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APPROACH
Predisposing factors Signs & symptoms Differential diagnosis (The Main Problem of every Systemic Condition) Management Reassess (The General Procedures of Maintaining the Pt Life; VS + Specific Management for each Condition)
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Collapse
Vaso-vagal syncope Acute Hypoglycaemia
Anaphylactic shock
Steroid crisis Myocardial Infarction Cardiac Arrest CVA
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Asthma
Anaphylactic Shock
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Convulsions
Epilepsy Any other cause of loss of consciousness
including fainting
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Fatigue
Hunger
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Pathophysiology
Stress
Release of catecholamines
Changes in tissue blood perfusion; decreased peripheral vascular resistance, increased blood flow to tissues leads to pooling of blood in tissue circulatory volume cerebral blood flow syncope
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Mechanism
Premonitory dizziness, weakness & nausea Pale, cold moist skin Pulse initially slow & weak, becoming full &
bounding
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Management
Lay flat & lift legs
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Prevention
Good history Reassurance General Anxiety (Stress) Reduction Protocol Well fed prior to treatment Glucose drink 10 mg Temazepam nocte (prior to appt) & 1
Anaphylactic Reaction
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
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Type
Hypersensitivity
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Adverse Reactions
Hypersensitivity
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Angio-oedema
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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
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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
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Acute Hypoglycaemia
CAUSES:
Overdose of insulin Prevented from eating
MANAGEMENT:
Glucose tablets/powder
If unconscious give
at expected time
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Hyperglycaemia
Slow onset Drowsiness/disorientation Dry skin & mouth Pulse slow & weak Rare More Severe Difficult to be managed
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Precipitating Factors:
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Management
Manifestations: Hyperpyrexia (Fever) Tachycardia Agitation Palpitation Nausia, Vomiting Abdominal pain Loss of Consciousness (Partial or Complete)
Management: Terminate all dental ttt Summon medical assist Administer O2 Monitor VS Initiate BLS, if necessary Start IV line & Fluids Transport to ER Care
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Pallor Weakness Nausia Rapid, weak or impalpable pulse Loss of consciousness Rapidly falling BP
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ASTHMA Causes
Anxiety Infection or exposure to
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Asthma
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
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Asthma
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
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Angina
Acute chest pain which may radiate to left arm or shoulder
If symptoms do not resolve rapidly with administration of GTN, consider it likely that the patient has suffered an MI
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Myocardial Infarction
Severe, crushing retrosternal pain Feeling of impending death Weak or irregular pulse
consciousness Vomiting
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Myocardial Infarction
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
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Anaesthetic overdose
Anaphylaxis Severe hypotension
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CARDIAC ARREST
Signs, Symptoms & Management
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
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STROKE (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
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CONVULSIONS (Epilepsy)
Grand mal, Petit mal (blank stare)
Predisposing factors: Anxiety Hunger Menstruation Alcohol External stimuli, flashing lights etc Non compliance with medications
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Convulsions
Signs & Symptoms (Grand mal)
Warning cry Immediate loss of consciousness Rigid (tonic phase)
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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
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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
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EMERGENCY KIT
Telephone Oxygen cylinder Disposable needles (23g) Tourniquet
Laerdal pocket
Cannulae (20g)
Portable suction
mask/Ambubag for hand ventilation Disposable airway (Sizes1-4) Guedel Disposable syringes (2,5,50 ml)
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DRUGS
Adrenaline 1:1000, 0.5 ml ampoules Glyceryl trinitrate 500 mcg spray Aspirin 300 mg Hydrocortisone 100mg vials Chlorpheniramine 10 mg Salbutamol 100 mcg (metered inhaler) Morphine sulphate tablets 10 mg Midazolam 10 mg Glucagon 1 mg ampoules Glucose powder or dextrose injection 50%
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Be Prepared
Adequate training Protocols
Medical history
Prevention Checks& Updating
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Reference
Medical emergency in dental office DCNA july
1995 by JEFFERY D BENNETT Medical emergency in dental office : Malamed 6th edition Text book of oral surgery by Bala JI.
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