Dental Office Emergencies.ppt
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Transcript of Dental Office Emergencies.ppt
ByByDr Saikat SahaDr Saikat Saha
Dental Office EmergenciesDental Office Emergencies
Be preparedBe prepared
Be alertBe alert
AnticipateAnticipate
By By Dr Saikat SahaDr Saikat Saha
Successful PreventionSuccessful Prevention
Updated medical & health historyUpdated medical & health historyOperator & patient rapportOperator & patient rapportMinimal stress levelMinimal stress levelObservation Observation Vital signs - baselineVital signs - baseline
By By Dr Saikat SahaDr Saikat Saha
Patient AssessmentPatient Assessment
Four step treatment approachFour step treatment approach
R - recognition of diseaseR - recognition of disease
A - assessment of the riskA - assessment of the risk
M - management for safetyM - management for safety
E - emergency careE - emergency care
By By Dr Saikat SahaDr Saikat Saha
Dental Hygienist’s RoleDental Hygienist’s Role
RDH often the first to RDH often the first to recognize a potential recognize a potential medical emergencymedical emergency
Observe and monitor Observe and monitor throughout care throughout care patient’s changes in patient’s changes in expression, skin tone, expression, skin tone, muscle tonus, muscle tonus, respiration, verbal respiration, verbal expressionsexpressions
By By Dr Saikat SahaDr Saikat Saha
Dental Hygienist RoleDental Hygienist Role
Course in First Aid Course in First Aid desirabledesirable
Course in CPR Course in CPR requiredrequired
Classify responses Classify responses and know when and know when emergency situation emergency situation seems imminent seems imminent
Prompt,appropriate Prompt,appropriate reactions to signs of reactions to signs of distress distress
Ability to provide care Ability to provide care until help is secured until help is secured
Provide complete Provide complete description of distress description of distress signs to DDS and signs to DDS and EMT EMT
By By Dr Saikat SahaDr Saikat Saha
Being Prepared to ReactBeing Prepared to React
Emergency phone Emergency phone numbersnumbers
Rehearsal of Rehearsal of emergency scenarioemergency scenario
Procedures for Procedures for alerting other staff alerting other staff membersmembers
Write out specific Write out specific protocols for action in protocols for action in the event of medical the event of medical emergencyemergency
Specific assignments Specific assignments made to ensure all made to ensure all designated designated procedures procedures completedcompleted
By By Dr Saikat SahaDr Saikat Saha
Generic Functions of Emergency Generic Functions of Emergency Response TasksResponse Tasks
Evaluate vital signsEvaluate vital signs Diagnose nature of Diagnose nature of
emergencyemergency Decide on appropriate Decide on appropriate
treatmenttreatment Instruct others what to Instruct others what to
dodo Phone for helpPhone for help
Prepare for treatment Prepare for treatment administrationadministration
Administer treatmentAdminister treatment Monitor vital signsMonitor vital signs Reassure patientReassure patient Record events that Record events that
occuroccur Ensure privacy/and or Ensure privacy/and or
manage other patientsmanage other patients
By By Dr Saikat SahaDr Saikat Saha
Medical EmergenciesMedical Emergencies
Predisposition to emergencyPredisposition to emergency
Patient with HBP, Cardiac insufficiency, asthma, Patient with HBP, Cardiac insufficiency, asthma, angina,diabetesangina,diabetes
High anxiety levelsHigh anxiety levels
Combination of both may trigger physical response Combination of both may trigger physical response that could be classified as emergencythat could be classified as emergency
By By Dr Saikat SahaDr Saikat Saha
Medical Emergency PreventionMedical Emergency Prevention
Practitioner must be able toPractitioner must be able to
Recognize patient anxietyRecognize patient anxiety
Modify dental therapyModify dental therapy
Prevent an emergencyPrevent an emergency
By By Dr Saikat SahaDr Saikat Saha
Emergency Situation Emergency Situation
Most responses to emergencies can be Most responses to emergencies can be
managed using basic life support (without managed using basic life support (without
use of drugs) until advanced life support use of drugs) until advanced life support
can arrive.can arrive.
By By Dr Saikat SahaDr Saikat Saha
Intro: Adrenal CrisisIntro: Adrenal Crisis
Adrenal gland consists of two distinct Adrenal gland consists of two distinct regions . regions . Adrenal cortex produces endogenous steroids. Adrenal cortex produces endogenous steroids. Medulla produces and secretes epinephrine Medulla produces and secretes epinephrine
and norepinephrine.and norepinephrine.Hypofunction of adrenal cortex results in Hypofunction of adrenal cortex results in
decreased cortisol production. Cortisol decreased cortisol production. Cortisol necessary to help body react to stressful necessary to help body react to stressful situations.situations.
By By Dr Saikat SahaDr Saikat Saha
Intro: Adrenal CrisisIntro: Adrenal Crisis
Individuals with decreased cortisol Individuals with decreased cortisol production cannot respond to stress and production cannot respond to stress and risk cardiovascular collapse and possible risk cardiovascular collapse and possible death.death.
Patients may be taking supplement. Patients may be taking supplement. (Addison’s disease)(Addison’s disease)
May need to increase level of exogenous May need to increase level of exogenous steroids before undergoing stressful steroids before undergoing stressful proceduresprocedures
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms: Adrenal CrisisSigns & Symptoms: Adrenal Crisis
Shocklike symptoms(cardiovascular Shocklike symptoms(cardiovascular collapse)collapse)HypotensionHypotensionBradycardiaBradycardiaFeverFeverRespiratory depressionRespiratory depression
HypercalcemiaHypercalcemiaLethargyLethargy
By By Dr Saikat SahaDr Saikat Saha
Treatment: Adrenal CrisisTreatment: Adrenal Crisis
Terminate treatmentTerminate treatmentMonitor and record vital signsMonitor and record vital signsPlace patient in Trendelenburg’s positionPlace patient in Trendelenburg’s positionAccess and support airway, breathing, Access and support airway, breathing,
circulation- BLScirculation- BLSActivate emergency protocolActivate emergency protocolProvide supplemental oxygenProvide supplemental oxygenAdminister saline, hydrocortisoneAdminister saline, hydrocortisone
By By Dr Saikat SahaDr Saikat Saha
Intro: Airway ObstructionIntro: Airway Obstruction
Unlikely to occur while being treated Unlikely to occur while being treated Upper airway obstruction usually Upper airway obstruction usually
reversiblereversibleMost common is unconsciousness - Most common is unconsciousness -
tongue and epiglottis occluding airwaytongue and epiglottis occluding airwayCan cause loss of consciousness and Can cause loss of consciousness and
cardiac arrestcardiac arrest
By By Dr Saikat SahaDr Saikat Saha
Intro: Airway Obstruction Intro: Airway Obstruction
Diagnose partial versus complete is Diagnose partial versus complete is critical and must be done rapidly to critical and must be done rapidly to prevent complications of anoxiaprevent complications of anoxiaPartial: person is making coughing or other Partial: person is making coughing or other
noisesnoisesComplete: no noises are made although Complete: no noises are made although
patient is attempting to cough or talk, patient is attempting to cough or talk, showing signal for chokingshowing signal for choking
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms:Airway ObstructionSigns & Symptoms:Airway Obstruction
ChokingChoking
GaggingGagging
Violent inspiratory Violent inspiratory effortsefforts
Flushed faceFlushed face
Extreme anxietyExtreme anxiety
CyanosisCyanosis
Cardiovascular Cardiovascular collapsecollapse
By By Dr Saikat SahaDr Saikat Saha
Treatment: Airway ObstructionTreatment: Airway Obstruction
Position headPosition headRemove foreign objectRemove foreign object
sweeping motion of fingerssweeping motion of fingersMagil or straight forcepsMagil or straight forcepsSuctionSuction
Perform abdominal thrusts/Heimlich Perform abdominal thrusts/Heimlich manuevermanuever
Repeat as needed, cricothyrotomyRepeat as needed, cricothyrotomy
By By Dr Saikat SahaDr Saikat Saha
Intro: Anaphylaxis/AllergyIntro: Anaphylaxis/Allergy
Allergy-hypersensitive state results from Allergy-hypersensitive state results from exposure to allergen.exposure to allergen.
Range in clinical manifestation from Range in clinical manifestation from immediate-life threatening condition seen immediate-life threatening condition seen within seconds or delayed type reaction within seconds or delayed type reaction which may not manifest until hours or days which may not manifest until hours or days after exposure.after exposure.
By By Dr Saikat SahaDr Saikat Saha
Intro: Anaphylaxis/AllergyIntro: Anaphylaxis/Allergy
Immediate or anaphylactic reaction that Immediate or anaphylactic reaction that occur in the dental office pose greatest occur in the dental office pose greatest risk to patient and are of greatest concern risk to patient and are of greatest concern to dental staff.to dental staff.
Usually result from drug administration or Usually result from drug administration or reaction to an allergen in impression reaction to an allergen in impression material or other materials used in oral material or other materials used in oral cavity.cavity.
By By Dr Saikat SahaDr Saikat Saha
Intro: Anaphylaxis/AllergyIntro: Anaphylaxis/Allergy
Generalized most life threatening and Generalized most life threatening and dramatic allergic reaction.dramatic allergic reaction.
Death can occur in minutes if not treated Death can occur in minutes if not treated appropriately.appropriately.
Reactions affect skin,smooth Reactions affect skin,smooth muscle,respiratory and cardiovascular muscle,respiratory and cardiovascular systemsystem
By By Dr Saikat SahaDr Saikat Saha
Intro: Anaphylaxis/AllergyIntro: Anaphylaxis/Allergy
Anaphylactic shock occurs when Anaphylactic shock occurs when consciousness lost as result of consciousness lost as result of hypotension from an anaphylactic hypotension from an anaphylactic reaction.reaction.
Symptoms begin with skin,followed by Symptoms begin with skin,followed by eyes,nose,and gastrointestinal eyes,nose,and gastrointestinal system,then respiratory system, finally system,then respiratory system, finally cardiovascular symptoms developcardiovascular symptoms develop
Prompt therapy can stop reactionPrompt therapy can stop reaction
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms: Signs & Symptoms: Anaphylaxis/AllergyAnaphylaxis/Allergy
Urticaria-Urticaria-itching,flushing,hivesitching,flushing,hives
RashRash
RhinitisRhinitis
BronchospasmBronchospasm
Laryngeal edemaLaryngeal edema
Weak pulse-syncopeWeak pulse-syncope
Loss of Loss of consciousnessconsciousness
Cardiac arrestCardiac arrest
By By Dr Saikat SahaDr Saikat Saha
Treatment: Anaphylaxis/AllergyTreatment: Anaphylaxis/Allergy
Acute Reaction:Acute Reaction:Basic Life SupportBasic Life SupportEpinephrine, injection IMEpinephrine, injection IMOxygenOxygenDiphenhydramine, injection IMDiphenhydramine, injection IMCorticosteroidCorticosteroidCPRCPRAirway management - intubation, Airway management - intubation,
cricothyrotomycricothyrotomy
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms: Signs & Symptoms: Anaphylactic ShockAnaphylactic Shock
Anaphylactic reaction: immediate allergic Anaphylactic reaction: immediate allergic response response For any allergic reaction to occur patient had For any allergic reaction to occur patient had
to have previous exposure to antigen-called to have previous exposure to antigen-called sensitizing dose sensitizing dose
Subsequent exposure to antigne termed Subsequent exposure to antigne termed challenging dosechallenging dose
By By Dr Saikat SahaDr Saikat Saha
Intro: Anesthesia ReactionsIntro: Anesthesia Reactions
Reaction can be varied in extent and Reaction can be varied in extent and severityseverity
Most are result of either local anesthetic Most are result of either local anesthetic agent itself or the vasoconstrictor within agent itself or the vasoconstrictor within formulationformulation
Toxicity can occur especially from rapid Toxicity can occur especially from rapid intravascular injectionintravascular injection
Reaction can occur 30-60 seconds to 1 Reaction can occur 30-60 seconds to 1 hour after injection hour after injection
By By Dr Saikat SahaDr Saikat Saha
Intro: Anesthesia ReactionsIntro: Anesthesia Reactions
Local anesthetic Local anesthetic dosing should be dosing should be calculated on: calculated on:
patient’s physical patient’s physical condition condition
body weightbody weight
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms: Local Signs & Symptoms: Local Anesthesia ReactionsAnesthesia Reactions
Lightheadedness
Slurredspeech
Diasphoresis
Blurred vision Anxiety Nystagmus
Changemental status
Tinnitus Seizures
Confusion Headache Bradycardia
Disorientation Tremors Tachypnea
Drowsiness Nausea/Vomiting
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms: Signs & Symptoms: Vasoconstrictor ToxicityVasoconstrictor Toxicity
AnxietyAnxiety
Tachycardia/ Tachycardia/ palpitationspalpitations
RestlessnessRestlessness
HeadacheHeadache
TachypneaTachypnea
Chest painChest pain
DysrhythmiasDysrhythmias
Cardiac arrestCardiac arrest
By By Dr Saikat SahaDr Saikat Saha
Treatment:Local Anesthesia Treatment:Local Anesthesia ToxicityToxicity
Initially, begin basic cardiac life supportInitially, begin basic cardiac life supportAssess and support Assess and support
airway,breathing,circulationairway,breathing,circulationSupportive treatment may be indicatedSupportive treatment may be indicatedAirway opened, oxygen givenAirway opened, oxygen givenSevere reactions, patient transported to Severe reactions, patient transported to
hospital emergency room as soon as hospital emergency room as soon as possiblepossible
By By Dr Saikat SahaDr Saikat Saha
Intro: Angina PectorisIntro: Angina Pectoris
Chest pain caused by temporary myocardial Chest pain caused by temporary myocardial ischemia without damage to heart muscle.ischemia without damage to heart muscle.
Due to narrowed coronary arteries’ inability to Due to narrowed coronary arteries’ inability to supply myocardium with sufficient blood to supply myocardium with sufficient blood to meet heart’s demand for oxygen during times meet heart’s demand for oxygen during times of stress.of stress.
Can be caused by atherosclerosis,coronary Can be caused by atherosclerosis,coronary artery vasospasm, or combination of both.artery vasospasm, or combination of both.
By By Dr Saikat SahaDr Saikat Saha
Intro: Angina PectorisIntro: Angina Pectoris
Detailed medical history important to Detailed medical history important to prevent these occurrences.prevent these occurrences.
Try to quantify the extent and pattern of Try to quantify the extent and pattern of the disease before beginning treatment.the disease before beginning treatment.
In other words, know what types of In other words, know what types of activities have caused symptoms in past.activities have caused symptoms in past.
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms: Signs & Symptoms: Angina PectorisAngina Pectoris
Chest pain brought on by myocardial Chest pain brought on by myocardial stress - left center or center chest stress - left center or center chest
Chest fullnessChest fullnessBurningBurningTightnessTightnessPain radiating to neck,left Pain radiating to neck,left
arm,jaw,back,shoulder and epigastriumarm,jaw,back,shoulder and epigastrium
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms: Signs & Symptoms: Angina PectorisAngina Pectoris
WeaknessWeaknessDyspneaDyspneaNauseaNauseaDiaphoresisDiaphoresisPain can last up to 20 minutes; prolonged Pain can last up to 20 minutes; prolonged
discomfort should be evaluated at discomfort should be evaluated at emergency medical facilityemergency medical facility
By By Dr Saikat SahaDr Saikat Saha
Treatment: Angina PectorisTreatment: Angina Pectoris
Avoid situations needing increased oxygen Avoid situations needing increased oxygen demandsdemands
Stop procedure and allow patient to restStop procedure and allow patient to restMonitor vital signs repeatedlyMonitor vital signs repeatedlyPlace patient in semireclined positionPlace patient in semireclined positionProvide supplemental oxygenProvide supplemental oxygen
By By Dr Saikat SahaDr Saikat Saha
Treatment: Angina PectorisTreatment: Angina Pectoris
Administer sublingual Administer sublingual nitroglycerin(0.4mg) nitroglycerin(0.4mg) every five minutes for every five minutes for three dosesthree doses
If not relieved, patient If not relieved, patient may be having may be having myocardial infarction myocardial infarction and transport to and transport to emergency medical emergency medical facility facility
By By Dr Saikat SahaDr Saikat Saha
Intro: AsthmaIntro: Asthma
Group of illnesses producing a reversible Group of illnesses producing a reversible hyperreactivity of large and small airwayshyperreactivity of large and small airways
Individuals may react to many stimuliIndividuals may react to many stimuli Incidence is rising in general populationIncidence is rising in general populationTriggering factors include pollen, Triggering factors include pollen,
stress,cold,upper respiratory tract stress,cold,upper respiratory tract infections, exercise, animal fur, infections, exercise, animal fur, nonsteroidal antiinflammatory medicationsnonsteroidal antiinflammatory medications
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms: AsthmaSigns & Symptoms: Asthma
WheezingWheezingShortness of breathShortness of breathCoughCoughSputum productionSputum productionUse of accessory muscles for breathingUse of accessory muscles for breathingTachycardiaTachycardia
By By Dr Saikat SahaDr Saikat Saha
Treatment: AsthmaTreatment: Asthma
Objective is to improve ventilation by reducing Objective is to improve ventilation by reducing or eliminating brochospasmor eliminating brochospasm
Patient removed from irritantsPatient removed from irritants Inhalants used: Albuterol-Ventolin,Proventil or Inhalants used: Albuterol-Ventolin,Proventil or
TerbutalineTerbutaline Monitor vital signsMonitor vital signs Possible oxygen supplementPossible oxygen supplement Assess need for emergency medical Assess need for emergency medical
treatment treatment
By By Dr Saikat SahaDr Saikat Saha
Intro: Cardiac DysrhythmiasIntro: Cardiac Dysrhythmias
Commonly known as heart palpitationsCommonly known as heart palpitationsOften result of anxiety over dental Often result of anxiety over dental
proceduresproceduresCan be result of epinephrine given in local Can be result of epinephrine given in local
anesthetic or of underlying cardiac anesthetic or of underlying cardiac conditioncondition
Use simple reassurance to patientUse simple reassurance to patientMore severe may need more interventionMore severe may need more intervention
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms: Signs & Symptoms: Cardiac DysrhythmiasCardiac Dysrhythmias
Racing heart (tachycardia)Racing heart (tachycardia) Irregular heart beatIrregular heart beatApprehensionApprehensionChest discomfortChest discomfortLight-headednessLight-headednessChest painChest pain
By By Dr Saikat SahaDr Saikat Saha
Treatment: Cardiac DysrhythmiasTreatment: Cardiac Dysrhythmias
Monitor vital signsMonitor vital signsPlace patient in reclined positionPlace patient in reclined positionAdminister supplemental oxygenAdminister supplemental oxygenActivate EMS Activate EMS
By By Dr Saikat SahaDr Saikat Saha
Intro: Cerebrovascular Accident/StrokeIntro: Cerebrovascular Accident/Stroke
Process that interferes with blood flow to Process that interferes with blood flow to the brainthe brain
Prolonged ischemic event causes Prolonged ischemic event causes infarction of part of brain. Can result in infarction of part of brain. Can result in neurologic deficit.neurologic deficit.
Three major causes of stroke: arterial Three major causes of stroke: arterial thrombosis, embolism, hemorrhage of the thrombosis, embolism, hemorrhage of the vasculaturevasculature
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms: Cerebrovascular Signs & Symptoms: Cerebrovascular Accident/StrokeAccident/Stroke
HeadacheHeadache ConfusionConfusion VertigoVertigo Nausea/vomitingNausea/vomiting
Alteration in Alteration in consciousness,vision consciousness,vision & speech& speech
Extremity weaknessExtremity weakness
Facial weaknessFacial weakness
HypertensionHypertension
Change in mental Change in mental statusstatus
By By Dr Saikat SahaDr Saikat Saha
Treatment: Treatment: Cerebrovascular Accident/StrokeCerebrovascular Accident/Stroke
Assess and monitor vital signsAssess and monitor vital signs Initiate basic cardiac life support as Initiate basic cardiac life support as
neededneededAdminister oxygen if patient goes Administer oxygen if patient goes
unconscious or has trouble breathingunconscious or has trouble breathingPlace patient in supine position with head Place patient in supine position with head
slightly elevatedslightly elevatedActivate EMSActivate EMS
By By Dr Saikat SahaDr Saikat Saha
Intro: Congestive Heart FailureIntro: Congestive Heart Failure
Failure of cardiac ventricles to pump blood Failure of cardiac ventricles to pump blood efficiently to the body and lungs.efficiently to the body and lungs.
Result is pulmonary edema and peripheral Result is pulmonary edema and peripheral edema, overfilling venous system.edema, overfilling venous system.
Pulmonary edema can be result of lung Pulmonary edema can be result of lung disease or left ventricular failure.disease or left ventricular failure.
By By Dr Saikat SahaDr Saikat Saha
Intro: Congestive Heart FailureIntro: Congestive Heart Failure
Causes of acute onset:Causes of acute onset:
new arrhythmiasnew arrhythmias
new myocardial infarctionnew myocardial infarction
acute volume overloadacute volume overload
stressstress
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms: Signs & Symptoms: Congestive Heart FailureCongestive Heart Failure
Shortness of breathShortness of breath Exertional dyspneaExertional dyspnea FatigueFatigue Orthopnea(2-3 pillows Orthopnea(2-3 pillows
to sleep) to sleep) CoughCough Rales (crackle) at Rales (crackle) at
lung baselung base
Edema-right side Edema-right side failurefailure
Plural effusion (fluid in Plural effusion (fluid in the lungs)the lungs)
Pink frothy sputumPink frothy sputum Jugular venous Jugular venous
distentiondistention
By By Dr Saikat SahaDr Saikat Saha
Treatment: Treatment: Congestive Heart FailureCongestive Heart Failure
Correct underlying causeCorrect underlying causeStress- Infection - Environmental Stress- Infection - Environmental
conditions(heat) conditions(heat)Administer supplemental oxygenAdminister supplemental oxygenActivate emergency responseActivate emergency responseMonitor vital signsMonitor vital signsDiscontinue procedureDiscontinue procedureHave patient rest in semireclined positionHave patient rest in semireclined position
By By Dr Saikat SahaDr Saikat Saha
Intro: Drug Related EmergenciesIntro: Drug Related Emergencies
Therapeutic agents can precipitate Therapeutic agents can precipitate physiologic crisisphysiologic crisis
Present as allergic or toxic reactionsPresent as allergic or toxic reactions Drug abuse most commonly found are alcohol Drug abuse most commonly found are alcohol
or cocaine relatedor cocaine related Act on central nervous systemAct on central nervous system Be aware of signs of drug abuse and drug Be aware of signs of drug abuse and drug
interactionsinteractions Explicit directions for patients drug useExplicit directions for patients drug use
By By Dr Saikat SahaDr Saikat Saha
Intro: Drug Related EmergenciesIntro: Drug Related Emergencies
Therapeutic agents can precipitate Therapeutic agents can precipitate physiologic crisisphysiologic crisis
Present as allergic or toxic reactionsPresent as allergic or toxic reactions Drug abuse most commonly found are alcohol Drug abuse most commonly found are alcohol
or cocaine relatedor cocaine related Act on central nervous systemAct on central nervous system Be aware of signs of drug abuse and drug Be aware of signs of drug abuse and drug
interactionsinteractions Explicit directions for patients drug useExplicit directions for patients drug use
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms: Drug Related Signs & Symptoms: Drug Related EmergenciesEmergencies
Actions on CNS Actions on CNS StimulationStimulation: : Headache, Headache, Nausea,Vomiting, Nausea,Vomiting, Vertigo, Twitching Vertigo, Twitching small muscles, small muscles, Hallucinations, Hallucinations, Increased Increased RR,Elevated body RR,Elevated body temp,Agitated, temp,Agitated, Restless,ExcitationRestless,Excitation
Advanced Advanced StimulationStimulation: : Seizures.Decreased Seizures.Decreased response to response to stimuli,Incontinence, stimuli,Incontinence, Tachycardia,HypertenTachycardia,Hypertension, Weak rapid sion, Weak rapid pulse, Rapid irregular pulse, Rapid irregular breathingbreathing
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms: Signs & Symptoms: Drug Related EmergenciesDrug Related Emergencies
Depression: Premorbid StateDepression: Premorbid Statecoma coma pupils fixed and dilatedpupils fixed and dilated flaccid paralysisflaccid paralysiscardiac arrestcardiac arrest respiratory arrestrespiratory arrestcyanosiscyanosis lethargy, stuporlethargy, stupor
By By Dr Saikat SahaDr Saikat Saha
Treatment: Treatment: Drug Related EmergenciesDrug Related Emergencies
Hypotension with evidence of shock in non Hypotension with evidence of shock in non responsive individuals is indication for responsive individuals is indication for parenteral fluid therapy.parenteral fluid therapy.
Activate emergency procedures protocol.Activate emergency procedures protocol.Basic life supportBasic life supportCPRCPR
By By Dr Saikat SahaDr Saikat Saha
Intro: HyperglycemiaIntro: Hyperglycemia
Increased blood sugarIncreased blood sugar
One of two life threatening complications One of two life threatening complications of diabetesof diabetes
Slow to develop but if not treated can Slow to develop but if not treated can result in diabetic coma and deathresult in diabetic coma and death
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms: HyperglycemiaSigns & Symptoms: Hyperglycemia
Deep,labored Deep,labored respirationsrespirations
Sweet fruity breathSweet fruity breath
Dry. Warm skinDry. Warm skin
Rapid,weak pulseRapid,weak pulse
ThirstThirst
LassitudeLassitude
HeadacheHeadache
By By Dr Saikat SahaDr Saikat Saha
Treatment: HyperglycemiaTreatment: Hyperglycemia
Terminate procedureTerminate procedureAdminister glucoseAdminister glucose
Oral- paste or drink(must be conscious)Oral- paste or drink(must be conscious)IVIV
Perform basic life supportPerform basic life supportActivate emergency response protocol Activate emergency response protocol
By By Dr Saikat SahaDr Saikat Saha
Intro: HypertensionIntro: Hypertension
Unlikely to be seen but may manifest as Unlikely to be seen but may manifest as underlying cause of another crisisunderlying cause of another crisis
Absolutely essential to control increased Absolutely essential to control increased blood pressure in response to any other blood pressure in response to any other situationsituation
Must decide if patient needs emergent or Must decide if patient needs emergent or referral care-depends on history or any referral care-depends on history or any symptoms presentsymptoms present
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms: HypertensionSigns & Symptoms: Hypertension
HeadacheHeadache
VomitingVomiting
Change in mental Change in mental statusstatus
Visual disturbanceVisual disturbance
SeizureSeizure
ShockShock
StrokeStroke
Blood Pressure Blood Pressure Readings - WNLReadings - WNL
By By Dr Saikat SahaDr Saikat Saha
Treatment: HypertensionTreatment: Hypertension
Discussed elsewhere Discussed elsewhere to control blood to control blood pressurepressure
Must refer for care in Must refer for care in hospital by physicianshospital by physicians
Focus on prevention-Focus on prevention-make sure medication make sure medication taken, anesthetic taken, anesthetic w/out epinephrinew/out epinephrine
By By Dr Saikat SahaDr Saikat Saha
Intro: HyperventilationIntro: Hyperventilation
Imbalance in ratio of blood oxygen and Imbalance in ratio of blood oxygen and blood carbon dioxide levelsblood carbon dioxide levels
Produced by either rapid or excessively Produced by either rapid or excessively deep respirationsdeep respirations
Common occurrence in dental office as it Common occurrence in dental office as it is result of anxiety or emotional stressis result of anxiety or emotional stress
Recognition and management of patient Recognition and management of patient anxiety can prevent this problemanxiety can prevent this problem
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms and Treatment: Signs & Symptoms and Treatment: HyperventilationHyperventilation
Signs & SymptomsSigns & Symptoms:: DizzinessDizziness Light-headednessLight-headedness Numb fingersNumb fingers Heart dysrhythmiasHeart dysrhythmias Abdominal crampsAbdominal cramps Muscle crampsMuscle cramps
Treatment: Treatment: Terminate dental Terminate dental
treatmenttreatment Reassure the patientReassure the patient Try to institute regular Try to institute regular
respirationsrespirations Rebreath exhalations Rebreath exhalations
to reverse alkalosis to reverse alkalosis (breath into (breath into hands/bag)hands/bag)
By By Dr Saikat SahaDr Saikat Saha
Intro: HypoglycemiaIntro: Hypoglycemia
Condition of acutely decreased blood Condition of acutely decreased blood sugarsugar
Life threatening- more critical than Life threatening- more critical than hyperglycemia in emergency situationhyperglycemia in emergency situation
Must be treated rapidlyMust be treated rapidlyAdministration of glucose is indicated - will Administration of glucose is indicated - will
not significantly affect patientnot significantly affect patient
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms and Treatment: Signs & Symptoms and Treatment: HypoglycemiaHypoglycemia
Signs & Symptoms:Signs & Symptoms:
HungerHunger NauseaNausea Cool, moist skinCool, moist skin Shallow respirationsShallow respirations IrritationIrritation ConfusionConfusion Bizarre behaviorBizarre behavior
Treatment:Treatment:
Terminate procedureTerminate procedure Administer glucoseAdminister glucose
Oral-paste or drinkOral-paste or drink IVIV
Perform basic life Perform basic life supportsupport
Activate EMS Activate EMS
By By Dr Saikat SahaDr Saikat Saha
Intro, Signs & Symptoms, Intro, Signs & Symptoms, Treatment: Nose BleedTreatment: Nose Bleed
Profuse or uncontrolled bleeding: Apply Profuse or uncontrolled bleeding: Apply compression over bleeding area. Digital compression over bleeding area. Digital pressure on pressure point of supplying pressure on pressure point of supplying vessel. vessel.
Nosebleed: Nosebleed: Request patient to pinch nostrils between thumb Request patient to pinch nostrils between thumb
and index finger for 5 minutesand index finger for 5 minutesApply cold compress to back of neck or over noseApply cold compress to back of neck or over noseUpright positionUpright position
By By Dr Saikat SahaDr Saikat Saha
Intro: Intraoral LacerationsIntro: Intraoral Lacerations
Rare but posssibleRare but posssibleHigh speed handpieces, overzealous High speed handpieces, overzealous
subgingival scalingsubgingival scalingSigns & Symptoms: Intraoral Signs & Symptoms: Intraoral
LacerationsLacerations Bleeding-Pulsation,bright red-arterial; Bleeding-Pulsation,bright red-arterial;
Oozing,dark,red-venous Oozing,dark,red-venous Pain at trauma site or over area of swelling Pain at trauma site or over area of swelling Swelling,slowly or rapidly, ecchymosisSwelling,slowly or rapidly, ecchymosis
By By Dr Saikat SahaDr Saikat Saha
Treatment: Intraoral LacerationsTreatment: Intraoral Lacerations
Discontinue treatmentDiscontinue treatmentRemove foreign bodies from mouthRemove foreign bodies from mouthPressure applied to site with sterile gauzePressure applied to site with sterile gauzeWound flushed and irrigated with salineWound flushed and irrigated with salineFollow emergency office protocol to inform Follow emergency office protocol to inform
dentist of situationdentist of situationMay be cared for in office or referred to May be cared for in office or referred to
oral surgeonoral surgeon
By By Dr Saikat SahaDr Saikat Saha
Intro: Myocardial InfarctionIntro: Myocardial Infarction
Occurs when myocardial oxygen demand Occurs when myocardial oxygen demand exceeds available oxygen supplied by exceeds available oxygen supplied by blood for an extended period.blood for an extended period.
Most myocardial infarctions result of Most myocardial infarctions result of atherosclerotic coronary artery diseaseatherosclerotic coronary artery disease
Plaques develop and occlude coronal Plaques develop and occlude coronal arteries, decrease blood flow to arteries, decrease blood flow to myocardium, cause irreversible damagemyocardium, cause irreversible damage
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms: Signs & Symptoms: Myocardial InfarctionMyocardial Infarction
Chest painChest pain CrushingCrushing Radiating to Radiating to
neck,jaw,arm,backneck,jaw,arm,back SubsternalSubsternal
Hypertension or Hypertension or hypotensionhypotension
IndigestionIndigestion Diaphoresis(sweatingDiaphoresis(sweating
))
Shortness of breathShortness of breath Tachycardia or Tachycardia or
bradycardiabradycardia DysrhythmiasDysrhythmias Loss of or alteration in Loss of or alteration in
consciousnessconsciousness
By By Dr Saikat SahaDr Saikat Saha
Treatment: Myocardial InfarctionTreatment: Myocardial Infarction
Discontinue dental treatmentDiscontinue dental treatmentPlace patient in semireclined positionPlace patient in semireclined positionAdminister supplemental oxygenAdminister supplemental oxygenContinually monitor and record vital signsContinually monitor and record vital signsAdminister sublingual nitroglycerin 0.4mg Administer sublingual nitroglycerin 0.4mg
every 5 minute for 3 dosesevery 5 minute for 3 doses If no improvement,activate EMSIf no improvement,activate EMS
By By Dr Saikat SahaDr Saikat Saha
Intro: Ocular InjuriesIntro: Ocular Injuries
Rare but these type of injuries do occurRare but these type of injuries do occurNeed same prompt attention even though Need same prompt attention even though
not life threateningnot life threateningMost ocular injuries affect trauma to Most ocular injuries affect trauma to
cornea or the globe itselfcornea or the globe itselfWant to minimize loss of visual acuityWant to minimize loss of visual acuityRefer patient opthalmologist for definitive Refer patient opthalmologist for definitive
treatmenttreatment
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms: Signs & Symptoms: Ocular InjuriesOcular Injuries
Chemical Burns:Chemical Burns: serious,alkali burns serious,alkali burns are true emergnciesare true emergncies
Mild to severe painMild to severe pain Blurred visionBlurred vision Excessive tearingExcessive tearing
Treatment:Treatment: Immediate copious Immediate copious irrigation with tap irrigation with tap water Alkali water Alkali and /or acid burns and /or acid burns require 15-20 minutes require 15-20 minutes of irrigation before of irrigation before transportation to transportation to opthalmologist for opthalmologist for immediate consult and immediate consult and evaluationevaluation
By By Dr Saikat SahaDr Saikat Saha
Treatment: Ocular InjuriesTreatment: Ocular Injuries
Foreign object in eye: Caution patient not Foreign object in eye: Caution patient not to rub eye to rub eye Blink repeatedly to stimulate tear flow. Blink repeatedly to stimulate tear flow. Locate object by lifting and rolling back Locate object by lifting and rolling back
eyelids. eyelids. Remove with tissue if possible or use eye Remove with tissue if possible or use eye
wash station. wash station. Always have patient wear protective eyewear. Always have patient wear protective eyewear.
By By Dr Saikat SahaDr Saikat Saha
Intro: SeizuresIntro: Seizures
Sudden and unexpected central Sudden and unexpected central paroxysmal neuronal depolarization of paroxysmal neuronal depolarization of nerve cells that result in uncontrolled nerve cells that result in uncontrolled muscular movement. muscular movement.
Two types: Two types: Focal- limitedFocal- limitedGeneralized- loss of consciousnessGeneralized- loss of consciousness
By By Dr Saikat SahaDr Saikat Saha
Intro: SeizuresIntro: Seizures
Caused by:Caused by:head injurieshead injuries infectionsinfectionsneoplasmsneoplasmscerebrovascular diseasecerebrovascular diseasesystemic conditions idiopathicsystemic conditions idiopathic
Signs & Symptoms: SeizuresSigns & Symptoms: Seizures
Feeling of aura-visual,auditory or olfactory Feeling of aura-visual,auditory or olfactory sensory disturbancesensory disturbance
Minor personality changesMinor personality changesDepressionDepressionAnxietyAnxietyHeadacheHeadacheLoss of consciousness, muscle rigidityLoss of consciousness, muscle rigidityTonic/Clonic movementsTonic/Clonic movements
Treatment: SeizuresTreatment: Seizures
Place patient in reclined or supine positionPlace patient in reclined or supine position Protect patient from injury during seizureProtect patient from injury during seizure Protect head from injury during seizureProtect head from injury during seizure Administer supplemental oxygen prnAdminister supplemental oxygen prn Suction mouth secretions-turn head to side Suction mouth secretions-turn head to side
if vomiting occurs-clear airwayif vomiting occurs-clear airway Monitor vital signsMonitor vital signs Initiate further support if neededInitiate further support if needed
Treatment: SeizuresTreatment: Seizures
Do not allow patients Do not allow patients to drive themselves to drive themselves home. Arrange for home. Arrange for transportation home transportation home by family member or by family member or other service. other service.
Intro: ShockIntro: Shock
Condition in which circulatory system Condition in which circulatory system inadequately perfuses body tissues inadequately perfuses body tissues resulting in cellular hypoxiaresulting in cellular hypoxia
Hypovolemic shock: due to sudden and Hypovolemic shock: due to sudden and acute loss of blood-secondary to traumaacute loss of blood-secondary to trauma
Septic shock: vasodilatory action of Septic shock: vasodilatory action of endotoxins produced by virulent systemic endotoxins produced by virulent systemic bacteremiabacteremia
Intro: ShockIntro: Shock
Cardiogenic shock: failure of heart to Cardiogenic shock: failure of heart to pump a sufficient amount of blood to pump a sufficient amount of blood to maintain perfusion pressuremaintain perfusion pressure
Neurogenic shock: result of spinal cord Neurogenic shock: result of spinal cord trauma causing loss of sympathetic trauma causing loss of sympathetic stimulation. Causes vasodilation.stimulation. Causes vasodilation.
Signs & Symptoms: ShockSigns & Symptoms: Shock
Hypotension/postural hypotensionHypotension/postural hypotensionTachycardiaTachycardiaCool skinCool skinPale skin colorPale skin colorAnxietyAnxietyChange in mental statusChange in mental statusDecrease capillary refillDecrease capillary refill
Treatment: ShockTreatment: Shock
Goal to maintain Goal to maintain perfusion pressure perfusion pressure and maintain and maintain oxygenation to vital oxygenation to vital organs and tissuesorgans and tissues
Monitor vital signsMonitor vital signs Place in Place in
Trendelenburg Trendelenburg positionposition
Keep quiet and warmKeep quiet and warm Activate EMSActivate EMS Provide supplemental Provide supplemental
oxygenoxygen Monitor skin signs Monitor skin signs
and capillary and capillary perfusionperfusion
Signs & Symptoms: Broken and Signs & Symptoms: Broken and Lodged Instrument TipLodged Instrument Tip
Don’t use incorrectly sharpened Don’t use incorrectly sharpened instruments which are extremely thininstruments which are extremely thin
Don’t force instruments out of contact areaDon’t force instruments out of contact areaTo loosen: relax the face of the instrument To loosen: relax the face of the instrument
toward the tooth (close blade),Attempt to toward the tooth (close blade),Attempt to back blade out of areaback blade out of area
Instruct patient not to swallow,check floor Instruct patient not to swallow,check floor of mouth and in gingival tissue, x-ray prnof mouth and in gingival tissue, x-ray prn
Signs & Symptoms: Emotional Signs & Symptoms: Emotional ProblemsProblems
Mental condition can affect physical Mental condition can affect physical condition: Hyperventilation, condition: Hyperventilation, lightheadedness,giddiness,anxiety, lightheadedness,giddiness,anxiety, confusion,dizziness,overbreathing,feelings confusion,dizziness,overbreathing,feelings of suffocation,heart pounds, tingling or of suffocation,heart pounds, tingling or numbness in extremitiesnumbness in extremities
Patient position should be upright;loosen Patient position should be upright;loosen tight collar,reassure patient,breath into bagtight collar,reassure patient,breath into bag
Intro: SyncopeIntro: Syncope
Vasodepressor syncope,fainting occurs Vasodepressor syncope,fainting occurs during stressful situationsduring stressful situations
Usually benign, unless left untreated,fatalUsually benign, unless left untreated,fatalCaused by transitory and sudden loss of Caused by transitory and sudden loss of
consciousness after cerebral ischemiaconsciousness after cerebral ischemiaPlace in supine position,restore blood flowPlace in supine position,restore blood flow
Intro: SyncopeIntro: Syncope
Predisposing factors: Predisposing factors: fright,fright,painpainemotional stress emotional stress anxiety anxiety hunger hunger sudden postural changes sudden postural changes exhaustionexhaustion
By By Dr Saikat SahaDr Saikat Saha
Signs & Symptoms: SyncopeSigns & Symptoms: Syncope
Early: Early: Loss of color, pallorLoss of color, pallor PerspirationPerspiration NauseaNausea Increased heart rateIncreased heart rate Feeling of warmthFeeling of warmth
Late:Late: YawningYawning Dilated pupilsDilated pupils Cold extremitiesCold extremities HypotensionHypotension DizzinessDizziness Loss of consciousnessLoss of consciousness
Treatment: SyncopeTreatment: Syncope
Position patient-supine, head lower than Position patient-supine, head lower than feet if possiblefeet if possible
Maintain open airwayMaintain open airwayAdminister oxygenAdminister oxygenAdminister ammonia inhalantAdminister ammonia inhalantMonitor vital signsMonitor vital signs
By By Dr Saikat SahaDr Saikat Saha
Procedural OverviewProcedural Overview
Respond in logical, Respond in logical, rehearsed pattern of rehearsed pattern of behaviorbehavior
For each possible For each possible situation clinician situation clinician should be prepared to should be prepared to respond in respond in predetermined predetermined fashionfashion
Move instruments or Move instruments or other potentially other potentially harmful equipmentharmful equipment
Reposition chairReposition chair Go for help calmlyGo for help calmly Let patient sit quietlyLet patient sit quietly Locate Emergency Locate Emergency
first Aid Kitfirst Aid Kit
By By Dr Saikat SahaDr Saikat Saha
Procedural OverviewProcedural Overview
Preparing a syringe Preparing a syringe for an intramuscular for an intramuscular injection (IM); injection (IM); intravenous injection intravenous injection (IV) or subcutaneous (IV) or subcutaneous injection.injection.
Performing CPRPerforming CPR
Directing emergency Directing emergency squad to right locationsquad to right location
Prepare dental team Prepare dental team to respond by role to respond by role assignment according assignment according to skill level and to skill level and abilities to react abilities to react appropriatelyappropriately
By By Dr Saikat SahaDr Saikat Saha
Importance of Dental Importance of Dental Hygienist’s RoleHygienist’s Role
Prompt, appropriate Prompt, appropriate reaction may reaction may
avert an emergency avert an emergency
save a lifesave a life
References:References:
Braun, Robert J. and Cutilli, Braun, Robert J. and Cutilli, Manuel of Manuel of Emergency Medical Treatment for theEmergency Medical Treatment for the Dental TeamDental Team.1999.Media:Williams & .1999.Media:Williams & Wilkins.Wilkins.
Wilkins,Esther, Wilkins,Esther, Clinical Practice of theClinical Practice of the Dental HygienistDental Hygienist,1994. Malvern:Williams ,1994. Malvern:Williams and Wilkins. and Wilkins.
Woodall,Irene. Woodall,Irene. Comprehensive DentalComprehensive Dental Hygiene CareHygiene Care.1993.St.Louis:Mosby..1993.St.Louis:Mosby.