Dental professionals must be prepared to manage medical emergencies that may arise in practices. A study in Japan showed that anywhere from 19% to 44% of dentists had a patient with a medical emergency during any one year. In the United States and Canada, studies have shown that syncope is the most common medical emergency seen by dentists.1 It represented approximately 50% of all emergencies reported in one study, with the next most common event, mild allergy, representing only 8% of emergencies.2
Chances are that as a dental assistant you will see a number of dental and medical emergencies. In this article, I will review the emergency procedures for syncope.
Syncope is a temporary loss of consciousness often related to insufficient blood flow to the brain. It's also called fainting or passing out. It most often occurs when blood pressure is too low (hypotension) and the heart doesn't pump enough oxygen to the brain. It can be benign or a symptom of an underlying medical condition.
Syncope is a symptom that can be due to several causes, ranging from benign to life-threatening conditions. Many non-life-threatening factors, such as overheating, dehydration, heavy sweating, exhaustion, or pooling of blood in the legs due to sudden changes in body position, can trigger syncope. In the dental office, fear and anxiety are common causes of syncope.
Neurally mediated syncope (NMS) is the most common form of fainting and a frequent reason for emergency department visits. It's also called reflex, neurocardiogenic, vasovagal (VVS), or vasodepressor syncope. It's benign and rarely requires medical treatment. So, the good news is, if a patient has syncope, he or she will likely recover very quickly. While NMS is more common in children and young adults, it can occur at any age. It happens when the part of the nervous system that regulates blood pressure and heart rate malfunctions in response to a trigger, such as emotional stress or pain.
Signs and symptoms of syncope include fainting, pale skin, lightheadedness, tunnel vision (field of vision narrows so person can see only what's in front of them), nausea, feeling warm, cold and clammy sweat, yawning, and blurred vision.2
When syncope occurs
● Discontinue treatment
● Assess the level of consciousness: evaluate the patient’s lack of response to sensory stimulation.
● Activate the office emergency system: call for help and have oxygen and the emergency drug kit brought to the site of the emergency.
● Position the patient: the patient should be in a supine position with feet elevated slightly.
● Assess airway and circulation: assess the patient’s breathing and airway patency and adjust the head and jaw position accordingly, also monitor the pulse and blood pressure.
● Administer oxygen
● Monitor vital signs
● Administer aromatic ammonia ampoules. Crush the ampule between the fingers and position it under the patient’s nose. The irritating fumes stimulate movement of the extremities and aid in blood return from the peripheral areas to the heart and brain.
● For post-syncopal management: if recovery occurs in less than 15 minutes, postpone further dental treatment. If recovery is delayed by more than 15 minutes, contact EMS while continuing definitive care until trained emergency care providers arrive.
Make the patient be aware of the situation for future visits and have the dental team alerted in case such an event happens again.
Options for prevention
● Take a thorough medical and dental history to identify any predisposing factors that might contribute to syncope, (i.e., fear of dental treatment, low blood pressure, etc.)
● Advise patients, especially those who are anxious, to eat before treatment to maintain a stable blood glucose level during stressful treatment.
● Recline the patient in a supine or semi-supine position (30–45 degrees) for treatment.
● Consider the use of nitrous oxide to alleviate anxiety.
Dental professionals play a crucial role in the patient’s wellbeing. Therefore, it is extremely important that we stay up to date on emergency procedures and supplies.
References
1. Haas DA. Management of medical emergencies in the dental office: conditions in each country, the extent of treatment by the dentist. Anesth Prog. 2006;53(1):20–24. doi:10.2344/0003-3006(2006)53[20:MOMEIT]2.0.CO;2.
2. Vasovagal syncope - Symptoms and causes. [online] Mayo Clinic. (2019). https://www.mayoclinic.org/diseases-conditions/vasovagal-syncope/symptoms-causes/syc-20350527. Accessed September 17, 2019.
Claire Jeong, MS, RDH, is an entrepreneur, author, educator, researcher, and international speaker. She is the founder of StudentRDH / SmarterDA, dental hygiene and assisting exam prep solutions. (Visit StudentRDH.ca in Canada.) Through her live and online courses, Claire helped tens of thousands of people gain valuable dental knowledge and clinical skills. With her expert knowledge in education, she authored the e-book WakeUp Memory, which teaches how to use the brain and remember anything. She combines the WakeUp Memory Technique in her courses and teaches educators to apply this method in their classrooms. Email Claire at [email protected].
