Dental Emergency Drug Kit part 4

• Most common medical emergencies in the dental setting covered

Emergency Drug Kit

• This section details essential drugs, knowledge of when to use them, and dosages. The kit includes:
  • GTN (Glyceryl Trinitrate)
  • Adrenaline
  • Midazolam
  • Oxygen
  • Aspirin
  • Glucagon
  • Glucose
  • Salbutamol

Emergency Drugs in the Dental Practice

• Table outlines drugs, indications, adult doses, routes of administration, pediatric doses, and routes

Key Features of Dealing with Medical Emergencies

• Keep calm
• Reassurance
• Lead and/or support
• Monitor and record

Choking/Foreign Body Airway Obstruction (FBAO)

• Signs: coughing, struggling to breathe, gasping for throat, cyanosis
• Symptom: Patient unlikely to be able to explain
• Triggers: Eating/drinking, tablets neurological or cerebral impairment, reduced ability to swallow, cancer treatment, Parkinson's, lunchtime
• Management
  • Assessing severity (mild airway obstruction - effective cough, severe airway obstruction - ineffective cough)

Prevention of Choking

• Risk assessment
• Taking a history
• Use of rubber dam

Anaphylaxis

• Signs: Sudden onset, angioedema (swelling), flushing, urticaria (rash), respiratory distress, stridor/wheezing, hypotension, tachycardia
• Symptoms: Itchiness, difficulty breathing, face/tongue swelling

Anaphylaxis

• Triggers: Known allergy (food, drugs, latex), may be unknown
• Management guidelines: ABCDE approach, remove trigger, call for assistance, place patient lying flat with legs elevated. Give O2 (15L/min), administer intramuscular adrenaline injection (500mg/0.5ml for adults), repeat every 5 minutes
• Prevention
  • Risk assessment, history taking, preparation, communication with team

Needle Length

• Regarding needle length and adrenaline dosage for anaphylaxis treatment, the Resuscitation Council (UK) advises a 25 mm needle length for IM injections and an adrenaline dose of 500 mcg for adults

Asthma

• Signs: Difficulty breathing, expiratory wheezing, breathlessness, fast pulse(RR > 25/min), pulse >110/min
• Symptoms: May start saying cannot breathe, may look for inhaler, exhaustion
• Triggers: Allergy, fear, stress, weather, pollutants
• Management: ABCDE, assess situation, sit upright, support with salbutamol inhaler (max 10 puffs over 2 mins), provide oxygen (15L/min)
• Prevention
  • Risk assessment, history taking, preparation, communication with team

Epilepsy

• Signs: Loss of consciousness, cry out as if in pain, body becomes rigid, noisy breathing, Jerking movements, frothing at the mouth, incontinence
• Symptoms: May feel an aura, and can small flowers.
• Triggers: Stress, brain injury, alcohol withdrawal, temperature, meningitis, brain tumors
• Management: Clear all instruments away, place supine or on the floor with a cushion under the head, time the seizure
• Prevention
  • Risk assessment with long history, preparation, communicate with team

Epilepsy - Post Seizure

• After a seizure:
  • Do not undertake further dental treatment that day.
  • Evaluate level of consciousness.
  • Do not restrain the patient.
  • Do not allow the patient to leave until full recovery is assured.
  • Contact family if the patient is alone.
  • Conduct oral exam for injuries.

Epilepsy - Remember

• Never put fingers or anything in their mouth.
• Do not try and move them unless they are in immediate danger.
• Do not restrain movements whilst fitting.
• Do not give them anything to eat/drink until fully recovered.

Faint/Syncope/Vasovagal Attack

• Signs: Pale, sweating, slow pulse, low BP
• Symptoms: Complains, feeling dizzy light headed, Felling sick/nausea
• Triggers: Fear, stress, hunger
• Management: ABCDE, Life flat, elevate legs
• Prevention: Risk assessment, taking a history, preparation, communicate with team

Stroke

• High stroke risk with those over 55, although about 1 in 4 strokes happen in younger people
• Signs: Face dropping, arm weakness, speech slurred
• Symptoms: N/A
• Triggers: Cholesterol, Diabetes, Stress, Obesity, Lack of exercise
• Management guidelines: Act fast and call 999, give oxygen to the patient, make the patient comfortable
• Prevention: Risk assessment, taking a history, preparation, communicate with team

Hypoglycemia

• Signs: Shaking trembling, slurred speech, sweating, temors, Blurred vision, Confusion and aggression
• Symptoms: Feels shaky, Feels dizzy, Heart racing
• Triggers: Stress, Anxiety, Missing medication, Not eating, Alcohol, Change in Diet,
• Management:Offer 15-20g quick-acting glucose., If patient is unable to safely swallow or unconscious administer Glucagon 1mg IM.

Adrenal Crisis

• Signs: Collapse, pallor, hypotension, vomiting, diarrhoea
• Symptoms: Dizzy, Nauseous
• Triggers: Stress, anxiety, missing prescription
• Management: Call for help, lie the patient flat, provide oxygen and manage as detailed in the text (hydrocortisone)

Dental Guidelines

• (Steroid-Dependent Patients)

Sepsis

• Signs: Patient looks really unwell If one red flag is present
• Symptoms: Does not feel well
• Triggers: Chemotherapy, infection
• Management: Call for help, lie the patient flat, provide oxygen and manage as detailed in the text

Cardiac Arrest

• If known angina patient.
• Death of myocardial heart muscle caused by loss of blood supply usually by a blood clot.
• Sudden Loss of heart function.

Associated Sessions

• This lecture should be used in isolation
• You will have annual MERRT training
• Is your responsibility to keep updated of any changes in protocol or processes
• Familiarise yourself with your emergency drug kit and its location
• Be aware of legal and ethical obligations as a registrant and trained professional