medicalemergencies in dentistry-170327110528.pptx

Medical emergency

1. MEDICAL EMERGENCIES IN DENTAL OFFICE By-Sai Lakshmi Rao III BDS Geetanjali Dental & Research Institute, Udr

2. CONTENTS Introduction Types of Emergencies Prevention Preparation Management Summary Conclusion Reference

3. INTRODUCTION What is an emergency? A serious and unexpected situation requiring an immediate action. It is an unforeseen combination of circumstances or the resulting state that calls for an immediate action.

4. TYPES OF EMERGENCIES UNCONSIOUSNESS Syncope Hypotension Hypoglycemia SEIZURES RESPIRATORY EMERGENCIES Airway obstruction Asthma

5. CARDIOVASCULAR EMERGENCIES Angina pectoris Myocardial infarction DRUG-RELATED EMERGENCIES Overdose reactions Allergies

6. Chest pain Drug toxicity Airway obstruction Allergies Hypoglycemia

7. SYNCOPE Syncope is a short loss of consciousness and muscle strength , characterized by a fast onset , short duration, and spontaneous recovery .

8. Causes H  Hypoxia / Hypoglycemia E  Epilepsy A  Anxiety D  Disorders of brain stem H  Heart attack E  Embolism A  Aortic stenosis R  Arrhythmias T  Tachycardia CNS causes CVS causes

9. V  Vasovagal causes ( common faint) E  Electrolyte abnormalities (ex. hypercalcemia ) S  Situational (cough, sneeze, micturation ) S  Subclavian steal syndrome E  ENT causes ( glossopharyngeal neuralgia) L  Low systemic vascular resistance S  Sensitive carotid sinus Vascular and other causes

10. Symptoms Breathing – irregular, jerky & gasping Dilated pupils Convulsive movements Bradycardia (<50 beats per minute) Weak thready pulse Loss of consciousness Partial or complete airway obstruction

11. Management Position: supine position with brain and heart at same level with feet elevated slightly (10 – 15 degrees). ABC: basic life support as needed. Definitive management: -monitor vital signs -administer aromatic ammonia -administration of atropine(0.1g/ml)

12. SEIZURE It is a paroxysmal disorder of cerebral function characterized by an attack, involving changes in the state of consciousness , motor activity or sensory phenomena . Usually sudden in onset and of brief duration. EPILEPSY: “A chronic disorder in which nerve cell activity in the brain is disturbed, causing seizures”.

13. Common symptoms of seizures

14. PREVENTION If a patient is known epileptic, make sure he/she has taken their regular dose of anti-convulsant on the day of treatment. Instruct him/her to alert you as the aura of the impending seizure manifests itself. Keep life support equipments ready, in case of an emergency status epilepticus.

15. MANAGEMENT Self limiting emergency Position: supine with patient placed on flat surfaces. Remove dangerous objects from the mouth and around the patient.(ex. sharp instruments, needles, etc.) Loosen any tight clothing. Avoid restraining the patient. In case the ictus fails to subside within a maximum of 10 minutes, declare status epilepticus and proceed with definitive care.

16. DEFINITIVE TREATMENT Diazepam – 10 mg i.v. , (2mg/min) repeat every 10 minutes. Phenobarbitone – 100-200 mg/min, i.v. Carbamazepine Phenytoin

17. HYPOGLYCEMIA Hypoglycemia is a clinical syndrome in which low serum (or plasma) glucose levels lead to symptoms of sympatho -adrenal activation. Empty stomach/ Morning insulin Low blood glucose level (<50mg/100ml) Anxious disposition Weakness/ dizziness, pale skin, depressed respiration Loss of consciousness/ syncope

18. Common symptoms

19. MANAGEMENT Glucose and sugar-containing beverages administered orally to conscious patients for rapid effect. Alternatively, milk candy bars, fruit, cheese, etc may be adequate in mild cases. IV dextrose is indicated for severe hypoglycemia, in patients with altered consciousness and during any restriction of oral intake.

20. TREATMENT 20-25 ml of 50% dextrose should be given immediately. Glucagon, 1mg i.m. (or s.c.) Metformin Sulfonylureas

21. RESPIRATORY EMERGENCIES

22. Airway obstruction May occur due to: Pathology on the airway Dental instruments Tongue Patient demonstrates symptoms ranging from coughing, gurgling, gagging, to choking & gasping with pain. Aspired object may pass into the trachea or oesophagus.

23. PREVENTION Rubber dam Oral packing Chair position Dental assistant Magill’s intubation forceps

24. MANAGEMENT Re-establishment of airway: Non-invasive procedures Forceful coughing Back blows Heimlich maneuver Chest thrust Finger sweeps

25. HYPERVENTILATION Excessive rate and depth of respiration leading to abnormal loss of carbon dioxide from the blood primarily predisposed to stress and anxiety . Characterized by: Rapid short strained breaths Cold sweats Palpitations Dizziness Chest muscle fatigue

26. PREVENTION Exhaled air is inhaled-in again using a paper bag. The point of breathing into a bag is to “re-breathe” your exhaled CO 2 to bring the body back to a normal state. Reduce patient’s stress and anxiousness by any means. The operator should stay calm and also make the patient be relaxed.

27. MANAGEMENT Administration of Benzodiazepenes : -Diazepam (2-5 mg i.m./i.v. every 3-4 hourly) - Lorazepam (2-3 mg oral per day, BD/TD) - Triazolam (0.25 – 0.5 mg) - Alprazolam (0.25 – 0.5 mg oral TD)

28. ASTHMA A clinical state of hyper reactivity of the tracheobronchial tree, characterized by recurrent paroxysms of dyspnea and wheezing.

29. MANAGEMENT Position pt upright or bending forwards with arms straight ahead Administer bronchodilators Asthma terminates? Yes No Continue dental procedure Declare status asthmaticus Summon EMS Recognize symptoms Stop dental procedure

30. CARDIOVASCULAR EMERGENCIES

31. Myocardial infarction It is a clinical syndrome caused by deficient coronary arterial blood supply resulting in ischemia to a region of the myocardium and causing cellular death and necrosis. Predisposing factors: - atherosclerosis, coronary artery disease - coronary thrombosis, occlusion and spasm - undue stress

32. PREVENTION Avoid overstressing the patient Supplemental oxygen during the treatment Pain control during therapy (appropriate use of local anesthesia) Psychosedation Elective dental care is avoided until atleast 6 months after MI IA and PSA nerve blocks should be avoided due to high risk of hemorrhage.

33. MANAGEMENT Antiplatelet agents - Clopidogrel (75 mg oral OD) - Ticlopidine (250 mg PO q12 hrs) Dipyridamole (75-100 mg oral TD) Beta-blockers - Propranolol (40 mg oral TD) - Metoprolol (100 mg oral BD) - Atenolol (50 mg oral BD or 100 mg oral OD)

34. Angina pectoris A condition marked by severe pain in the chest, often also spreading to the shoulders, arms, and neck, owing to an inadequate blood supply to the heart. Types: - Stable - Variant - Unstable

35. PREVENTION Stress reduction Reassurance Psychosedation

36. MANAGEMENT Recognize the problem Discontinue dental treatment Activate office emergency team Position patient upright comfortably Assess and perform BLS Definitive management Use Beta-blockers

37. Drug-related emergencies

38. Overdose reactions An overdose is when a person ingests or takes in more than normal of recommended or prescribed amount of drug. It can be accidental or intentional. In a dental practice, most common overdosage is by local anesthesia.

39. SYMPTOMS Confusion, talkativeness, blurred speech Muscular twitching, facial tremor Headache, tinnitus Drowsiness, disorientation Elevated BP, HR, RR If uncontrolled, generalized tonic clonic seizures, generalized CNS carbopathy

40. MANAGEMENT Administer BLS as needed 100% oxygen, anticonvulsants Allow recovery to occur In case of continuation of symptoms, summon EMS

41. allergy It is a hypersensitive state of skin and various mucosae acquired through the exposure to a particular allergen, re-exposure to which produces a heightened emergent capacity to react. Occurring via expression of IgE in response to allergen exposure.

42. Symptoms Red, itchy, watery eyes Sneezing, congestion, runny nose Itchy or sore throat, postnasal drip, cough

43. MANAGEMENT Reassure the patient Initiate the BLS as needed Administer antihistaminics (diphenhydramine 50mg), epinephrine 0.123-0.3 ml of 1:1000 i.m. or s.c. Monitor vitals regularly

44. CONCLUSION As the saying goes, “PREVENTION IS BETTER THAN CURE”. ALWAYS BE PREPARED. Prompt recognition and efficient management of medical emergencies by a well-prepared dental team that can increase the likelihood of a safe & a satisfactory outcome. Basic life support training – A MUST.

45. REFERENCES Stanley F. Malamed , Handbook of Local Anesthesia, 6 th edition James R. Hupp , Contemporary Oral and Maxillofacial Surgery, 6 th edition