Medical Emergencies

recognition and treatment

University of Illinois at Chicago College of Dentistry Department of Oral and Maxillofacial Surgery 2013

Common Emergencies in Dental Practice Malamed SF. Managing Medical Emergencies. JADA 124: 40, 1993 (30, 602 emergencies over ten year study) • •Syncope 15,407 • •Mild Allergic Reaction 2,583 • •Angina Pectoris 2,552 • •Postural Hypotension 1,595 • •Asthmatic Attack (Bronchospasm) 1,392 • •Hyperventilation 1,326 • •Epinephrine Reaction 913 • •Insulin Shock (Hypoglycemia) 890 • •Cardiac Arrest 331 • •Anaphylactic Reaction 304 • •Myocardial Infarction 289 • •LA Overdose 204 • •Acute Pulmonary Edema (CHF) 141 • •Diabetic Coma 109 • •Stroke 68 • •Adrenal Insufficiency 25 • •Thyroid Storm 4

Syncope

• S/S: (signs/symptoms): pallor, nausea, diaphoresis, bradycardia, hypotension, Possible: LOC, seizure, vomiting. (often occurs around injections of local anesthesia)

• Tx: Trendelenberg position, O2, reassurance, maintain airway if LOC, suctioning if vomiting, turn patient on right side.

Postural Hypotension

• S/S: Orthostatic hypotension, nausea/vomiting, lack of fluids/food, dehydration.

• Tx: fluids by mouth or IV, check blood glucose.

Seizures

• S/S: history of seizure disorder/medication,

tonic/clonic seizure, self-limiting. • Tx: safe supine position dental chair or floor,

maintain airway, suction mouth / pharynx PRN. Call 5-5555 if seizures continue.

Insulin Shock (Hypoglycemia)

• S/S: history of IDDM, anxiety, dread, weakness, lethargy, low blood glucose (80 or less).

• Tx: oral or IV glucose. Call 5-5555 if unconscious.

Diabetic Coma (Hyperglycemia, Hyperosmolar Syndrome)

• S/S: dehydration, nausea, weakness, very high

blood glucose (>400). • Tx: call 5-5555, hydration and DM control.

Mild Allergic Reaction

• S/S: delayed or immediate itching, possible

hives, possible angioneurotic edema. • Tx: Diphenhydramine (Benadryl) 25-50 mg

oral tabs, observation.

Anaphylactic Reaction

• S/S: immediate severe reaction of

hypotension, hives, acute broncospasm, angioneurotic edema.

• Tx: epinephrine subcutaneously (Epi-Pen), call 5-5555, Diphenhydramine 50mg orally, maintain airway, support respirations, repeat epinephrine PRN, monitor vital signs.

Asthmatic Attack (Bronchospasm)

• S/S: immediate acute expiratory wheezing, history of severe asthma/broncospasm.

• Tx: epinephrine 0.3 mg subcutaneously (Epi-Pen), call 5-5555, O2, maintain airway, support respirations, repeat epinephrine PRN, monitor vital signs.

Angina Pectoris

• S/S: history of angina/coronary artery disease. • Tx: NTG sublingually, call 5-5555, O2, chew

and swallow Aspirin 325mg tab, possible repeat NTG, support airway and respirations.

Cardiac Arrest

• S/S: LOC, loss of pulse, loss of respirations. • Tx: start BLS, call 5-5555.

Myocardial Infarction

• S/S: chest pain pressure, possible history of

angina/coronary artery disease. • Tx: NTG sublingually without relief, call 5-

5555, O2, chew and swallow aspirin 325mg tab, possible repeat of NTG, support airway and respirations.

Acute Pulmonary Edema (CHF)

• S/S: acute SOB (dyspnea), rales or crackles audible in lung fields.

• Tx: O2, call 5-5555 (unlikely to see in the dental office).

Hyperventilation

• S/S: history of anxiety/panic attacks, possible anxiety medication, panic, uncontrolled hyperventilation, possible carpal-pedal spasms.

• Tx: recognition, reassurance, control CO2 by paper bag over mouth to lower breathing rate to 12 - 16 breaths per minute (similar to doctor’s breathing-breathe with patient).

Epinephrine Reaction

• S/S: tachycardia, palpitations, anxiety,

headache, dysrhythmias, history of sensitivity to epinephrine often, possible drug reaction (antidepressant or other psychotropic drug).

• Tx: reassurance, cancel appointment perhaps, observation, likely self-limiting.

Local Anesthesia Overdose

• S/S: perioral numbness, possible seizure

without aura, followed by lethargy, possible LOC, coma.

• Tx: call 5-5555, support respirations, airway, lipid emulsion therapy (binds toxin).

Stroke (Cerebrovascular Accident)

• S/S: likely headache followed by sudden loss of motor function/ sensory function, possible LOC, coma.

• Tx: call 5-5555 (time is critical for transfer and treatment), support respirations, airway, monitor vital signs, protect patient.

Adrenal Insufficiency

• S/S: lethargy, weakness, history of Addison's disease or adrenal suppression.

• Tx: call 5-5555, acute steroid replacement therapy, support blood pressure, monitor vital signs.

Thyroid Storm

• S/S: Tachycardia, hypertension, history of hyperthyroidism. Unlikely to present de novo in the dental office.

• Tx: Call 5-5555.