Medical Emergencies. The Dental Assistants Role Be observant of your patient! Be observant of your...

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Medical Medical Emergencies Emergencies

Transcript of Medical Emergencies. The Dental Assistants Role Be observant of your patient! Be observant of your...

Medical EmergenciesMedical Emergencies

The Dental Assistants RoleThe Dental Assistants Role

Be observant of your patient!Be observant of your patient!– Do they have trouble walking, moving or Do they have trouble walking, moving or

talking?talking?– Do their eyes respond to light?Do their eyes respond to light?– Is their speech slurred?Is their speech slurred?– Are they anxious about their treatment?Are they anxious about their treatment?

All dental personnel should be well-All dental personnel should be well-trained for an emergency and CPR trained for an emergency and CPR certifiedcertified

Dental Emergency KitDental Emergency Kit

Each office should have an up-to-date Each office should have an up-to-date emergency kit that includes:emergency kit that includes:– Sterile syringes, tourniquets, barrier Sterile syringes, tourniquets, barrier

devices for CPR and other oral airway devices for CPR and other oral airway devicesdevices

– Oxygen equipment (green tank)Oxygen equipment (green tank)– Stimulants—ammonia inhalants Stimulants—ammonia inhalants – Vasodilators such as translingual Vasodilators such as translingual

nitroglycerin, which increases oxygenated nitroglycerin, which increases oxygenated blood supply to the heartblood supply to the heart

Dental Emergency KitDental Emergency Kit

Antihistamines such as epinephrine, Antihistamines such as epinephrine, adrenaline, benadryl. An epi-pen can adrenaline, benadryl. An epi-pen can be used for quick and easy delivery.be used for quick and easy delivery.

Analgesics—pain relieversAnalgesics—pain relievers Depressants—such as diazepam, Depressants—such as diazepam,

used for seizure treatment.used for seizure treatment. PPE—personal protective equipment.PPE—personal protective equipment.

Dental Emergency KitDental Emergency Kit

SyncopeSyncope

AKA fainting, The most common AKA fainting, The most common emergency in a dental officeemergency in a dental office

Caused by physical or emotional Caused by physical or emotional stress and decreased blood flow to stress and decreased blood flow to the brain.the brain.

Symptoms may include: dizziness, Symptoms may include: dizziness, nausea, weakness, pale skin, nausea, weakness, pale skin, clammy, shallow breathingclammy, shallow breathing

Treatment for SyncopeTreatment for Syncope If conscious, have the patient sit, recline If conscious, have the patient sit, recline

them if able.them if able. If unconscious, place in the Trendelenburg If unconscious, place in the Trendelenburg

position (supine with feet slightly elevated)position (supine with feet slightly elevated) Administer oxygen and vital signs. Most Administer oxygen and vital signs. Most

patients will resume spontaneous breathing patients will resume spontaneous breathing within 10 seconds. within 10 seconds.

If they don’t, crack open the vial of ammonia If they don’t, crack open the vial of ammonia and wave under their nose (not too close or and wave under their nose (not too close or it can irritate the nasal membranes.it can irritate the nasal membranes.

Postural HypotensionPostural Hypotension

Low blood pressure that occurs upon Low blood pressure that occurs upon standing up standing up

May occur after long appointments May occur after long appointments when the patient has been supine for when the patient has been supine for an extended length of timean extended length of time

Raise the patient chair slowly and Raise the patient chair slowly and have them remain seated for 1 have them remain seated for 1 minute prior to dismissalminute prior to dismissal

AsthmaAsthma

Narrowing of the bronchioles in the Narrowing of the bronchioles in the lungslungs

Recurrent attacks of breathlessness Recurrent attacks of breathlessness accompanied by wheezing during accompanied by wheezing during exhalation. May have a dry cough.exhalation. May have a dry cough.

When an asthma patient exhales, the When an asthma patient exhales, the lungs collapse to expel air, which lungs collapse to expel air, which narrows the bronchioles even morenarrows the bronchioles even more

1 in 10 US children have asthma and it 1 in 10 US children have asthma and it is on the rise.is on the rise.

Asthma, contAsthma, cont

Causes:Causes:– HeredityHeredity– AllergiesAllergies– Most often occurs in the morningMost often occurs in the morning

Treatment: antihistamines administered Treatment: antihistamines administered via an inhalervia an inhaler

Allergic ReactionsAllergic Reactions

An acute reaction which may be in a An acute reaction which may be in a general area or cover the entire bodygeneral area or cover the entire body

Causes in the dental office may include Causes in the dental office may include drugs, latex or dental materialsdrugs, latex or dental materials

Symptoms include edema (swelling), Symptoms include edema (swelling), erythema (redness) or urticaria (hives)erythema (redness) or urticaria (hives)

Treatment includes removing the Treatment includes removing the irritant or administering an irritant or administering an antihistamineantihistamine

Anaphylactic ReactionAnaphylactic Reaction

A severe allergic reaction that is life A severe allergic reaction that is life threatening.threatening.

Symptoms include decrease in blood Symptoms include decrease in blood pressure, constriction of airway, pressure, constriction of airway, swelling of tongue and throat, swelling of tongue and throat, stomach painstomach pain

Treatment is by epinephrine injectionTreatment is by epinephrine injection Call 911 if symptoms do not improve Call 911 if symptoms do not improve

quicklyquickly

HyperventilationHyperventilation

Abnormally fast or deep breathing which Abnormally fast or deep breathing which results in the loss of carbon dioxide from results in the loss of carbon dioxide from the blood (caused by patient panic!)the blood (caused by patient panic!)

Symptoms include low blood pressure, Symptoms include low blood pressure, numbness or tingling in the extremities, numbness or tingling in the extremities, possible faintingpossible fainting

Treatment includes stopping dental Treatment includes stopping dental treatment, set patient upright, have them treatment, set patient upright, have them breathe in and hold for several seconds breathe in and hold for several seconds before exhaling or have them breathe into before exhaling or have them breathe into their cupped hands or a paper bagtheir cupped hands or a paper bag

Epilepsy/SeizuresEpilepsy/Seizures

Neurological disorder characterized Neurological disorder characterized by sudden, recurring attacks of by sudden, recurring attacks of motor, sensory or psychic motor, sensory or psychic malfunction with or without loss of malfunction with or without loss of consciousnessconsciousness

Two main types:Two main types:– Petit MalPetit Mal– Grand MalGrand Mal

Petit MalPetit Mal

Patient experiences a momentary loss of Patient experiences a momentary loss of consciousness. May have a blank stare or consciousness. May have a blank stare or blinking of the eye that lasts 5-10 secondsblinking of the eye that lasts 5-10 seconds

Others may not be aware of it, as the Others may not be aware of it, as the person looks like they’re daydreamingperson looks like they’re daydreaming

Occurs more frequently in children and Occurs more frequently in children and decreases with agedecreases with age

May be a warning of a grand mal to followMay be a warning of a grand mal to follow

Grand MalGrand Mal

Most commonMost common Usually lasts from 2-5 minutesUsually lasts from 2-5 minutes The body jerks, twitches and stiffensThe body jerks, twitches and stiffens Breathing is irregular and person may be Breathing is irregular and person may be

unconsciousunconscious Bladder and bowel control may be lostBladder and bowel control may be lost After seizing, the patient may be After seizing, the patient may be

disoriented and not be aware of what disoriented and not be aware of what happenedhappened

Grand Mal, cont.Grand Mal, cont.

Stop dental treatment and remove Stop dental treatment and remove anything from the mouth (if possible)anything from the mouth (if possible)

Clear all harmful objects out of the wayClear all harmful objects out of the way Allow seizure to run its courseAllow seizure to run its course After seizure, place the patient in the After seizure, place the patient in the

recovery position (right side)recovery position (right side) If seizure lasts more than 5 minutes, If seizure lasts more than 5 minutes,

call 911call 911

Grand Mal, cont.Grand Mal, cont.

Status Epilepticus: when a patient Status Epilepticus: when a patient has one seizure after another, call has one seizure after another, call 911911

Dilantin: a common medication used Dilantin: a common medication used to treat seizures. May cause gingival to treat seizures. May cause gingival hyperplasia (overgrowth of gingival hyperplasia (overgrowth of gingival tissue)tissue)

DiabetesDiabetes

High blood sugar caused by the High blood sugar caused by the pancreas not producing enough pancreas not producing enough insulininsulin

Too much sugar in the Too much sugar in the bloodblood Symptoms include: thirst, excessive Symptoms include: thirst, excessive

urination, weight loss, fatigueurination, weight loss, fatigue Two types of diabetes: I and IITwo types of diabetes: I and II

Diabetes, cont.Diabetes, cont. Type I:Type I:

– AKA: juvenile diabetesAKA: juvenile diabetes can occur in all agescan occur in all ages

– Most severeMost severe– May be caused by heredity.May be caused by heredity.– Patient must have regular insulin Patient must have regular insulin

injections or coma will resultinjections or coma will result– Experience the most medical Experience the most medical

complicationscomplications Disease present for long timeDisease present for long time

– Susceptible to infectionsSusceptible to infections slow healing, toothaches, gingivitis, slow healing, toothaches, gingivitis,

periodontitis and xerostomia (dry mouth)periodontitis and xerostomia (dry mouth)

Diabetes, cont.Diabetes, cont.

Type II:Type II:– 90% of diabetics90% of diabetics– Controlled by diet and meds that lower Controlled by diet and meds that lower

blood sugar levelsblood sugar levels Insulin injections not required Insulin injections not required

– It can result in hyperglycemia (too much It can result in hyperglycemia (too much sugar in the blood). Patient may sugar in the blood). Patient may experience excessive thirst, increased experience excessive thirst, increased urination, nausea and vomiting with urination, nausea and vomiting with abdominal pain, etc.abdominal pain, etc.

– Patient may go into a diabetic comaPatient may go into a diabetic coma

Diabetes, cont.Diabetes, cont.

Type II, cont:Type II, cont:– Stop dental treatmentStop dental treatment– If patient is conscious, have them If patient is conscious, have them

administer an insulin shot (many carry administer an insulin shot (many carry insulin pens)insulin pens)

– If unconscious, call 911If unconscious, call 911– Diabetic acidosis: if the patient goes Diabetic acidosis: if the patient goes

into a coma and is not treated quickly, into a coma and is not treated quickly, they will die. they will die.

HypoglycemiaHypoglycemia Too little sugar in the bloodToo little sugar in the blood Rapid onset. Usually caused by Rapid onset. Usually caused by

skipping meals, stress or skipping meals, stress or overexertionoverexertion

Patient will become nervous, have Patient will become nervous, have trembling and weakness, cold sweatstrembling and weakness, cold sweats

May become hungry and show May become hungry and show personality changepersonality change

Stop dental treatment and give sugar Stop dental treatment and give sugar (orange juice works well)(orange juice works well)

If unconscious, call 911If unconscious, call 911

Cardiovascular DiseaseCardiovascular Disease

AKA heart disease, a leading cause of AKA heart disease, a leading cause of death in the USdeath in the US

Avoid epinephrine in anesthetic and Avoid epinephrine in anesthetic and gingival retraction cordgingival retraction cord

The patient may need prophylactic The patient may need prophylactic antibiotics prior to treatment, which antibiotics prior to treatment, which lowers the risk of bacterial lowers the risk of bacterial endocarditis (inflammation of the endocarditis (inflammation of the lining of the heart)lining of the heart)

Cardio, cont.Cardio, cont. Causes of heart disease:Causes of heart disease:

– Arteriosclerosis: hardening of the arteriesArteriosclerosis: hardening of the arteries

– Angina pectorisAngina pectoris: “strangling of the chest”, : “strangling of the chest”, First sign of heart disease. First sign of heart disease. Causes pain in the chest, may radiate to the jaw. Causes pain in the chest, may radiate to the jaw. high blood pressure and pulse rate. high blood pressure and pulse rate. May become pale and clammy. May become pale and clammy.

– Stop treatment and place nitroglycerin pills Stop treatment and place nitroglycerin pills sublingually. Administer oxygen. Patient can sublingually. Administer oxygen. Patient can be given 3 doses. If no response, assume the be given 3 doses. If no response, assume the patient is having a myocardial infarction.patient is having a myocardial infarction.

Cardio, cont.Cardio, cont.

Myocardial infarctionMyocardial infarction– AKA heart attackAKA heart attack– Coronary arteries are blocked or Coronary arteries are blocked or

narrowednarrowed– Symptoms are similar to anginaSymptoms are similar to angina– Stop dental treatment, position patient Stop dental treatment, position patient

with head slightly elevated.with head slightly elevated.– Administer oxygen and nitroglycerin.Administer oxygen and nitroglycerin.– Call 911Call 911

Cerebrovascular AccidentCerebrovascular Accident Aka Stroke, a leading cause of Aka Stroke, a leading cause of

disability and death in the USdisability and death in the US Caused by the blood supply to the Caused by the blood supply to the

brain being interrupted by a blockage:brain being interrupted by a blockage:– Embolism: blood clotEmbolism: blood clot– Hemorrhage: rupture of a blood vesselHemorrhage: rupture of a blood vessel

Patient may experience extreme Patient may experience extreme headache, loss of speech, dizziness, headache, loss of speech, dizziness, paralysis on one side of the body, loss of paralysis on one side of the body, loss of consciousnessconsciousness

MiscellaneousMiscellaneous

Dentists are required by law to report Dentists are required by law to report suspected child abusesuspected child abuse

If a patient has a pacemaker, do not If a patient has a pacemaker, do not use the ultrasonic scaler or magnetic use the ultrasonic scaler or magnetic headrestheadrest

Remember the tips for blind, hearing Remember the tips for blind, hearing impaired and disabled patients.impaired and disabled patients.