Medical Emergencies and Resuscitations in Dental Practice

8/2/2019 Medical Emergencies and Resuscitations in Dental Practice

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Medical Emergencies AndResuscitation In Dental Practice

Ziad Malkawi D.D.S.,M.Sc., Max.Fac.S.CertFF DRCSI University Of Jordan


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MEDICAL EMERGENCIES AND

RESUSCITATION

Be Prepared

- SurgeryD rugsEquipment

- Staff C PR trainingObtaining help


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- Patients

Medical historyD rug historyAllergiesInstructionscommunication


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MEDICAL EMERGENCIES ANDRESUSCITATION

Emergencies that might occur:- Loss of consciousness

F aintC ardiac arrestHypoglycemiaC erebrovascular accidentdrugs


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- Breathing difficultiesAsthmaHeart failureAnaphylaxishysteria


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-C

hokingInhaled foreign bodyLaryngeal oedema


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- F itting

EpilepsyHypoglycemiaC ardiac arrest


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MEDICAL EMERGENCIES AND

RESUSCITATIONManagement- Assessment

ResponsivenessAirwayBreathingC irculation

-F

irst aid treatment- Obtaining help- D efinitive treatment


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Appendix ALIST OF DRUGS FOR EMERGENCY USE

1 . D rugs to be available in very dental practice

Minimum

(i) Oxygen

(ii) Adrenaline 1 mg in 1 m x 5 ampoules

(iii) Lignocaine 1% 1 mlx

5 ampoules

(iv) Atropine O .6 mg 1 mlx

5 ampoules

(v) C alcium C hloride 10 % 10 ml x

2 ampoules

(vi) Sodium Bicarbonate 8 .4 %

5 0 ml x

3 ampoules


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(vii) Glycery Trinitrate Tabs3 00 mcg or Glyceryl

Trinitrate 400 mcg permetered dose sub-lingual

spray

x

x

10

1

(viii) Aminophylline 25 0 mg 10 ml x

2 ampoules

(ix) Salbutamol inhaler100 mcg per metered

dosex 2 refills

(x) C hlorpheniraminemaleate 10 mg

1 mlx

2 ampoules

(xi) D extrose 5 0% 5 0 ml x

1

(xiv) Hydrocortisone100

mg 2mlx 5 ampoules


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(xiv) Infusion solution(a) D extrose 4% saline

0.1 8 %

(b) C olloid solution

5 00 ml x5 00 ml x

2 . D rugs to be available in dental practices providingintravenous sedation .

(i) F lumazenil 5 00 mcg 5ml x 5 ampoules

(ii) Naloxone 0.4 mg

3 . D rugs to be available in dental practices providinggeneral anaesthesia .

(i) Suxamethonium 100 mg 2mlx

5 ampoules


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Appendix B

List Of Essential Items Of Equipment ForResuscitation Which Must Be Available In

Every Dental PracticeAIRWAY MAINTENANCE1. Suction apparatus powered and portable (

independently powered) .2 . Simple airway adjunct (e . g . pocket resuscitator mask

with valve) .3 . C ricothyroid puncture needle x 1

Oxygen and Artificial Ventilation1. Portable oxygen with appropriate valves, metering and

delivery system2 . Self-inflating bag, valve and mask with oxygen

enhancement facility .


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Appendix B

List Of Essential Items Of Equipment ForResuscitation Which Must Be Available In

Every Dental Practice

Maintenance of Circulation

1. D isposable syringes sizes 2, 5, 10 ml x 5of each

2 . D isposable needles sizes 2 1 & 23g x 10 of each

3 . D isposable IV vannulae sizes 16 & 22g x 5of each

4. Disposable IV Infusion Sets x 25 . Scissors x 1

6. Tourniquet, Sphygmomanometer, Stethoscope x 1 of EA C H

7 . Injection Swabs


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Medical Emergencies AndResuscitation

Faint- Features

Reflex response that occurs in the conscious individual .C onsciousness lost if systolic BP falls below 60 mmHg .Effects aggravated by starvation, pain or stuffyenvironment .

- DiagnosisLight headed +/- nauseaPale and unwellC old sweaty handsThready pulse, low BPUnresponsive


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- Management of faint:Lie flat, elevate legsRecovery positionMaintain airway, check

breathing and pulsePostpone treatment .


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H eart Attack- Diagnosis

Previous history

Retrosternal chest pain that might radiatePale and unwellC old and sweaty

- ManagementReassure and sit downGTN under tongueC heck pulse and BPAngina is self-limiting if pain or symptoms persistsuspect MIOxygen by face maskRapid transfer to hospital by ambulance .


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Medical Emergencies And

ResuscitationAsthma- Features

bronchospasm may occur in acute asthma, acuteor chronic bronchitis or in anaphylaxis .

- DiagnosisHistory of asthmaBreathing difficulty especially breathing out .Audible wheeze

Sweaty, tachycardia, cyanosis .- Management

ReassureSit upSalbutamol inhaler

Oxygen by face maskArran e transfer to hos ital .


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ResuscitationDiabetic coma (hypoglycaemia)- Features

D iabetics on insulin or oral hypoglycaemicsmay drop their blood sugar if they take theirmedication and do not eat . Presence of oral sepsis may make control of diabetes difficultUse of synthetic human insulin .

- DiagnosisHistoryconfusional aggressionPale and sweatyRapid, thready pulse

Unresponsive


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Resuscitation- Diabetic coma (hypoglycaemia )- Management

Oral glucose if able to swallowIf unresponsive may need to give IV 5 0% dextrose or IM or S C glucagon . If delayed response or unwell arrange transfer

to hospital


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ResuscitationAnaphylactic shock- Features

Allergy to an administered antigen (usually a drug orfood ) causes histamine release from mast cellsresulting in vasodilatation, increased capillarypermeability and bronchospasmUncommon with local anaesthetic agents, morecommon with antibiotics or anaesthetic agents

- Diagnosis

Rash and oedemaTachycardiaHypotensionBronchospasmC ardiopulmonary arrest


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ResuscitationAnaphylactic shock:- Management

If mild symptoms, reassure, sit down,check pulse and BP . IV access if possibleadrenaline 1:1000 0. 5ml S C , IMHydrocortisone 2 00 mg IM/IVIf bronchospasm give oxygen by face mask

If collapse check AB CArrange transfer to hospital


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ResuscitationCerebrovascular accident- Features

An ischaemic episode in the brain caused byvascular spasm, a clot or a bleedSymptoms may last only a short time and acomplete recovery is made . This is a transientischaemic attackIf symptoms are prolonged and neurological

impairment persists it is a completed stroke


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ResuscitationCerebrovascular accident

- DiagnosisVaried symptoms

Slurred speechWeakness of arms or legs, often one-sidedVisual problemsC onfusion, aggressive behaviourUnrousable

- ManagementIf unrousable put in recovery position, maintain airway,check breathing and pulseArrange transfer to hospital


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ResuscitationEpilepsy- Featureson medication and a fit is precipitated by extreme

anxiety, starvation or omission of medicationprior to treatment

- DiagnosisAuraC olonic tonic contractionsLoss of consciousness

- ManagementProtect from injuryMaintain airwayIf rapid recovery, arrange escort and transporthomeIf not known to be epileptic or in statusepilepticus arrange transfer to hospital


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ResuscitationUpper airway obstruction- Causes

Inhaled foreign bodyLaryngeal edema due to infection, trauma or anaphylaxis .

- DiagnosisNo symptomsC oughing and gaggingSpasm of vocal cords giving strider and even respiratoryarrestBronchospasm

- ManagementIf asymptomatic check mouth and faucets carefully;postpone treatment; escort for chest X-ray; may requireendoscopy of gut or bronchoscopy for lungsIf symptoms of upper airway obstruction; encouragecoughing; back blows; heimlichs abdominal thrust;cricothyrodotomy .


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Medical Emergencies and Resuscitations in Dental Practice

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