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Vasovagal syncope in dental practice — ORE Part 1 MCQ

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EasyOral SurgeryVasovagal syncope in dental practiceORE Part 1

A nervous 19-year-old becomes pale, sweaty and light-headed immediately after local anaesthetic injection. His pulse is slow and blood pressure is low. He briefly loses consciousness in the dental chair. He is breathing normally and has no rash or wheeze. What is the most appropriate immediate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Lay him flat, raise his legs and assess ABC

This is vasovagal syncope precipitated by anxiety and injection. Pallor, sweating, bradycardia and hypotension reflect a reflex fall in heart rate and blood pressure, causing transient cerebral hypoperfusion. The immediate management is to lay the patient flat, elevate the legs and assess airway, breathing and circulation (ABC); this promotes venous return and cerebral perfusion while recovery is observed. Intramuscular adrenaline is indicated for suspected anaphylaxis, which would more typically feature airway or breathing compromise and/or skin or mucosal features; these are specifically absent. Sitting upright may worsen cerebral hypoperfusion. Buccal glucose would be appropriate only if hypoglycaemia were suspected or confirmed, which is not suggested here. Antibiotics have no role in an acute syncopal episode.

Reference: NHS, “Fainting”, reviewed 23 February 2023, https://www.nhs.uk/symptoms/fainting/