Medical Emergencies in the Dental Officewestliberty.edu/health-sciences/files/2014/02/...Medical...

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Cindy Kleiman, RDH, BS

Oral Care Consultant and Speaker

West Liberty UniversitySarah Whitaker Glass School of Dental Hygiene

April 11, 2014

Medical Emergencies

in the Dental Office:“Vital Signs” for the

Dental Professional

Many thanks to my sponsor:

P Position

A Airway

B Breathing

C Circulation

D Definitive CareDiagnosis

Drugs

Emergency Management

Non-Cardiac Arrest

H

P Position

C Circulation

A Airway

B Breathing

D Defibrillation

New CPR Guidelines 2010

Cardiac Arrest Only

H

Circulation

If conscious and responding,

assisted circulation not necessary

If unconscious:

Assess carotid pulse for max 10 seconds -deemphasized

Chest compressions if pulse not definite

P A B C D P C A B D

H

Airway

If conscious and speaking, airway is open

If unconscious:

Assess airway

Maintain airway as needed

(Head tilt – Chin lift)

P A C B D P C A B D

H

2

Breathing

If conscious and speaking, breathing is adequate

If unconscious:

Assess breathing - deemphasized

Chest compressions ASAP

Ventilations as per CPR guidelines

P A C B D P C A B D

H

Definitive Treatment

Diagnosis

Drugs

Defibrillation

P A B C D P C A B D

H

Basic Emergency Kit

Injectables: Epinephrine

Histamine blocker

Non-injectables: Oral Histamine Blocker

Vasodilator

Aspirin (Baby)

Anti-hypoglycemic (Sugar)Bronchodilator

Ammonia Inhalant

Equipment: O2, BP Cuff, Barrier Mask, AED

H

Homework!

Contact me within 2 weeks with

your changes and accomplishments:

[email protected]

H

Chest Pain

Causes Of Chest Pain

Cardiac Related Non-Cardiac

Angina pectoris Muscle strain

Myocardial infarction Esophageal reflux

Hiatal hernia

Indigestion

Gas pain

H

Indigestion is similar to the pain of

angina or MI and should not be

ignored. Seek medical assistance if

chest pain persists for 2 minutes or

longer, if episode is the first.

H

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Angina Pectoris

A transient chest pain caused by

insufficient supply of oxygenated

blood to the heart

Often brought on by exertion or

emotion

Relieved by rest or nitroglycerin

H

Medical History Interview

How frequently do you suffer angina attacks?

How long do the attacks last?

What precipitates your attacks?

How quickly does nitroglycerin relieve your attacks?

When was your last attack?

* Phone patients day prior to treatment

requesting them to bring their nitroglycerinH

Angina Pectoris

Management

P Comfortable, usually upright

A

B

C

D Nitroglycerin

Oxygen

Usually not needed

H

Vasodilator

Nitroglycerin

Nitrostat tablets

Sublingual 0.4 mg

Nitrolingual spray

Translingual

application

0.4 mg/spray

H

Basic Emergency Kit


Histamine blocker


Vasodilator

Aspirin (Baby)


Ammonia Inhalant


H

Consider Myocardial Infarction

if…

No prior history of chest pain

Patient with history of angina

Pain more intense than usual

Nitroglycerin x 3 fails to alleviate pain

Nitroglycerin resolves pain… then pain returns

H

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Myocardial InfarctionSymptoms

Pain

Severe to intolerable

Crushing, choking

Radiates: L arm,

hand, shoulders,

neck, jaw

Nausea, weakness,

dizziness

Palpitations

Cold perspiration

Sense of impending

doom

Signs

Restlessness

Acute distress

Skin

Cool, pale, moist

Heart rate

Bradycardia to tachycardia

H

Women’s Signs and Symptoms

Shortness of Breath

Weakness

Unusual fatigue

Indigestion

Disturbed Sleep

50% of women have no chest pain

H

Myocardial Infarction

Management

P Comfortable

A

B

C

D Call 911

Nitrous Oxide

Oxygen

Nitroglycerin

Aspirin (4 Baby, chewed)

As Needed

H

Vasodilator

Nitroglycerin

Nitrostat tablets

Sublingual 0.4 mg

Nitrolingual spray

Translingual

application

0.4 mg/spray

H

Thrombolytic (Clot buster)

Aspirin

Tablets, 325 mg

4 Baby CHEWED

Administer if MI is

considered

Contraindicated if allergic

H

Cardiac Arrest:

Basic Life Support - CPR

P Position

C Circulation

A Airway

B Breathing

D Defibrillation

H

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Medical Alert Bracelet

Michael Holzberg

[email protected]

universalmedicaldata.comH H

Basic Emergency Kit


Histamine blocker


Vasodilator

Aspirin (Baby)


Ammonia Inhalant


H

Diabetes Mellitus

A metabolic disease that occurs as

either a deficiency or a complete

lack of insulin in the body

H

Diabetes Mellitus

Hypoglycemia

Hypoglycemia occurs when the body's blood sugar, or glucose, is abnormally low. The term insulin shock is used to describe severe hypoglycemia that may result in unconsciousness.

H

Diabetic Emergency:

Hypoglycemia

Causes

Too much insulin

Too little food

Signs and Symptoms

Shaking

Sweating

Anxiety

Palpitations

Restlessness

Mental Confusion

H

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Do you use oral medication or insulin?

How well controlled is your diabetes?

What was your last blood sugar and how long ago was it taken?

(Fasting: 80-110 normal)

What is your A1C reading?H

When did you last eat and when are you due for your next snack or meal?

Do you have a sugar source readily available; if so, could you please get it out?

Are you feeling okay at this time for treatment? (If they are unsure, ask them to please check their blood sugar before you proceed.)

What signs do you exhibit with a low blood sugar? H

Hypoglycemia Management Conscious

P Comfortable

A

B

C

D Administer “sugar”

As Needed

Glucose gel

Fruit juices (Orange preferred by many)

Hard candy

Soft drinks (non-diet)H

Hypoglycemia Management Unconscious

P Supine

A

B

C

D Call 911

Absorbable sugar (gel)―Under lips, canine to canine ?

Sugar IV by EMS

As Needed

H

Anti-hypoglycemic

Management of hypoglycemia

Orange juice

Soft drink

No contraindications

H

Final Word

All insulin diabetic patients should

monitor their blood glucose levels

at the end of each dental

appointment prior to driving.

H

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Basic Emergency Kit


Histamine blocker


Vasodilator

Aspirin (Baby)


Ammonia Inhalant


H

The Asthma Attack

This leads to one or more of the following symptoms

Tightness in the chest

Shortness of breath

A chronic or recurring cough

Wheezing, particularly when trying to exhale

Anxiety

Constriction of the airways and formation of

thick mucus makes it progressively more

difficult to inhale and exhale

H


What brings on an attack?

How often do you get an attack and how long does it typically last?

What drugs do you use to prevent acute episodes?

What is the usual number of doses needed?

Have you ever been hospitalized for your asthma?

Do you have your inhaler with you?

When was your last attack?

*Call asthmatic patients prior to day of treatment,requesting them to bring bronchodilator H

P Upright

A

B

C

D Inhaler

Oxygen

Epinephrine if critical

Usually not needed

Asthma Attack

Management

H

Bronchodilator for Asthma

Albuterol rescue inhaler


H

Asthma Attack Management

Summon EMS if…

Patient requests

Episode is continuing with

2 doses of bronchodilator

(Status Asthmaticus)

H

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Basic Emergency Kit


Histamine blocker


Vasodilator

Aspirin (Baby)


Ammonia Inhalant


H

Syncope: Predisposing Factors

Psychogenic Factors

Fright/Anxiety

Extraction

Injections

Pain, especially of a sudden

and unexpected nature

The sight of blood or of

surgical or other dental

instruments (such as a local

anesthetic syringe)

Non-psychogenic Factors

Sitting upright or standing

Hunger

Exhaustion

Hot, humid, crowded

environment

Male sex

Age between 16 and 35 years

H

Syncope Management

P Supine, slight elevation of legs

A

B

C

D

Ammonia inhalant

Oxygen

As needed

H

Ammonia Inhalant


H

Recovery

May continue to be light-headed, weak, pale

May be disoriented/confused

Pulse & blood pressure should return to normal

Takes 24 hours to completely recover

Discharge in custody of responsible adult

H

Basic Emergency Kit


Histamine blocker


Vasodilator

Aspirin (Baby)


Ammonia Inhalant


H

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Allergy

An overreaction by the body’s

immune system to a foreign

substance

H

Allergy Facts

The faster the onset of signs and symptoms after exposure to the allergen, the more severe the reaction

Allergy involving only skin is NOT life-threatening and requires milder, less aggressive management

Allergy involving difficulty with breathing IS life-threatening, requiring immediate, aggressive management

H

Allergic Reactions

What to look for:

Sneezing, coughing, or wheezing

Shortness of breath

Tightness and swelling in the throat,

face, tongue, or chest

Itching, burning, or rash

Dizziness and weakness

Nausea and vomiting

H

Allergy ManagementDelayed Onset Skin Reaction

P Comfortable

A

B

C

D Oral histamine blocker

Continue for 2-3 days prn

Usually not needed

H

H

Anaphylaxis

A severe, and sometimes fatal, allergic

reaction characterized by respiratory distress and hypotension, leading to cardiovascular collapse

H

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Usual Progression of Anaphylaxis

Skin

Eyes, nose, GI

Respiratory System

Cardiovascular System

H

Anaphylaxis Management

P Based upon primary complaint:

“Can’t breathe” – upright

“Feel faint” – supine, feet elevated

A

B

C

As Needed

H

Anaphylaxis Management

D Call 911

Oxygen

Epinephrine

−Every 5 minutes or until EMS arrives

−Multiple doses usually required

Histamine blocker IM

H

Epinephrine

Adrenalin

Anaphylaxis

Life-threatening allergy


Preloaded syringe

(EpiPen)

H

Why Epinephrine?

Reverses 2 components of anaphylaxis which lead to death Bronchospasm – epinephrine is

bronchodilator

Hypotension – epinephrine is vasopressor (BP↑)

Works quickly IM top of thigh (EpiPenÜ), works in 1-2

minutes

H H

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Causes of Seizures

Epileptic patients

Stress induces seizures

Cerebral anoxia

Neonatal injury

CVA (stroke, ‘brain attack’)

Tumor

Previous head injury

Idiopathic

H

Tonic-Clonic Generalized Seizure

Is self-limiting

Lasts not more than 2 - 5 minutes

Usually does not require IV

anticonvulsant therapy

Usually does not result in injury

H


What type of seizure do you have?

How often do you have seizures?

What is your aura?

How long do your seizures last?

Did you take your medicine today?

H

Tonic-Clonic Seizure Management

H

P – SupineProtect victim:

Rescuer 1: arms – gently!

Rescuer 2: legs – gently!

A

B As needed

C

D – Call 911

Remove “pillow” or “donut” from headrest of chair

Do not put anything into the mouth

Post-Ictal Phase

ABC as needed

Patient is disoriented, sleeping

Position

Turn on side, if possible

― Aids in airway maintenance

Dental Chair

―Maintain supine, maintain airway as needed

H

Remember:

The Common Sense Approach to

preventing medical emergencies

requires preparation

Preparation creates the ability to

recognize a problem BEFORE

it becomes an emergency

H

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Medical Emergency Kits and AED

Health First

[email protected]

www.healthfirst.com

H

Mark Spearman - [email protected]

www.physio-control.com

Physio-Control AED

Thank you!

Cindy Kleiman, RDH, BSOral Care Consultant and Speaker

480-342-9655

www.cindyspeaking.com

[email protected]

www.healthfirst.com

www.physio-control.com

www.cindyspeaking.com

Medical Emergencies in the Dental Officewestliberty.edu/health-sciences/files/2014/02/...Medical...

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