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Emergency management in dental clinic
- 1. Emergency Management in Dental Clinic How to Avoida BadDay ??? Presented By Dr Arya V Devi
- 2. Reality bites!! You know that you are not having a good day when:
- 3. Prevention is always better than cure… Never treat as a stranger Comprehensive medical history Preparation for emergencies Vital signs
- 4. Emergency kit in dental office •Epinephrine •Oxygen •Chlorpheniramine maleate •Sugar/cake frosting •Ammonia inhalants •Atropine •Diazepam •Hydrocortisone •Inhaler-Albuterol •Nitrospray/nitroglyceride tablets •Aspirin •Paper bag •Laryngoscope •Oral airways Each staff member should know where it is located
- 5. Rules To Remember To keep the patient alive remember Emergency Mangement Algorithm P-A-B-C-D-E The very step in management of all medical emergencies are BLS as needed
- 6. Position Supine or Trendelenburg position
- 8. Breathing • Check breathing • If not give 2 breaths via pocket mask • Insert oral airway if apneic
- 9. Circulation (CPR) • Check for pulse • If no, move patient to floor & begin chest compressions – Push hard 2 inch depth (Full recoil) – 100 depths per minute(Decrease interruptions)
- 10. C-A-B
- 13. Airway Obstruction Coughing “Crowing” sounds Patient reaches for neck Inability to speak Cyanosis Loss of consciousness Death
- 14. Treatment Ask the pt to cough forcefully Back blows Use laryngoscope for direct visualization and remove with Magill forceps
- 15. Treatment
- 18. Prevention Adequate protection of the oropharynx Ligatures around small dental objects • Rubber dam • Throat screen
- 20. Management Reassure the patient Position pt upright with arms forward Administer 1 puff from pt’s own inhaler Give oxygen Give Adrenaline Hydrocortisone 200 mg i.v. Epinephrine 0.3-0.5 mg SC/IM/IV Salbutamol 500 mg i.m/s.c. Monitor VS Call An Ambulance
- 21. Prevention Avoid precipitating factors Confirm that patient took asthma medications Avoid narcotics Stress reduction Prophylactic bronchodilator
- 22. Hyperventilation • Patient restlessness • Increased respiratory rate • Increased depth of respiration • Light headedness • Tingling in hands and feet • Carpal-pedal spasm • Increased anxiety • Loss of consciousness
- 23. Management Stop procedure Clear all objects from mouth Verbally calm the patient Rebreathe CO2 • Paper bag • Face mask • Hands Self-limiting problem Diazepam 5 mg IV or midazolam 2 mg IM/IV No O2
- 27. Myocardi al infarction Angina that is prolonged or not responsive to nitroglycerin Pallor Shortness of breath Unconscious ness Weak pulse
- 28. Management Semi Fowlers position Nitroglycerin 0.4 mg sublingual or spray, repeated every 5 minutes X 3 oxygen CPR/ Emergency dept.
- 30. Syncope Pale Sweating Room “feels warm” Nausea Pulse rapid BP nearly normal Loss of consciousness Possible seizure activity BP extremely low Pulse extremely slow and weak
- 31. Treatment Stop dental treatment Remove objects in mouth Trendelenburg position Raise feet Loosen restrictive clothing Supplemental oxygen Cool towel to forehead Monitor vital signs Ammonia vaporole
- 32. Prevention Short appointments Morning appointments Distraction techniques Patient education and communication Sedation Treat in more supine or slight Trendelenburg position Snack before appointment
- 34. Treatment Stop dental treatment, all objects out of mouth Remove dangerous items from around patient Gently restrain and protect patient NO tongue blades, maintain airway Oxygen Monitor vital signs Call emergency dept Valium 5-10 mg IV or midazolam 2-4 mg IV/IM
- 35. Prevention Confirm that patient has taken antiseizure medications on day of procedure Limit stress Sedation • Benzodiazepines • Barbiturates
- 36. Stroke • Check these signs F-A-S-T • Smile: Is 1 side drooping Face • Raise both arms: Is 1 side weak Arms • Unable? • Words slurry Speech • Time lost means brain lost Time
- 37. Management BLS, supine position BUT head slightly elevated Reassurance and transfer to hospital
- 39. Allergic reactions Timing of the reaction • Immediate • Delayed Extent of the reaction • Rash • Swelling • Respiratory compromise
- 40. Treatment Delayed onset skin reaction • Stop dental treatment/medications • Assess respiration • Consider observation if localized • If more generalized, diphenhydramine (Benadryl) 25- 50 mg TID x 2 days Immediate skin reaction • Stop dental treatment • Assess respiration • Diphenhydramine 25-50 mg IM/IV • Diphenhydramine 25-50 mg TID x 2 days Respiratory or cardiovascular compromise • Stop treatment • Oxygen • Basic life support as indicated • Epinephrine 0.3-0.5 mg SC/IM/IV • Bronchodilator inhaler if wheezing present • Diphenhydramine 25-50 mg IM/IV • Hydrocortisone 100 mg IM/IV
- 41. Prevention Careful medical history Avoid prescribing medications in the same class as those to which known allergy exists Prophylactic antihistamines?
- 42. Hypoglycemia Confusion Abnormal behavior Diaphoresis Tachycardia Anxiety Loss of consciousness Seizure
- 43. • Juice • Cake frosting If conscious: • Epinephrine 0.3-0.5 mg SC/IM/IV • Dextrose • Glucagon 1 mg IM/IV If unconscious: Treatment
- 44. Prevention Assure appropriate food intake Request serum glucose level Stress reduction Check blood sugar level before dental procedure Keep ‘em sweet
- 45. Conclusion Prevention Recognation Management Satisfactory Outcome When you prepare for an emergency, the emergency ceases to exist