Saturday, February 20, 2010

Syncope - Finally

As morbid and terrible at it sounds, I have secretly been hoping to see a patient go into syncope for the last few months. I realize the best chance of this would be in my OS rotation which finally wrapped up yesterday. I am glad to finally have more time in my normal clinic for my own patients but dissapointed at the same time because OS is fun.

So what is syncope? Simply put, it means to faint. Of all the 'emergent' situations in dentistry, syncope is by far and away the most common. It is also the easiest to treat if you follow a few easy steps.

Why does it happen? Most commonly, blood is not getting up to the brain which causes hypoxia (no oxygen) up there eventually leading to loss of consciousness. A great example is a young male patient who is super anxious about needles. He knows it is coming, so his body naturally goes into 'fight or flight' mode. This means the blood vessels dialate to get the blood pumping and moving (especially into the leg muscles). Most dental patients are in a sitting position which means that gravity is also kicking in so all that blood is just pooling up down in their feet.

So they pass out. And it finally happened to a patient I was working on. A classmate and myself were tag teaming this guy on an alveoloplasty and the attending surgeon was going over a few pointers just after I opened the flap . Suddenly, the patient's eyes just rolled into the top of his head and he sagged off to the right. The instructor had us grab the O2 tank while he brought the patient into a supine (or laid down flat) position. He technically brought him all the way into trendelenburg (head lower than feet) but either way, that is the first step. We hooked him up to the oxygen and the guy came back really quickly. His BP had dropped a bit, but it wasn't dangerously low (which ruled out cardiac issues). So we finished up and sent him on his way.

There really isn't much else to say. It was crazy to finally see it happen, and equally amazing at how simple it was to manage. Laying him back got the blood going towards his head and the oxygen just sealed the deal.

Obviously many things can cause someone to pass out, and many of them much worse. The surgeon recommended that we have an emergency protocol/practice day in our private practices once every six months to keep everyone up to date. I completely agree.