Medical Emergencies in Dental Practice

Medical Emergencies in Dental Practice

• Topics covered include respiratory distress, chest pain, syncope, seizures, stroke, allergy-related emergencies, and hypoglycemia.
• Learning objectives focus on medical emergencies and their clinical management in dental settings.
• Emergency preparation involves being certified in basic life support (BLS), knowing emergency equipment locations/use, understanding patients, using good patient management techniques, reacting promptly to emergencies, having a documented office emergency plan, and having an emergency call list.

Respiratory Distress

• Asthma causes airways to narrow and swell and mucus production, leading to breathing difficulty.
• Manifestations include shortness of breath, wheezing, cough, chest tightness, anxiety, and cyanosis.
• Management of asthma attack: terminate procedure, position patient upright, use a beta-2 agonist inhaler (albuterol, etc.), give one puff at a time (maximum ten puffs), administer oxygen, summon assistance, and call 997.

Chest Pain

• Acute Myocardial Infarction (MI) results from coronary artery occlusion, causing heart muscle death (necrosis).
• Angina is characterized by plaque buildup in coronary arteries, making blood flow harder.
• Heart attack is caused by plaque cracking and a blood clot blocking the artery.
• Manifestations can include sudden severe pain, crushing chest pain radiating to the jaw and/or left arm, sweating, weakness, restlessness, sense of impending doom, dyspnea. Some patients, especially women and diabetics, may not show classic signs.
• Management involves calling 997, chewing regular aspirin (325 mg) or four baby aspirins (4 x 81 mg), monitoring vitals, relieving pain (morphine or nitrous oxide), supplemental oxygen (if SpO2 < 92%), and performing basic life support (BLS) if needed.

Syncope

• Definition: An abrupt, transient loss of consciousness with rapid spontaneous recovery, likely due to cerebral hypoperfusion.
• Causes: Cardiac, neurological, or vasovagal conditions.
• Warning signs include dizziness, nausea, turning pale, ringing in the ears, blurry vision, feeling faint.
• Management: Stop the procedure, place the patient in the Trendelenburg position, apply a cold washcloth to the forehead, administer ammonia, assess and document vitals, and call 997.

Seizures

• Definition: An excessive and/or hypersynchronous activity of cortical neurons resulting in transient neurological symptoms.

• Triggers: Excessive physical exertion, alcohol consumption, fever (febrile seizures), sleep deprivation, flashing lights (e.g., strobe lights, video games), music, hormonal changes (related to menstrual cycle), medication issues (eg. nonadherence, changes to dosages), and new medication interactions.

• Causes of acute symptomatic seizures: Traumatic brain injury, stroke, anoxic encephalopathy, intracranial surgery, Acute CNS infections, electrolyte imbalances, acute metabolic disturbances, alcohol withdrawal, recreational drug use, and prescription drug toxicity.

• Management: Stay calm, remove dangerous items from surroundings, note the time the seizure starts, cushion the head (if necessary), do not restrain the individual, do not attempt to place anything in the mouth, stop bystanders from crowding around, place the individual in recovery position after the seizure ends, and call 997.

• Postictal status: a specific condition following a seizure, characterized by altered consciousness, confusion, or various neurological symptoms. Its duration varies; it may last minutes or hours. Caregivers should provide support and ensure safety during this recovery period.

Stroke

• Manifestations: Muscle weakness, paralysis, speech or vision problems, loss of balance, confusion, headache, and loss of consciousness.
• Management: Call 997 and reassure the patient.
• Identifier: The acronym “BE FAST” helps identify potential stroke symptoms: Balance, Eyes, Face, Arm, Speech, and Time

Allergy-Related Emergencies

• Most common allergen: Latex.
• Mild allergic reaction: Itching, hives, rash, which may be managed by oral antihistamines.
• Severe allergic reaction (anaphylaxis) causes respiratory distress, cardiac compromise, and could lead to coma or death.
• Management of severe allergic reaction (anaphylaxis): Use EpiPen (if available) or administer epinephrine (0.3–0.5 mg IM); call 997 and perform CPR, if needed.

Hypoglycemia

• Manifestations: Hunger, nausea, sweating, tachycardia, anxiety, diaphoresis, decreased ventilation, and may progress to loss of consciousness, seizures, and coma.
• Management of conscious patients: Assess vitals and blood glucose; provide oral carbohydrates (orange juice, candy, dextrose gel).
• Management of unconscious patients: Assess vitals and blood glucose; perform CPR if necessary, administer 25-50 ml of 50% dextrose if IV access is available; administer 1 mg of glucagon IM if no IV access; and call 997.

General Recommendations

• Have emergency equipment readily available, and all personnel should know location and use.
• Consider practice scenarios for emergency situations.
• BLS certification can save lives.
• Always call 997 for emergencies.