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syncope (common faint) is the medical emergency most often reported in the dental environment,

accounting for more than 50% of all emergencies

initial management of the unconscious person, regardless of cause, is the same; these steps are

directed primarily toward certain basic, life-sustaining procedures: P (position), C (circulation), A (airway), and

B (breathing)

Predisposing factors

(1) stress, (2) impaired physical status, and (3) the administration or ingestion of drugs.

And Others :NEUROGENIC CAUSES :Breath holding

VASCULAR CAUSES:Cerebrovascular diseaseENDOCRINOPATHIES:HypoglycemiaEXPOSURE TO TOXINS AND DRUGS

Psychogenic problemsCardiogenic causes:Dysrhythmia

DISORDERS OF OXYGENATION:Anemia

Prevention• Loss of consciousness can be prevented in many, if not

most, instances by a thorough pretreatment medical and dental evaluation of the prospective patient. Important elements of this evaluation include a determination of the patient’s ability to tolerate the stresses—both physiologic and psychological—associated with their planned treatment

• The supine position (ideally with the feet elevated about 10 to 15 degrees) prevents the decrease in cerebral blood pressure that is the most common mechanism producing syncope. Increasing the use of the supine position during dental treatment has the potential to dramatically decrease the number of episodes of syncope occurring during dental treatment

Pathophysiology• 1. Reduced cerebral metabolism resulting from

inadequate delivery of blood or O2 to the brain• 2. Reduced cerebral metabolism resulting from

general or local metabolic deficiencies• 3. Direct or reflex effects on that part of the CNS

that regulates consciousness and equilibrium• 4. Psychic mechanisms affecting levels of

consciousness with their respective mechanism or mechanisms.

Management

1. Recognition of unconsciousness2. Management of the unconscious victim, including the recognition of possible airway obstruction and

its management

Recognition of unconsciousness

• Step 1: Assessment of consciousness. • Step 2: Termination of dental procedure.

• Step 3: Summoning of help.

Management of the unconscious patient

• Step 4: P—Position victim.

Management of the unconscious patient

• Step 5: C—assess circulation.

Management of the unconscious patient

• Step 6: A—Assess and open airway

Management of the unconscious patient

• Step 7a: B—assess airway patency and breathing

Management of the unconscious patient

• Step 7b: B—rescue breathing (if necessary).

Management of the unconscious patient

• Step 8: D—definitive management

End

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