Escolar Documentos
Profissional Documentos
Cultura Documentos
of
Medical Emergencies
in
Dental Practice
Management
Reassess
(The General Procedures of Maintaining the Pt Life; VS +
Specific Management for each Condition)
COLLAPSE
Vaso-vagal syncope
Acute Hypoglycaemia
Anaphylactic shock
Steroid crisis
Myocardial Infarction
Cardiac Arrest
CVA
ACUTE CHEST PAIN OR DIFFICULTY OF
BREATHING
Angina
Myocardial Infarction
Asthma
Anaphylactic Shock
CONVULSIONS
Epilepsy
Any other cause of loss of consciousness
including fainting
FAINTING
Predisposing factors:
Stress Conditions
Anxiety
Pain
Injections
Fatigue
Hunger
Mechanism
Good history
Reassurance
General Anxiety (Stress) Reduction
Protocol
Well fed prior to treatment
Glucose drink
10 mg Temazepam nocte (prior to appt) & 1
hour before treatment
Delay the procedure
Anaphylactic Reaction
Immediate
IgE mediated
Anaphylaxis
Urticaria
Angio-oedema
Allergic Asthma
Rhinitis
Adverse Reactions
•Hypersensitivity
Angio--oedema
Angio
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
Management of Anaphylaxis
CAUSES: MANAGEMENT:
Overdose of insulin Glucose
tablets/powder
Prevented from eating
at expected time If unconscious give
50ml 50% glucose IV
SC glucagon 1mg
The Diabetic Patient
Hypoglycaemia Hyperglycaemia
Precipitating Factors:
Infection
Surgery
Trauma
Pregnancy
Other Physiologic or Emotional Stress
Management
Manifestations: Management:
Hyperpyrexia Terminate all dental
(Fever) ttt
Tachycardia Summon medical
Agitation assist
Palpitation Administer O2
Monitor VS
Nausia
Nausia,, Vomiting
Initiate BLS, if
Abdominal pain
necessary
Loss of
Start IV line & Fluids
Consciousness
Transport to ER Care
(Partial or
Complete)
STEROID CRISIS
Circulatory Collapse
The Pt Problem
Adrenocortical Insufficiency: Primary (Addison`s
(Addison`s Disease); Rare
Secondary (Exogenous ttt
ttt);
); more common (20 mg cortisol
daily/2weeks/year)
Loss of consciousness
Absence of arterial pulse
“SUMMON HELP”
Patient on flat, firm surface
CLEAR AIRWAY (keep patent)
Start CPR
Defibrillation
Transfer patient to hospital
STROKE (CVA)
(CVA)
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
CONVULSIONS (Epilepsy)
Grand mal, Petit mal (blank stare)
Predisposing factors:
Anxiety
Hunger
Menstruation
Alcohol
External stimuli, flashing lights
etc
Non compliance with
medications
Convulsions
Signs & Symptoms (Grand mal)
Warning cry
Immediate loss of consciousness
Rigid (tonic phase)
Widespread jerking (clonic
(clonic phase)
Vomiting
Flaccid after a few minutes
Consciousness is regained after a variable
period
Patient may remain confused
Convulsions
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
Status Epilepticus
Adequate training
Protocols
Medical history
Prevention
Checks& Updating