Emergencies in dental practice Instructor – Dr.Jesus George

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Common emergencies in dental practice Syncope Chest pain Cardiac arrest Anaphylactic shock Stroke

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Cont.

Asthmatic attacks Drug reaction Bleeding Injuries as a result of surgical

procedure

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Syncope

Syncope or fainting or loss of consciousness

Fainting refers to sudden loss of consciousness

Predisposing factors – fear, anxiety, pain

- fatigue - fasting - hot & humid weather

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Cont.

Signs & symptoms – cold & moist skin

- slow pulse initially followed by rapid pulse

- pale skin - dizziness - weakness - nausea - loss of consciousness

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Cont.

Management – monitoring pulse - lowering head to improve

cerebellar circulation - loosening of tight cloths at neck - smelling of salt of aromatic

ammonia - reassurance of patient - if not recovered other causes of

collapse should be considered 6

Other causes of collapse

Anaphylaxis Hypoglycemia in diabetic patient Myocardial infarction Uncertain causes

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Collapse of diabetic patient Hypoglycemia - dampness of skin - rapid pulse - irritability - aggressiveness - decreased blood

sugar - urine sugar is -ve

Hyperglycemia - dry mouth & skin - weak pulse - drowsiness - disorientation - increased blood

sugar - urine sugar is

+ve8

Cont.

Management (hypo) If patient can take orally

– 15g oral carbohydrate If the patient is unable

to take orally, i/v 25-50ml 50% dextrose or 1mg glucagon

If i/v line is not there, s/c or i/m 1mg glucagon

Patient is observed for 30-60 min

Management (hyper) immediate medical

assistance Maintenance of

airway & circulation , monitoring vital signs

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Uncertain causes

Management – make the patient lie down flat & monitor pulse

- administer oral glucose - maintenance of airway - administer oxygen - i.v. hydrocortisone sodium

succinate 250 mg

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Chest pain

Mainly caused by angina pectoris, myocardial infarction

Angina pectoris – pain lasts for only a short duration

MI – pain persists for long duration Diagnosis – severe chest pain in

retrosternal region, dyspneoa, vomiting, weak pulse, irregular pulse ( MI), loss of consciousness

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Management

s/l 0.5mg glyceryl trinitrate, if pain is not relieved by 3 min. MI

Nitrous oxide & oxygen 50/50 ratio to relieve pain & anxiety, immediate medical attention

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Cardiac arrest

Sudden appearance of pallor & respiratory arrest

Etiology – MI - Anaphylactic reaction - severe hypotension - hypoxia - anesthetic overdose

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Cont.

Diagnosis – fainting or collapse Late signs – respiratory arrest,

cyanosis, dialatation of pupil, absence of pupillary response to light, absence of BP

Management – immediate cardiopulmonary resuscitation

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Anaphylactic shock

Caused by drugs like penicillin C/Fs – wheezing - abdominal pain - nausea, urticaria - flushing of face, paraesthesia - pallor, rapid & weak pulse - cyanosis, edema of face

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Cont.

Management – make the patient lie down flat with legs raised

- i.m. 1ml in 1000 adrenaline repeated after 15 min. till improvement

- low i.v. infusion 10-20mg chlorpheniramine

- i.v.200mg hydrocortisone sodium succinate

- oxygen administration & medical help

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Cerebrovascular accidents (stroke) Usually occurs in hypertensive

patients Clinical features – depends on site &

extend of brain damage - loss of consciousness - weakness of arm & leg on one side - drooping of one side of face Management – maintenance of

airway - hospitalization

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Asthmatic attacks

Causes – anxiety, exposure of allergen, infection

Clinical features – breathlessness, wheezing, use of accessory muscles for respiration

Management – reassurance of patient

- patient should never be allowed to lie down flat

- inhalation of salbutamol nebulizer18

Cont.

- oxygen administration - if no response slow i.v. salbutamol - i.v. 200mg hydrocortisone sodium

succinate - hospitalization

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Bleeding

Occurs mainly after extraction Occurs in hemorrhagic disorders

(hemophilia A, Christmas disease, Vit. K deficiency, anticoagulant therapy, liver disease, congenital cyanotic heart disease, c/c renal failure)

Management – reassurance of patient - oral cavity is cleaned & source of

bleeding is identified

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Cont.

- socket is sutured - local hemostatic measures –

pressure packs - if bleeding persists hospitalization

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Drug reactions

Anaphylaxis Allergy to LA solution Hypotension due to interaction of i.v.

barbiturates with antihypertensive drugs

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Reaction due to LA

Causes – i. v. injection of LA - allergy to LA LA may cause cardiovascular effects

& facial palsy I.V. injection is caused by –

aspiration was not carried out during injection & rapid infusion of LA

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Cont.

- Clinical features – drowsiness - agitation - loss of

consciouness - Management – make the patient lie

down flat - maintain airway - recovery in 30 min.

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Cont.

Allergy to LA – management similar to anaphylaxis

Cardiovascular effects - Manifested as palpitation

- If MI – manage MI Facial palsy – temporary effect - caused by tackling of LA to facial

nerve

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Cont.

- management – wears of gradually -reassurance of patient

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Hypotension

Prevented by proper drug history before procedure

Management – maintenance of airway

- patient is made to lie down flat - artificial ventilation if required - medical help

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Hypertension

Management – medical assistance

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Traumatic injury

Burns Laceration Fractures of jaw

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