Medical Emergencies in the Dental Office.pdf

8/19/2019 Medical Emergencies in the Dental Office.pdf

1/52

Medical

Emergencies in theDental Office


2/52

Life Threatening

Situations! Factors to help decrease

! Pretreatment physical evaluation! Medical history questionnaire! Dialogue histoy! Physical examination! Modications in dental care


3/52

Top 7 Emergencies

! Syncope! Mild allergic reaction! Angina pectoris! Postural hypotension!

Seizures! Bronchospasm! Hyperventilation


4/52

Emergencies

! Most medical emergencies areentirely stress induced

! Pain, anxiety, fear! Exacerbation of preexisting

conditions due to stressful situations


5/52

Stress Induced Situations

! Vasopressor syncope! Hyperventilation! Acute cardiovascular emergencies! Broncospasm!

Seizures


6/52

Drug-related adverse

reactionsLocal Anesthetics

-psychogenic (stress related)-overdose-allergy


7/52

Common Medical

Emergencies! Unconsciousness

! Vasodepressorsyncope

!

Orthostatichypotension! Airway obstruction! Angina! Acute myocardial

infarction! Cardiac arrest! seizures

! Hyperventilation! Asthma! Altered

consciousness! Diabetes mellitus! Thyroid gland dysfxn! Cerebral vascular

accident! Drug related

emergencies! Drug overdose

reactions!

allergy


8/52

Prevention

! 90% of all life threatening situationscan be prevented with appropriatephysical exam

! 10% are sudden unexpected deathsin spite of all preventative measures


9/52

Emergency Drugs

! Drug administration is notnecessary for the immediatemanagement of medicalemergencies

! Primary management of allemergency situations involves BLS

! When in doubt, never medicate


10/52

Critical Injectable Drugs

! Epinephrine*! Histamine blockers*! Atropine

! * used in the management of acuteallergic reaction


11/52

Primary Injectable Dug for Acute Allergic

Reaction (Anaphylaxis) Drug of Choice EpiDrug Class CatecholamineTrade Name Ana-Guard,

Epipen, Epipen Jr.Dose 1mg

Side Effects Tachydysrhythmias


12/52

Primary Injectable for

Allergic ReactionDrug of Choice DiphenhydramineDrug Class Antihistamine

Indications delayed onset allergicreactionsSide Effects drowsiness, dizziness,

urinary retention,

hypotension,tachycardiaDose 15-50mg, (25mg tabs)


13/52

Critical Noninjectable

Drugs! Oxygen! Vasodilator! Bronchodilator! Antihypoglycemic!

Aspirin


14/52

Primary Noninjectable

VasodilatorDrug of Choice NitroglycerinDrug Class Vasodilator

Alternative Amyl nitrateIndications Chest painSide Effects Pulsating headache,

facial ushing,hypotension

Dose sublingual tabstrans lingual spray


15/52


AntihypoglycemicDrug of Choice Orange Juice pulp freeDrug Class Antihypoglycemic

Alternative Soft Drink (not diet)Indications Hypoglycemic

secondary to diabetes

mellitus or fastinghypoglycemic


16/52


Antiplatelet Drug of Choice AspirinDrug Class AntiplateletAlternative NoneIndications Suspected MI or

angina

Side effects Hemmorrhage


17/52

Unconsciousness

! Account for 50% of all emergencysituations in the dental ofce

! Initial steps in the management ofunconsciousness, regardless of thecause, remain the same

! Steps are directed toward basic lifesustaining procedures


18/52

Common Causes of

Syncope in Dental Ofce! Vasodepressor syncope! Drug administration of ingestion! Orthostatic hypotension! Epilepsy!

Hypoglycemic reaction


19/52

Management of

Unconsciousness! Recognition! Terminate dental procedure! Call for help! Initiate BLS


20/52

Presyncopal Signs and

Symptoms! Early

! Feeling of warmth! Loss of color! Heavy perspiration! Nausea! BP at baseline or lower! tachycardia


21/52


22/52

Management of Syncope

! Position patient! Administer oxygen!

Ammonia capsule! Treat vitals if needed! Postpone further treatment! Determining precipitating factors! Get up gradually! Delayed recovery?

! Activate emergency medical services


23/52

Management of

Respiratory Distress! Recognize respiratory distress-

sounds, abnormal rate or depth of

respiration


24/52

Respiratory Difficulty:

! Asthmatic attack:! A paroxysmal state of hyperactivity

of the tracheobronchial tree;bronchospasm orbronchoconstriction caused byallergin or non-allergic factors.

!

Physical finding:! Wheezing, coughing, chest tightness,tachycardia, fatigue, airwayobstruction.


25/52

Asthmatic Attack:

! Management:! Place in comfortable position.! Administer inhalant therapy with

bronchodilator.! Oxygen.!

Epinephrine.! Call for medical assistance.


26/52

Asthmatic Attack:

! Prevention:! Minimize anxiety.! Have medication available for use.! History taking.


27/52

Hyperventilation

! Dened as ventilation in excess ofthat required to maintain normal

blood PaO2 and PaCO2! One of the most common

emergency situations that occur in

the dental ofce


28/52

Hyperventilation:

! Etiology: characterized by anincrease depth of ventilation.

Usually anxiety-related but mayoccur with other conditions.

! Physical finding:! Dyspnea, air hunger, chest

tightness, hyperventilation, loss ofconsciousness.


29/52

Hyperventilation:

! Management:! Place in comfortable position.! Guide patient in slow breathing.! Let patient rebreathe his or her own exhaled air

by using paper bag of full-face mask.! Prevention:

! Appropriate pain control and sedation techniques

to reduce anxiety.


30/52

Altered Consciousness

! Altered consciousness may be therst clinical sign of a serious

medical problem! Most common cause in the dental

setting is drugs


31/52

Causes of Altered

Consciousness! Drug overdose! Hyperventilation! Hypoglycemia! CVA! Hyper/hypothyroidism


32/52

Management of Altered

Consciousness! Terminate dental procedure! Position! BLS! Manage signs and symptoms! Call 911?


33/52

Vasovagal Syncope:

! Etiology: transient cerebral ischemialeading to loss of consciousness, oftenrelated to peripheral pooling of blood.

! Physical findings:! Sudden loss of consciousness, pallor, nausea.! Irregular and decreased ventilation.! Hypotension and bradycardia.


34/52

Vasovagal Syncope:

! Management:! Place in comfortable position.! Establish a airway, oxygen

supplement.! Administer reflex stimulants;

Ammonia and cold compression.! Prevention:

! Minimize anxiety and stress.


35/52

Orthostatic hypotension:

! Etiology: pooling of blood in the peripherythat is not remobilized quickly enough toprevent cerebral ischemia when a patientrapidly assumes an upright posture.

! Physical findings: palpitations andgeneralized weakness, feel lightheaded orbecome syncopal.


36/52

Orthostatic hypotension:

! Management:! Position patient in supine posture

with legs raised above the level ofthe head.! Monitor vital signs.

! Prevention:! History taking.! Slowly return patient to sitting

posture.


37/52

Diabetes Mellitus

! Represents a syndrome ofdisordered glucose metabolism and

inappropriate hyperglycemia thatresults from:

! An absolute deciency in insulin!

A reduction in the biologiceffectiveness of insulin! Or both


38/52

Diabetes

Mellitus(hypoglycemia):! Etiology: rapid decrease in serum blood

sugar usually seen in diabetics.! Physical findings:

! Sudden decreased cerebral functioncharacterized by mental confusion, lethargy,slurred speech.

! Hypotension, shock, eventual death.


39/52

Diabetes

Mellitus(hypoglycemia):! Management:

! Administer oral carbohydrate.! Or IV infusion.

! Prevention:! History taking.! Early recognition of insulin dose

and dietary habits.


40/52

Seizure:

! Etiology: paroxysmal neuronal discharge inthe brain characterized by alteredconsciousness, uncoordinated muscleactivity or abnormal sensory phenomena.

! Physical findings:! Tonic-clonic movements of trunk and extremities,

loss of consciousness, vomiting, airway

obstruction.


41/52

Seizure:

! Management:! Place patient supine position.! Suction and vital sign monitor.! Diazepam 5 mg IV.! BLS and transport if necessary.

! Prevention:! History taking.! Avoid toxic doses of local anesthetics.

C f Hi h Bl d


42/52

Causes of High Blood Levels of Local

Anesthetics! Biotransformation of drug is slow! Drug slowly eliminated by kidneys! Total dose too large! Rapid absorption at site! Intravascular injection


43/52

Signs of Overdose

! Headache! Lightheadedness! Dizziness! Blurred vision! Ringing in ears!

Numbness! Drowsiness, disorientation! Loss of consciousness


44/52

Chest Pain!

! Cardiac! Acute MI!

ischemia! Noncardiac

! Musculoskeletal! Pericarditis! Esophagitis! Pulmonary embolus! Dissecting aortic aneurysm


45/52

Clinical Signs and

Symptoms! Location: Not reliable - substernal! Description: squeezing, tightness,

heaviness, crushing! Response to medication: Most

reliable diagnostic tool


46/52

Clinical Management of

Chest Pain! Termination of dental procedure! Positioning! BLS! Administer oxygen and vasodilator


47/52

Nitroglycerine

! The single most effective drug for themanagement of acute anginal episodes

!

Decreases coronary artery resistance andincreases coronary blood ow - this is oflittle consequence in patients withsignicant CAD

! Preferable to administer patients ownmedicine


48/52

Clinical Manifestations of Acute MI

! Crushing pain, rarely described as“sharp ”, not relieved with rest, or

nitroglycerin! Cold sweat! Patient feels weak and apprehensive! Dyspnea! Nausea and vomiting


49/52

Management in DentalOfce

! Terminate procedure! Diagnosis! BLS (911?)/ACLS! Administer oxygen! Nitroglycerine - acts within 2-4 min!

Record vitals before and after meds! administer brinolytic- aspirin


50/52

Local AnestheticToxicity:

! Management:! Monitor vital sign.!

Administer oxygen.! Observe for 1 hour.! Diazepam (if convulsions occur)! BLS and transport.

! Prevention: dose of localanesthetics.


51/52

Local AnestheticToxicity:

! Etiology: level of a narcotic resultingin blood level producing adversereaction.

! Physical findings:! Talkativeness, anxiety, slurred speech,

confusion.! Stuttering speech, nystagmus, tremors,

headache, dizziness, blurred vision,drowsiness.

! Seizure, cardiac dysrhythmia or arrest.


52/52

Thank You!!!!

Medical Emergencies in the Dental Office.pdf

Documents

Transcript of Medical Emergencies in the Dental Office.pdf