Medical Emergencies PO 004.01

1. Medical EmergenciesPO 004.01 UNCLASSIFIED//REL TO NATO/ISAF

2. Medical Emergencies in Dentistry Definition: • A serious unpredictable, unexpected potentially dangerous situation that require immediate action. • It can progress to mortality or neurological deficit in a short space of time if not properly managed

3. Preventing a medical emergency • Prevention is accomplished by conducting a thorough medical history with appropriate alterations to dental treatment as required.

4. Emergency preparedness • Practice, Practice, Practice • Check Emergency Drugs and Oxygen At Least Monthly • Know Who to Call in Case of Emergency • Arrange for Assistance in Advance with Nearby Medical Personnel

5. Assessing Risk • Review Medical History at EACH Appointment • Determine Medication Compliance • Did the Patient Take Their Medication Today??

6. Assessing Risk • Take Vital Signs, Particularly Older Patients • Determine Apprehension Level • How Are You Feeling Today??

7. Vital Signs(as required) • Blood Pressure • Heart Rate • Respiratory Rate • Temperature

8. Determine Apprehension Level Stress • Is the major cause of medical emergencies in the dental office

9. Stress Reduction Protocol • Good Patient Relations • Morning Appointment • Most emergencies occur during or immediately after the admistration of local anesthesia or at the beginning or a procedure.

10. Stress Reduction Protocol The types of procedures during medical emergencies most frequently arise: • Tooth Extractions • Endodontic treatment

11. Emergency equipment and supply

12. Emergency equipment and supply Oxygen: • The most frequently used “drug” in medical emergency

13. Emergency equipment and supply Epinephrine 1:1000 • Allergic reaction

14. Emergency equipment and supply Diphenhydramine (Benadryl) • Allergic reaction

15. Emergency equipment and supply Nitroglycerin • Angina

16. Emergency equipment and supply Glucose • Hypoglycemia

17. Emergency Situations • Syncope • Hyperventilation • Foreign Body Aspiration • Allergy & Anaphylaxis • Acute Asthmatic Episode • Hypoglycemic Shock • Chest Pain • Seizure • Stroke

18. Necessary Skills & Procedures • Basic Life Support (BLS-C) • Emergency Management Protocol and Plan • Recording of Vital Signs

19. Syncope(Fainting)

20. Syncope • Vasovagal Syndrome • Most Common Emergency in Office • Men > Woman • Younger Ages  14 - 35 • Frequently During LA Injection

21. Syncope Symptoms: • Feeling of warmth • Nausea • Perspiration • Pale skin color • Lower blood pressure

22. Syncope Response Steps: • Place the patient in supine position (with the head lower than the feet) • Loosen any binding clothes • Have oxygen ready to administer • Monitor and record vital signs • If unresponsive, call for emergency assistance

23. Postural Hypotension • Occur when the patient assumes an upright position too quickly • Symptoms: • Low blood pressure • Altered state of consciousness

24. Postural Hypotension Response steps: • Place the patient in supine position (with the head lower than the feet) • Slowly move the patient into an upright position • Monitor and record vital signs • If unresponsive, call for emergency assistance

25. Pregnant patient If postural hypotension: • Turn onto her left side

26. Cerebrovascular accident (stroke) • A cerebrovascular accident (CVA), commonly referred to as a stroke • Is a interruption of blood flow to the brain

27. Cerebrovascular accident (stroke) • If blood flow is interrupted for a sufficient duration, damage to the brain may occur, resulting in loss of brain function.

28. Cerebrovascular accident (stroke) • Most CVAs occur in older individual who have other predisposing diseases, such as arteriosclerosis, heart disease, or uncontrolled high blood pressure.

29. Cerebrovascular accident (stroke) Signs and Symptoms: • Paralysis • Speech problems • Vision problems • Possible seizure • Difficulty swallowing • Headache • Unconsciousness

30. Cerebrovascular accident (stroke) Response Steps: • Call for emergency assistance • Initiate basic life support (CPR) if the patient becomes unconscious • Monitor and record vital signs

31. Chest Pain Is It Angina Pectoris, Myocardial Infarction Or Something Else???

32. Chest Pain - Angina • Pain from angina usually last 3 to 8 minutes • Angina pain is relieve or eased promptly by the administration of sublingual nitroglycerin (spray or tablet)

33. Chest Pain - Angina • A patient with history of angina usually carries some form of nitroglycerine to relieve the symptoms of an attack • Even if a patient has a history of angina, when an attack strikes, it is important to remember that the patient could be having a heart attack

34. Chest Pain - Angina Symptoms: • Tightness or squeezing sensation in the chest • Pain radiating to the left shoulder • Pain radiating to the left side of the face, the jaws and the teeth

35. Chest Pain - Angina Response steps: • Call for emergency assistance • Position the patient upright • Help the patient to medicate himself with nitroglycerin • Administer oxygen • Monitor and record vital signs

36. Chest Pain –Heart Attack • During a heart attack, the muscle of the heart are damaged because of an insufficient oxygen supply

37. Chest Pain –Heart Attack • Any unexplained chest pain should be treated as a potential heart attack

38. Chest Pain –Heart Attack Symptoms: • Chest pain ranging from mild to severe • Pain in the left arm, the jaws and the teeth • Shortness of breath and sweating

39. Chest Pain –Heart Attack Symptoms: • Nausea and vomiting • Pressure, aching or burning feeling of indigestion • Generalized feeling of weakness

40. Chest Pain –Heart Attack Response steps: • Call for emergency assistance • Initiate basic life support (CPR) if the patient becomes unconscious

41. Chest Pain –Heart Attack Response steps: • Medicate with nitroglycerin and an aspirin tablet from the office’s emergency kit • Administer oxygen • Monitor and record vital signs.

42. Hyperventilation • Is precipated (initated) by stress and anxiety • Is an increase in the frequency or depth of respiration • Patient usually remains conscious

43. Hyperventilation Signs and Symptoms: • Rapid, shallow breathing • Panic-stricken appearance • Lump in the throat

44. Hyperventilation Response Steps: • Place the patient in a comfortable position • Use quiet tone of voice to calm and reassure the patient

45. Hyperventilation Response Steps: • Have the patient breathe into cupped hands

46. Asthma • Airway narrows, causing difficulty in breathing, coughing and a wheezing sound • An allergic reaction, severe emotional stress or respiratory infection may cause an asthma attack

47. Asthma Signs and Symptoms: • Coughing • Wheezing • Pallor • Cyanosis (bluish skin)

48. Asthma Response Steps: • Call for assistance • Position the patient upright • Help the patient self-medicate with an inhaler • Administer oxygen as needed • Assess and record vital signs

49. Allergic reaction • Altered state of reactivity • Every drug or dental material introduced to a patient can produced a reaction

50. Allergic reaction Two factors to consider when managing an allergic reaction: • The speed which symptoms appear • The severity of the reaction The symptoms of anaphylaxis can be life threatening and may develop very quickly. Without appropriate care the patient could die within a few minutes.