Untitled Quiz

Medical Emergencies in Dental Practice

• Focus: Medical emergencies that can occur during dental procedures
• Types of Emergencies:
  • Respiratory Distress
  • Chest Pain (including Acute Myocardial Infarction)
  • Syncope
  • Seizures
  • Allergy-Related Emergencies (e.g., latex allergy, anaphylaxis)
  • Hypoglycemia
• Knowledge & Understanding Objectives: Discuss medical emergencies, and management strategies used in a dental setting.

Emergency Preparation

• Basic Life Support (BLS) Certification: Essential for all staff
• Proper Use of Emergency Equipment: Staff should know where emergency equipment is located. This includes instructions on how to use the equipment
• Patient Management: Understand your patient's medical history and any conditions
• Prompt Reaction: Immediate response is crucial in emergencies
• Training: Continuous training to handle emergencies, including team-based approaches, is beneficial and important for practice
• Emergency Plan: A documented office emergency plan is vital, and clear communication protocols, including a dedicated emergency contact list is needed.

Respiratory Distress

• Asthma: Symptoms include narrowing and swelling of airways, accompanied by extra mucus, leading to breathing difficulties
• Manifestations: Shortness of breath, wheezing, chest tightness, anxiety, and cyanosis
• Management of Asthma Attack:
  • Terminate the procedure
  • Place the patient in an upright position
  • Use a beta-2 agonist inhaler (albuterol) — one puff at a time, every 60 seconds (maximum of 10 puffs)
  • Provide oxygen (O2) as needed (if SpO2 < 92%)
  • Summon assistance (e.g., call 997)

Chest Pain

• Acute Myocardial Infarction (MI): Caused by coronary artery occlusion, leading to heart muscle death.
• Angina: Chest pain caused by restricted blood flow.
• Manifestations: Sudden, severe chest pain often radiating to the jaw or left arm. Possible sweating, weakness, restlessness, or a sense of impending doom; and shortness of breath
• Silent MI: Classic signs aren't always present
• "Silent MI" Concerns: Women, and diabetics are particularly prone to silent MI
• Management:
  • Call 997 immediately.
  • Chew one regular aspirin (325 mg) or 4 baby aspirin (81 mg x 4 times).
  • Monitor vital signs (heart rate, blood pressure)
  • Manage pain (e.g., morphine, nitrous oxide).
  • Provide oxygen (O2) as needed (if SpO2 < 92%).
  • Use Basic Life Support (BLS) procedures if needed.

Syncope

• Definition: An abrupt loss of consciousness with rapid recovery, likely caused by reduced blood flow to the brain
• Causes: Cardiac, neurologic, or vasovagal
• Management:
  • Stop the procedure
  • Place the patient in the Trendelenburg position
  • Apply a cold compress to the forehead
  • Administer ammonia inhalant (for complete loss of consciousness)
  • Check vital signs
  • Call 997

Seizures

• Definition: An excessive hypersynchronous activity of cortical neurons, causing transient neurological symptoms
• Triggers: Excessive physical exertion, alcohol, fever, sleep deprivation, flashing lights, music, hormonal changes, and certain medications
• Causes: Traumatic brain injury, stroke, anoxia, intracranial surgery, acute CNS infections, electrolyte imbalance, drug intoxication
• Management:
  • Remain calm
  • Remove potential hazards from the area
  • Note the time the seizure begins
  • Protect head from injury, by placing a soft surface
  • Do not restrain the person
  • Do not put anything in the mouth
  • Stop bystanders from crowding near the person having a seizure -After the seizure has stopped, place the person in a recovery position -Call 997

Postictal Status

• Definition: Period after the seizure, characterized by altered consciousness, confusion, and various neurological symptoms.
• Duration: Can vary from minutes to hours, depending on the patient's overall health and the type of seizure.

Stroke

• Manifestations: Muscle weakness or paralysis, speech and vision problems, balance issues, confusion, headache, and loss of consciousness. Use the BEFAST mnemonic to assess for stroke.
• Management:
  • Call 997 immediately.
  • Reassure the patient.

Allergy-Related Emergencies

• Mild Allergic Reaction: Localized reaction (itching, hives, rash), often managed with oral antihistamines.
• Severe Allergic Reaction (Anaphylaxis): Life-threatening, requires rapid intervention with epinephrine (often via auto-injector like an EpiPen) — administer (0.3–0.5 mg).
  • Assess vitals, and blood glucose
  • Follow appropriate protocols for anaphylaxis
  • Call 997
• Common Allergen (Dental Clinics): Latex

Hypoglycemia

• Definition: Low blood sugar levels.
• Manifestations: Hunger, nausea, sweating, tachycardia, anxiety, diaphoresis decreased ventilation, and possible loss of consciousness, seizures, and coma.
• Management (Conscious Patient):
  • Assess vitals, and blood glucose.
  • Provide oral carbohydrates (orange juice, candy).
• Management (Unconscious Patient):
  • Assess vitals, and blood glucose.
  • CPR if necessary.
  • If IV access available, administer 25–50 mL of 50% dextrose.
  • If no IV access, administer 1 mg of glucagon IM via injection.
  • Call 997

Practice Questions (Examples)

• Question 1 (Latex Allergy): A patient develops hives and difficulty breathing during a dental procedure, what is appropriate first action? — Administer epinephrine as an injection, call 997
• Question 2 (Hypoglycemia): A patient experiencing dizziness and blurry vision — administer oral glucose

Summary

• Preparedness: Essential for all dental office staff in handling medical emergencies.
• Emergency Equipment: readily available and easy to use. Knowledge of equipment location essential.
• Communication: Accurate and immediate communication (including calling emergency services) is crucial.
• Procedures: Following protocols (e.g., administering epinephrine, positioning a patient, assessing vitals, administering appropriate treatment) is paramount to safety.