time and day Activities preceding (recurrent/at rest, exercise associated, on standing) Prodromes, associated symptoms Duration of LOC Injuries Medications, ingestions Cardiac History MA N A G E ME N T PRESYNCOPE Procedure should be stopped P-Patient placed into the supine position with the legs slightly elevated A- airway B- B- breathing C- C- circulation D- D- drugs SYNCOPE Step 1:- Assess consciousness Step 2:-Call for assistance Step 3:-Position the patient:- placing the patient in supine position

4 Step 4:-Assess and open airway Step 5:-Assess airway potency and breathing Step 6:-Assess circulation Step 7:- if the patient continues to remain unconscious summon medical assistance immediately Step 8:-Administer oxygen Step 9:-Monitor vital signs Step 10:-provide definitive management DEFINITIVE MANAGEMENT Loosening of clothes Respiratory stimulant:-aromatic ammonia Cold towel on patient s forehead. Blanket placed If bradycardia persist:- anticholinergics atropine-0.5mg or max 3 mg PHARMACOLOGICAL MANAGEMENT Salt tablets, fludrocortisone Beta-adrenergic blockers: atenolol Disopyramide SSRIs Vasoconstrictors (e.g., midodrine) POSTSYNCOPE Patient should not be subjected to additional dental care. The possibilities of second episode of syncope during this period of time. Prior to dismissal,the doctor should determine from the patient what the primary precipitating event was and what other factors may have been present such as hunger or fear. TREATMENT

5 Immediately stop any dental treatment going on Loosen tight clothing Place the patient in head low position with lower limb elevated (trendelenburg position) 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 mg i.m. If patient is still not responding support respiration (start oxygen) CONCLUSION Syncope is a common symptom, often with dramatic consequences, which deserves thorough investigation and appropriate treatment of its cause. Be vigilant in ruling out the life-threatening ones! Use the ultrasound machine Take into account the risks of hospitalization

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