PATIENT MANAGEMENT IN A DENTAL CLINIC

Dr. Shahzadi Tayyaba Hashmi

MEDICAL EMERGENCIES THAT CAN OCCUR IN THE DENTAL SURGERY

Vasovagal attack (faint/syncope)

Hyperventilation (panic attack) Seizures Hypoglycemia

Asthma attack Angina Myocardial infarction Anaphylaxis

Airway obstruction (including choking) Respiratory arrest Cardiac arrest Adrenal/steroid

crisis

Common principles to apply in the management of medical emergencies

Actions• Stay calm• Shout for a colleague to help you• Is the patient conscious• or unconscious?• Reassure the conscious patient and

assess their level of consciousness• Consider the position of the patient• Assess and monitor the:• Airway• Breathing• Circulation• Would Drugs help?

• Note the time Comments• If conscious make them comfortable,• if unconscious lie them flat – consider

the recovery position if they are breathing spontaneously

• A patent airway must be maintained• Oxygen nearly always helps!• This can be helpful in deciding when• to summon the emergency services e.g.

in prolonged epileptic seizures or in recording how long a patient remains unconscious)

2)HYPOGLYCEMIA

• Hypoglycemia is a deficiency of glucose in the bloodstream. Precipitating factors in a known diabetic are anxiety, infection and fasting. This is sometimes seen in a patient with type I diabetes who has taken their insulin as normal but has not ingested a sufficient quantity of carbohydrate

SIGNS AND SYMPTOMS:• The patient will feel cold and may have clammy skin, be

trembling, confused, have double vision, slurring of speech or show behavior changes (e.g. they may become excitable, irritable, aggressive or uncooperative)

• Drowsiness and disorientation and loss of consciousness can occur

MANAGEMENT

In the first instance the management is aimed at elevating the blood glucose:

■ In the conscious patient: administer 10–20 g of glucose in the form of a drink, tablets, sugar cubes or gel (e.g. Hypostop gel which is absorbed through the oral mucosa). Patients can be given 90 ml of non-diet Coca-cola or 200 ml milk which is equivalent to 10 g of glucose

• ■ In the unconscious patient: give 1 mg (1 unit) of glucagon by intramuscular (IM) or subcutaneous (SC) injection. A child under the age of 8 years or less than 25 kg should be given 500 μg. This hormone increases serum glucose by converting glycogen stores into glucose. Administer oxygen and monitor A, B, C.

• When the patient has recovered it may be necessary to give oral glucose to maintain blood glucose levels. Call the emergency services if the patient does not recover following the above measures; give oxygen and monitor

3) ASTHMA

• In asthma there is narrowing of the bronchial airways and this leads to coughing, wheezing and breathing difficulties.

• Bronchial asthma may be precipitated by exposure to an antigen, drugs (typically non-steroidal anti-inflammatory analgesics), air pollution, anxiety, infection and exercise

SIGNS AND SYMPTOMS:• There is breathlessness with wheezing on expiration. In addition

there can be restlessness, difficulty in talking, tachycardia, low peak respiratory flow, using accessory muscles of respiration and cyanosis of the lips and nail beds. If untreated breathing may become increasingly difficult and the patient may develop status asthmatics;

• respiratory arrest is also possible

MANAGEMENT

• Administer the patient’s bronchodilator (usually salbutamol or terbutaline) to relax the bronchial smooth muscle; if this is not possible, use the surgery’s emergency inhaler to give two inhalations (salbutamol100 μg/puff). Give oxygen and repeat the administration of the bronchodilator if there is no improvement. Place the patient in a comfortable position and monitor A, B, C.

• If the asthma remains uncontrolled or deteriorates, summon the emergency services