11. Management
•Lay flat & lift legs
•Loosen tight clothing around neck
»Give sweetened drink on regaining
consciousness
•Prolonged fainting, atropine 600 mcg/ml
slow iv (1 ml only)
12. prevention
• Good history
• Reassurance
• General Anxiety (Stress) Reduction Protocol
• Well fed prior to treatment
• Glucose drink
10 mg Temazepam nocte (prior to appt) & 1hour before
treatment
• Delay the procedure
13. Anaphylactic shock
• Drugs e.g. penicillin
• Insect stings
• Foods, nuts, shellfish, materials
Quicker onset the more severe the reaction
• Widespread vasodilatation & increase in
capillary permeability, potentially fatal
• Hypotension
17. Anaphylaxis
•
• Signs & Symptoms variable
Rapid weak or impalpable pulse
• Facial flushing, itching, tingling, cold extremities
• Bronchospasm (wheezing)
• Loss of consciousness
Pallor going on to cyanosis
Cold, clammy skin
Facial oedema & sometimes urticaria
Deep fall in BP
18. Management of Anaphylaxis
•Lay flat with raised legs
•
•Give Adrenaline (1:1000) 0.3-0.5 ml SC or IM
•
•Hydrocortisone 200 mg i.v.
•
•Chlorpheniramine 10-20 mg slow i.v.
•
•Give oxygen 6L/min & assisted ventilation
•
•Consider Cricothyrotomy if NO quick
•improvement
•
•Call an ambulance
19.
20.
21. Accidental swallowing of foreign
bodies
• A case of swallowed dental root canal instrument
Esophagogastroduodenoscopy
•needle-like foreign body sticking deep in the
duodenal wall
22. • the object was removed by forceful extraction
with a rat tooth forceps and identified as a
dental root canal instrument, distinctly
changed by gastric acid.
Extracted instrument
Original instrument
23. • The patient then remembered that the pain was started
after a dental root canal treatment under local
anesthetics.
• The pain was probably due to the irritation of the
duodenal wall by needle while moving the upper part of
the body during ironing.
• Generally foreign bodies passes through the gastro
intestinal tract within 1 week, but might get stuck
especially when sharp.
• Earliest symptom is dysphagia.
• An ingestion of such an instrument is extremely rare i.e.
0.12/100,000 root canal treatments.
24. A case of swallowed
Dental Prosthesis
• Plain abdominal radiograph
25. • The Endoscopic view shows the extraction
from jejunum to the
mouth, here the image shows that foreign
body is at the esophagus.
26. Extracted Prosthesis
• The prosthesis was a successfully managed
endoscopically.
• Observe at the right of
• the dental bridge has a sharp edge.
27. Acute Hypoglycemia
:Causes
Overdose of insulin
Prevented from eating
at expected time
• MANAGEMENT:
• Glucose tablets/powder
• If unconscious give
• 50ml 50% glucose IV
SC glucagon 1mg
28. The Diabetic Patient
HyperglycemiaHypoglycemia
Slow onsetRapid onset
Dry skin & mouthMoist skin
Pulse slow & weakPulse full & rapid
Drowsiness/disorientationIrritability
RareMore common
more SevereLess Severe
Difficult to be managedEasy to be managed
29. THYROID CRISIS (STORM)
Sudden, Severe Exacerbation of Hyperthyroidism
• Precipitating Factors:
• Infection
• Surgery
• Trauma
Pregnancy
• Other Physiologic or Emotional Stress
31. Management
• Terminate all dental ttt
•
• Summon medical assist
•
• Administer O2
•
• Monitor VS
•
• Initiate BLS, if necessary
•
• Start IV line & Fluids
•
• Transport to ER Care
32. STEROID CRISIS
Circulatory Collapse
The Pt Problem
Adrenocortical Insufficiency:Primary(Addison`s
Disease);Rare
Secondary(Exogenous);more common
(20mgcortisol
daily/2weeks/year)
33. • CAUSES: Stress Conditions
• GA
• Surgical/Other trauma
• Infection
• Other stress
• SIGNS & SYMPTOMS
• Pallor
• Weakness
• Nausea
• Rapid, weak or
• impalpable pulse
• Loss of consciousness
• Rapidly falling BP
34.
35. • Steroid Crisis Management
• Lay flat and raise legs
• Hydrocortisone 200mg i.v.
• Give oxygen
• Monitor VS
• Start BLS if necessary
• Consider other possible reasons for loss of
• consciousness
• Ambulance & transfer to hospital
36. ASTHMA
• Causes
• Anxiety
• Infection or exposure to
• specific allergen
• Loss or forgetting to bring
• Salbutamol inhaler
37. Signs & Symptoms
• Breathlessness
• Expiratory wheezing may be
• disguised as shallow breathing
• Rapid pulse over 110
• Accessory muscles of
• respiration brought into use
• Cyanosis of mucous membrane
• & nail beds
• Mental confusion
38. Management •
• Reassure the patient
• DO NOT lay the patient flat
• Give the anti asthmatic drug
• normally used
• Give oxygen
• Give Adrenaline
• Hydrocortisone 200 mg i.v.
• Monitor VS
• If no response to Salbutamol 500
mcg i.m/s.c., CALL AN
• AMBULANCE
39. Angina
• Signs & Symptoms
• Acute chest pain which may
• radiate to left arm or shoulder
• Relieved by anti anginal drug
e.g
• .
GTN 0.5mg sublingually
• Aspirin 300mg
• If symptoms do not resolve
• rapidly with administration of
• GTN, consider it likely that the
• patient has suffered an MI
40. Myocardial Infarction
Signs & Symptoms
• Severe, crushing retro-
• sternal pain
• Feeling of impending death
• Weak or irregular pulse
• Pain may radiate to left
• shoulder, arm or jaw
• Shock, loss of consciousness
• Vomiting
41. Management
• Place patient in a comfortable position
• allowing easy breathing
• Send for an ambulance
• Give 50/50 Nitrous Oxide/Oxygen or Oxygen
only
• Aspirin 300mg
• Good pain control
• Constant reassurance
45. Stroke (CVA)
• Signs ,Symptoms & management
• Severe Headache
• Weakness or Paralysis of arms or legs
• of one side
• Unilateral Facial muscle Paralysis
• Difficulty or inability to Speak
• Partial or Total Loss of consciousness
• Patient is very anxious, needs
• reassurance and transfer to hospital
• immediately, BLS, Supine Position
• BUT Head slightly Elevated
46.
47. CONVULSIONS (Epilepsy)
Grand mal, Petit mal (blank stare)
• Predisposing factors:
• Anxiety
• Hunger
• Menstruation
• Alcohol
• External stimuli, flashing lights etc
• Non compliance with medication
48. Convulsion
•Signs & symptoms
•Grand mal
•Warning cry
•Immediate loss of consciousness
•Rigid (tonic phase)
•Widespread jerking (clonic phase)
•Vomiting
•Flaccid after a few minutes
•Consciousness is regained after a variable period
•Patient may remain confused
49. Management
• Prevent patients from damaging themselves
•
• Place in Supine position
•
• Maintain patent airway
•
• No medications, await recovery
•
• Recovery position after fits have ceased
•
• Suctioning & Monitor VS
•
• Oxygen
•
• Reassure on recovery
•
• After fully recovered requires an escort home
50. Status Epilepticus
• Continuous or repeated convulsions for 15
• minutes (patient can have severe anoxia)
•
• Give 10mg Midazolam IV repeat if no recovery
• within 10 minutes
•
• Maintain airway & give oxygen
•
• Call an ambulance, transfer to hospital
56. Be Prepared
• Adequate training
• Protocols
• Medical history
• Prevention
• Checks& Updating
57. Reference
• Medical emergency in dental office DCNA july
• 199
• 5 by JEFFERY D BENNETT
•
• Medical emergency in dental office : Malamed
• 6
• th
• edition
•
• Text book of oral surgery by Bala JI
