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Agenda slide
1. Introduction
2. Medical emergencies that may be encountered in dental practice
3. Local anesthesia emergencies
4. Conclusion
5. Q&A
Dentist's duty
Dentists have an ethical and professional duty to be cognizant of appropriate guidelines for the management of acute medical problems that might occurthey also need to have the skills and resources to follow this guidance.
Life-threatening emergencies are rare but can occur at any time in dental practice. Dentists must be able to provide acutely ill patients with life-saving measures prior to the arrival of specialist help. It is essential, therefore, that they are trained in the management of medical emergencies that they might precipitate or encounter.
Methods of pain and anxiety control are of paramount importance in the management of medically compromised patients
Be an oral physician
An awareness of potential problems or complications
associated with medical conditions can sometimes prevent a critical
incident. For example, hypoglycaemia is an acute complication of both
type 1 and 2 diabetes mellitus. The timing of dental appointments
should be discussed with the patient so that they are compatible with
the patient's diabetic management, allowing adherence to usual eating
schedules.
Medical emergencies that may be encountered in dental practice and that require prompt management
Vasovagal attack Seizures Angina Asthma attack Hypoglycaemia Myocardial infarction Anaphylaxis Cardiac arrest
Faint
Faint
Causes
Transient hypotension and cerebral ischaemia
Predisposing factors include hypoglycaemia, anxiety, fear, pain, and fatigue
Faint
Signs
Weakness, dizziness, pallor, sweating, nausea, confusion, tachycardia followed by a bradycardia, loss of consciousness.
Minor convulsions or incontinence can occur.
Faint
Management
Place patient in a supine position with the legs elevated above the level of the heart to improve cerebral owA
patient who is sitting may lower their head by placing it between their knees, this is not as effective as lying a patient down.Lay a pregnant patient on her side.
Administer oxygen.
Reassure the recovering patient, a glucose-rich drink may be helpful.
When a member of the dental team recognizes that a patient is likely to faint the patient should be placed in a supine positionthis may prevent loss of consciousness.
If the patient fails to regain consciousness promptly other causes of loss of consciousness must be considered.
Epileptic seizure
Epileptic seizure
Causes
Known epileptic
Poorly controlled or non-compliance with drug regimeStress,
Hypoglycaemia;
May accompany a faint.
Overdose of local anaesthetic may cause seizures.
Epileptic seizure
Signs
Loss of consciousness
Muscle rigidity followed by jerking movements; incontinence may occur.
Confusion may be present during recovery
Epileptic seizure
Management
Protect from injury
Administer oxygen and maintain airway if possible.
If the patient can be discharged home, ensure that they are accompanied
Status epilepticus is probable if seizure continues in excess of 7 minutes; therefore emergency services should be called.
If status epilepticus is diagnosed diazepam (up to 10 mg) by slow IV injection may be given; it is not always efcacious
Asthma
Asthma
Causes
Pre-existing disease that is poorly controlled, anxiety, infection, exercise, exposure to an antigen
Asthma
Signs
Breathlessness with wheezing on expiration.
If untreated, breathing may become increasingly difcult
Asthma
Management
Salbutamol inhaler or nebulizer and oxygen.
Place the patient in a comfortable position.
If there is no improvement summon emergency servicesHydrocortisone IV or IM may be given
Status asthmaticus is a life-threatening condition
Chest pain
Chest pain
Chest pain
Signs
Usually a crushing retrosternal pain, irregular pulse, may experience breathlessness, nausea, or vomiting
Chest pain
Management
Sublingual GTN, oxygen,
Place patient in a comfortable position
consult with the patient.
Call emergency services if pain does not subside in 3 minutes
Possible administration of oral aspirin (300 mg) if MI suspected; nitrous oxide and oxygen, if available, can be helpful to reduce pain and anxiety.
Monitor.
If loss of consciousness follow the protocol for cardiopulmonary resuscitation.
Hyperventilation
Hyperventilation
Causes
Stress, pain, or expectation of pain.
This is often a response to unfocused fears.
Can be associated with chronic generalized anxiety disorder
Hyperventilation
Signs
Rapid breathing, tachycardia, trembling, dizzy, faint, sweating
Paraesthesia, muscle pain/stiffnessCan lead to tetany.
Patients can complain of chest pain
Hyperventilation
Management
Reassure
Ensure comfortable position
Stop treatment
Rebreathe expired air
Cerebrovascular accident
Cerebrovascular accident
Causes
Ischaemia, haemorrhage, or embolism in a cerebral artery.
Cerebrovascular accident
Signs
A stroke (partial or total weakness on one side of the body), dysarthria, aphasia, hemiplegia, and possible loss of consciousness
Cerebrovascular accident
Management
Lay at and administer oxygen,
maintain airway,
monitor
Summon expert help.
Hematoma (causes)
The needle can nick vessels as it passes through highly vascular tissues. A nicked artery will usually result in a rapid hematoma, while a nicked vein may or may not result in a hematoma.
Hematomas most often occur during a posterior superior alveolar or inferior alveolar nerve blocks.
The most common cause of needle breakage is sudden unexpected movement of the patient.
Some practitioners habitually bend the needle and the metal is weakened in this area.
A & Q
Thank you.
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