Prevention and Management of medical emergencies'

1
Prevention and Management of medical
emergencies.

• By
• Dr Waleed A Aabdulaah
• Bds, Msc, Phd
• Assistant professor
• of maxilofacial surgery King Saud University

2
Preparation for medical emergencies
_ Personal continuing education -- auxiliary
staff education --- establishment and periodic
testing of a system to access medical
assistance ----equipping office with supplies
necessary for emergency care
3
Basic life support
Abcs A air way B breathing C circulation
4
Emergency supplies for the dental
office -Establishing and maintenance of iv
access. -- high-volume suction --- drug
administration ----Oxygen administration
5
(No Transcript)
6
Hypersensitivity Reactions
7
(No Transcript)
8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11

• Hypersensitivity reactions
• Skin signs
• Delayed onset
  -stop administration of all drugs
• Erythema, urticaria, pruritius -iv or
  im benadryl 50 mg
• 
  - refer to physician
• Immediate onset -stop
  administration of all drugs
• Erythema, urticaria,
  -epinephrine 0.3ml of 11000 sc,im,or iv
  pruritius
  -antihistamine iv, or im
• 
  -monitor vital signs
• 
  - consult physician

12
Respiratory tract signs with or without
cardiovascular or skin signs Wheezing, mild
dyspnea -stop administration of all
drugs
-place the patient in sitting position

- epinephrine
- iv access
- consult physician
or emergency Stridorous breathing
-stop administration of all drugs Moderate to
sever dyspnea -sit thee patient upright
-
epinephrine
- oxygen by face mask (6l/m)
-- iv
access, monitor vital signs
- antihistaminic
-
consult physician
13
Anaphylaxis ( with or without skin
signs) Malaise, wheezing, moderate to
-stop administration of all drugs Sever dyspnea,
cyanosis, total -position patient
supine on


-

floor air way obstruction, nausea
and - epinephrine vomiting,
abdominal cramps, - BLS, and
monitoring tachycardia, hypotension,
- cricothyrotomy Cardiac dysrhythmias,
- iv access Cardiac arrest
- oxygen 6
l/m
- antihistaminic im or iv

- prepare for transport
14
(No Transcript)
15
Chest Discomfort
16
Chest Discomfort
Differential diagnosis of acute onset chest pain
Common causes- CVS Angina pectoris, MI. GIT
Gastric ulcers, reflux eosphagitis, dyspepsia. M
SK S Intercostal muscle spasm, rib or muscle
contusion. Psychogenic Hyperventilation.
17
Uncommon causes- CVS Pericarditis. GIT
Esophageal rupture. M SK S Osteocondritis. RESP
S Pulmonary embolism, pleuritis, mediastinitis,
pneumothorax. Psychogenic imagined chest pain
18
Clinical characteristics of chest pain caused by
myocardial ischemia or infarction Pain or
discomfort described by the patient 1-
Squeezing, pressing, burning, choking, or
crushing in character ( not typically sharp or
stabbing in quality) 2- Substernally located with
variable radiation to left shoulder, arm,
left side, or combination of these areas with
neck and mandible.. 3- Frequently associated
with exertion, heavy meal, anxiety, or
assuming horizontal position. 4- Relived with
vasodilator (nitroglycrin), or rest (as in
angina). 5- accompanied by dyspnea, nausea,
weakness,, palpitations
19
Management of patient with chest pain- 1-
terminate all procedures 2- position patient in
semi-reclined position 3- give nitroglycrin
(TNG) 0.4 mg tab or spray 4- oxygen 5- check
pulse and blood pressure
Discomfort continues after 3 m of TNG 6- Give 2ed
TNG dose. 7- monitor vital signs
Discomfort relived 6- assume angina p. present 7-
slowly taper oxygen. 8- modify dental treatment
Discomfort continues after 3 m of TNG 8- Give 3ed
TNG dose. 9- monitor vital signs
20
Discomfort relived 10- refer patient to medical
evaluation before further dental care
Discomfort continues after 3 minutes of 3ed
TNG 10- Assume MI in progress. 11- start IV
line 12- to relive the discomfort morphine
sulfate 2mg subcutaneously or intravenously
every 3 minutes until pain relived. 13- prepare
for transport to emergency care.
21
(No Transcript)
22
Respiratory Difficulty
23

• Respiratory Difficulty
• Asthma
• Hyperventilation
• Foreign-body aspiration

24
Asthma
Manifestations of acute asthmatic episode Mild
to moderate -Wheezing Dyspnea Tachycardia Coughin
g Anxiety
25

• Sever
• Intense dyspnea ( with flaring of the nostrils,
  and use of accessory muscles of respiration.
• Cyanosis
• Minimal breath sound.
• -flushing of the face
• -Mental confusion
• - prespiration.

26
Management 1- terminate the procedures 2-
patient in fully sitting position. 3-bronchodilato
r (isoproterenol). 4- oxygen. 5- monitor vital
signs
Not relived 6- Epinephrine 0.3ml
of 1/1000 IM or Sc 7-IV line with crystalloid
solution 30ml/h 8-monitor vital signs
Relived 6- STILL monitoring 7- DC IV lines. 8-no
dental ttt until consultation.
Not relived 9-
Theophylline 250 mg IV, and cortisone 100mg
IV 10- Prepare for transport to emergency care
27
(No Transcript)
28
Hyperventilation syndrome
29
Manifestations of hyperventilation syndrome
Neurologic Dizziness Numbness of fingers, toes,
lips syncope
Cardiac Palpitations, tachycardia
Musculoskeletal Myalgia, muscle spasm , tremor,
tetany
Respiratory Increase rate and depth of
breath Feeling of shortness of breath Chest
pain xerostomia
Psychologic anxiety
30
Management 1- terminate all procedures 2-Patient
in almost fully upright position. 3-verbally
calm the patient 4- patient breath Co2 enriched
air, such as in a small bag.
Symptoms persist 5-diazebam 10mg IM or slowly
IV until anxiety relived. 6- monitor vital
sings 7- perform all further dental procedures
using anxiety reducing measures
31
Foreign- body aspiration
32
Foreign-body aspiration
Manifestations

• Large foreign body
• -coughing
• -choking sensation
• -stridorous breathing
• -dyspnea
• Feeling something caught in throat
• Inability to breath
• Cyanosis
• Loss of consciousness

Gastric content -coughing -stridorous
breathing -wheezing -tachycardia -hypotension -dys
pnea -cyanosis
33
Management
1- terminate all procedures 2-pt in sitting
position 3-ask the pt . To cough the object out
Unconscious pt. 4-medical assistance 5-supine
position 6-begin abdominal thrusts followed by
turning pt. on side and use the finger to sweep
the oral cavity for foreign body 7-ventillate
Conscious pt.
34
Able to ventilate 8-BLS 9-O2 10- Transport
Unable to ventilate 8-repeat steps 6,7 twice then
9-laryngoscope 10-cricothyrotomy
35
Conscious pt.
Symptoms persist 4-heimlich maneuvers
Symptoms stopped, or ceased , you unsure where is
the foreign body 4-O2 5-Monitor vital
signs 6-transport, radiograph, and bronchoscope
5- O2 6-medical assistance 7-monitor vital
signs 8-transport
36
(No Transcript)
37
Altered Consciousness
38

• Altered consciousness
• Vasovagal syncope.
• Orthostatic hypotension.
• -Seizure
• Local anesthetic toxicity
• -Diabetes mellitus.
• -Thyroid dysfunction
• Adrenal insufficiency
• - Cerebrovascular compromise

39
Vasovagal syncope
40
anxiety
Pathophysiology of vasovagal attack
Catecholamine release
peripheral vascular resistance
Pooling of blood in periphery
arterial blood pressure
heart rate, warmth, perspiration, reapid
breathing
decompensation
Reflex vagally mediated bradycardia, nausea,
hypotension
Reduced cerebral blood flow
syncope
seizure
41
Management Prodrome 1- terminate all
procedures. 2-supine position, legs
elevated 3-calm the patient 4-place cool towel on
patient forehead 5-monitor vital sings.
42
Syncope 1- terminate all procedures 2-supine
position and legs elevated. 3-check for breathing
If absent 4-start basic life support 5- search
medical assistance 6-consider other causes of
syncope
If present 4- ammonia
under nose 5- O2 6- monitor vital signs 7-
anxiety control measures during future dental
ttt.
43
Orthostatic hypotension
44
Orthostatic hypotension
Management 1- Terminate all procedures 2-
patient in supine position with legs
elevated 3-monitor vital ssigns 4-once blood
pressure improves, slowly return patient to
sitting position. 5-discharge to home once vital
sings are normal 6- medical consultation before
any future dental treatment.
45
Seizure
46
Seizures
Manifestations (I) Isolated, brief
seizure Tonic-clonic movements of trunk and
extremities, loss of consciousness, vomiting,
air way obstruction, loss of anal and urinary
sphincter control
Acute management 1- terminate all dental
procedures 2-place in supine possition 3-protect
from nearby objects
47
After seizure
Conscious pt. 4-Suction air way 5-monitor vital
signs 6-O2 7-consult physician
Unconscious pt. 4- medical assistance 5-pt. on
side and suction air way 6-monitor vital
signs 7-basic life support 8-O2 9-transport to
emergency care
48
(II) Repeated or sustained seizures ( status
epilepticus) Acute management 1- diazepan
5mg/min IV up to 10 mg or midazolam 3mg/min up to
6 mg. 2-medical assistance 3-protect patient from
nearby objects
Once seizures ceases 4- pt. on side, and suction
air way. 5-monitor vital signs. 6-Basic life
support. 7-O2 8-transport to emergency care.
49
Local anesthetic toxicity
50
Local anesthetic toxicity
Manifestations Mild toxicity
talkativeness, anxiety, slurred
speech, confusion

• Management
• Stop administration of local anesthesia
• Monitor all vital signs
• Observe for 1 h

51
Moderate toxicity Stuttering speech,
headache,dizziness, blurred vision, drowsiness

• Management
• -Stop administration of local anesthesia
• - Supine position
• -Monitor all vital signs
• - O2
• -Observe for 1 h

52
Sever toxicity Seizure, cardiac dysrhythmia or
arrest

• Management
• -supine position
• -protect from nearby objects
• Suction oral cavity if vomiting occur
• Medical assistance
• -Monitor all vital signs
• -O2
• - Start IV
• -DIAZEPAM 5-10 mg slowly or midazolam 2-6 mg
• Basic life support
• Transport to emergency care

53
Diabetes Mellitus
54
Diabetes Mellitus
Manifestations off acute hypoglycemia
Moderate Tachycardia Prespiration Pallor Anxiety B
ehavior change Confusion uncooperativness
Sever Hypotension Unconsciousness seizures
Mild Hunger Nausea Mood change weakness
55
Mangement
Mild hypoglycemia -glucose source like sugar or
fruit by mouth -monitor vital signs -consultation
before future dental treatment
56
MODERATE HYPOGLYCEMIA -glucose source like
sugar or fruit by mouth -monitor vital signs -If
symptoms do not improve, administer 50 ml 50
glucose or 1 mg glucagon IV or IM - Consultation
57

• Sever hypoglycemia
• -50 ml of 50 glucose IV, or IM, or 1mg glucagon
• Medical assistance
• Monitor vital signs
• O2
• Transport to emergency care

58
Thyroid dysfunction
59
Thyroid dysfunction
Manifestations -hyperpyrexia -tachycardia -nervous
ness -tremor -weakness -palpitations -cardiac
dysrhythmias -nausea and vomiting -abdominal
pains -Partial or complete loss of conciousness
60

• Management
• Terminate all procedures
• Medical assistance
• O2
• Monitor vital signs
• BLS
• IV line with crystalloid solution
• Transport to medical emergency care

61
Adrenal insufficiency
62
Adrenal insufficiency
Manifestations -weakness -feeling of extreme
fatigue -confusion -hypotension -nausea -abdominal
pain -myalgias -partial or total loss of
consciousness
63

• Management
• -terminate all procedures
• -supine position with legs elevated
• -medical assistance
• -corticosteroids (100mg of hydrocortisone IM or
  IV
• -O2
• -monitor vital signs
• -IV line
• BLS
• -transport to emergency care

64
Cerebrovascular compromise
65
Cerebrovascular compromise
Manifestations -headache -unilateral weakness or
paralysis of extremities or facial muscles or
both. -slurring of speech or inability to
speak -difficulty of breathing or swallowing or
both -loss of bladder control -seizures -visual
disturbance -dizziness -partial or total loss of
consciousness
66

• Management
• -terminate all procedures
• -medical assistance
• -supine position with head slightly raised
• -monitor all vital signs
• If loss of consciousness O2, BLS.
• Transport to emergency care

67
Thank You