Dental / Medical Emergencies

Definitions
Medical Emergency

A condition or circumstances requiring immediate action before or during a life-threatening situation

Definitions
Symptom

Something the patient tells you about how he/she feels such as I feel dizzy or My arm hurts.

Definitions
Sign

Something that you observe in a patient such as increase in respiration or pallor. Signs are considered more reliable than symptoms as they are observed rather than described.

DENTAL EMERGENCIES

Syncope
AKA fainting. A temporary loss of

consciousness caused by insufficient blood to the brain Possibly the most frequent medical emergency in the dental office

Syncope
Causes

Surprise Emotional distress Pain Symptoms Pale, clammy skin Rapid, weak pulse Decreased blood pressure

Syncope
Treatment

Place the patient in a supine position with the feet elevated to a position higher than his/her head (trendelenberg position) Establish an airway and loosen any constricting garments Administer oxygen

Syncope
Treatment (contd)

Monitor and record the patients blood pressure and other vital signs If the patient has not revived within 10 - 15 seconds, remove oxygen and use ammonia inhalants.

Postural Hypotension
Abnormally low blood pressure. An

alteration of consciousness that can occur when a patient position too quickly. Caused by prolonged seating of patient in supine position during treatment then suddenly placing him or her in upright position

Postural Hypotension
Most often seen in patients receiving

nitrous oxide (N O ) or IV sedation or in pregnant patients.

2 2

Postural Hypotension
Signs and symptoms

Low blood pressure Patient is dizzy and appears disoriented Loss of consciousness

Postural Hypotension
Treatment

Return patient to supine position Establish an airway Slowly return patient to upright position If patient does not recover, call for assistance Monitor and record vital signs

Medical Emergencies

SOMEONE CALL : (9)911

Respiratory Emergencies
Hyperventilation

An increase in the frequency and/or depth of respiration resulting in too much oxygen Usually occurs in patients that are extremely frightened or apprehensive of dental care

Respiratory Emergencies
Hyperventilation

Signs and symptoms Rapid, shallow breathing Lightheadedness Tightness of the chest Rapid heartbeat

Respiratory Emergencies
Hyperventilation

Treatment
Place the patient in a comfortable position Calm the patient Have the patient breath into either cupped hands or a paper bag

Respiratory Emergencies
Airway obstruction

Caused by the patient aspirating of a foreign object

Respiratory Emergencies
Airway obstruction

Signs and symptoms Patient grasps for throat High pitched sound when attempting to breath Ineffective or inability to cough Change in skin color

Respiratory Emergencies
Airway obstruction

Treatment Call for assistance and administer abdominal thrusts If coughing and has good air exchange, encourage to continue to cough

Cardiac Emergencies
Angina pectoris

Caused by narrowing of the coronary arteries that decreases blood supply to the heart and is usually brought on by physical exertion or stress Symptoms closely resemble myocardial infraction but usually only last 3-8 minutes and are relieved by rest or nitroglycerine

Cardiac Emergencies
Angina pectoris

Signs and symptoms Tightness or pressure in chest Pain often radiates to left shoulder, mandible, or left side of face

Cardiac Emergencies
Angina pectoris

Treatment Call for medical assistance Position the patient in the upright position Assist the patient in placing a sublingual nitroglycerine tablet or translingual spray

Cardiac Emergencies
Angina pectoris

Treatment (contd) Administer 100 % oxygen Record and monitor vital signs

Cardiac Emergencies
Acute Myocardial Infarction (AMI) or

heart attack Complete blockage of a coronary artery (infarct) that deprives part of the heart of blood

Cardiac Emergencies
AMI

Signs and symptoms Crushing sub-sternal pain that radiates to the left arm, jaw or teeth, and is not relieved by rest or nitroglycerine Shortness of breath and sweating Nausea and vomiting

Cardiac Emergencies
AMI

Treatment Call for medical assistance Initiate CPR if patient loses consciousness Administer oxygen Prepare nitroglycerine Monitor and record vital signs

Hypoglycemia
Diabetic complications are related to

diabetes mellitus Insulin shock Causes Too much insulin in system Hyperglycemia Not enough sugar in system Hypoglycemia

Hypoglycemia
Signs and symptoms

Clammy, cool skin Mild tremor Headache Confusion Unconsciousness, coma, and death

Hypoglycemia
Treatment

Offer the patient food containing sugar (candy, orange juice, etc.) Notify a physician immediately

Grand Mal Epileptic Seizure

A disorder characterized by

convulsions (seizures) or disturbances of consciousness Signs and symptoms Warning aura Patient loses consciousness Violent contractions/relaxation of muscles

Grand Mal Epileptic Seizure

Treatment

Remove all items from the patients mouth Maintain the patients airway Protect the patient from injuring themselves Contact EMS upon onset of seizure

Allergic Reactions
An allergy is a heightened state of

reactivity in the body to certain substance Patients are questioned as to their known allergies - not always accurate

Allergic Reactions
Allergic responses manifest themselves

in two forms Localized allergic (cellular) response, usually slow to develop and mild Symptoms include itching, redness of the skin, and hives Call for assistance and prepare basic life support in case it is needed

Allergic Reactions
Anaphylaxis (systemic response) Life threatening allergic response and the patient can die within minutes of its onset

Allergic Reactions
Anaphylaxis (systemic response) Signs and symptoms Patient feels physically ill Nausea or vomiting Shortness of breath Irregular heartbeat Loss of blood pressure Loss of consciousness

Allergic Reactions
Anaphylaxis (systemic response) Treatment Call for medical assistance Place patient in supine position Initiate Basic Life Support (BLS) if patient becomes unconscious Administer oxygen Monitor and record vital signs

Preventive Measures
Practice and rehearse emergency

procedures CPR training every 2 years Emergency exercises Review patients medical history Patient management Comfortable, empathy, avoid trigger words, and place in supine position

ANY QUESTIONS ? ? ?

BOTTOM LINE
BE VIGILANT ABOUT YOUR SURROUNDINGS AND PATIENTS CONDITION.

Summary
Definition of Terms Syncope and Postural Hypotension Common Medical Emergencies Allergic Reactions Prevention Measures