The House of Hygiene · Case No. 02

The Syncope Emergency
Quick Reference

For RDHs: recognizing the prodrome, managing a faint, knowing when to call EMS, and preventing the next episode. Syncope is the most common medical emergency in the dental office.

HOH-02
Self-Study
Recognize the Prodrome

Warning Signs Come First

The prodrome lasts seconds to a couple of minutes. It is your window to act before loss of consciousness.

PhaseSigns
EarlyAnxiety, pallor, pupil dilation, palpitations, warmth
LaterSweating, nausea, salivation, yawning, dizziness, visual changes
ImminentSlow pulse, falling BP, "I feel weird," then LOC
Pallor can be masked by tattoos and darker skin tones. Read the full cluster and the patient's own words. A chatty patient going suddenly quiet is a vital sign.
Triggers & Risk Factors

Who Is At Risk

Appearance does not predict who faints. Screen everyone: "Did you get a chance to eat today? How do you usually do with dental work? Ever felt faint at an appointment?"
Immediate Management
The Sequence
  1. 1Stop. Remove all instruments from the mouth.
  2. 2Position. Supine, legs elevated about 10 degrees.
  3. 3Airway. Head-tilt, chin-lift.
  4. 4Breathing. Confirm breathing; oxygen per office protocol.
  5. 5Circulation. Check pulse; monitor vital signs.
  6. 6Call for help. Summon the dentist and team; EMS if not prompt.
Do NOT
  • Sit the patient up; it cuts cerebral perfusion
  • Put liquids or objects in the mouth of someone not fully conscious
  • Rely on ammonia inhalants; they are not in current guidelines
  • Lift a heavy, limp patient alone
Most simple faints resolve within about a minute once the patient is flat with legs up.
Large Patient
  • Recline the dental chair to position; do not move them to the floor alone
  • Get help early; safe repositioning is a two-person-plus job
  • Abdominal weight can press the diaphragm when supine; watch the airway
  • If breathing is compromised, use a lateral recovery position
Is It Really Just a Faint?

Differentiation

CauseDistinguishing Features
VasovagalProdrome, brief LOC, slow pulse, fast recovery when supine
OrthostaticTriggered by standing or sitting up fast; BP drop, weak vagal prodrome
HypoglycemiaGradual, confusion, sweating, fast pulse; needs glucose
SeizureTonic-clonic movement, tongue biting, incontinence, post-event confusion
CardiacChest pain, palpitations, SOB, abrupt LOC, little prodrome
Activate EMS / Call 911 If

Escalation Criteria

Unresponsive, no normal breathing, no pulse: treat as cardiac arrest. Start CPR, use the AED, ensure EMS is en route.
Recovery, Prevention & Documentation
Recover and Prevent
  • Keep the patient flat until vital signs return to baseline
  • Bring them upright slowly, in stages, to avoid a second faint
  • Screen for injury and red flags; confirm full orientation before discharge
  • Next visit: treat supine, have them eat beforehand, reduce stress, ensure profound anesthesia, move slowly
  • Flag the chart so the whole team positions defensively next time
Sample Chart Entry

"During LA, patient reported feeling warm and lightheaded with diaphoresis, then brief loss of consciousness. Procedure stopped; placed supine with legs elevated, airway opened, oxygen per protocol, dentist summoned, vitals monitored. Regained consciousness in under 1 minute; no chest pain, no injury, fully oriented. Raised in stages, observed, discharged stable. Prevention plan for next visit documented."

Template: modify to match the actual visit
The House of Hygiene · Education for RDHs Case No. 02 · The Syncope Emergency · Self-Study thehouseofhygiene.org