Medical Emergencies in the Dental Practice PDF

Medical Emergencies in the Dental Practice Dr. Muhammad Reihan, MD Associate professor Internal Medicine Department  Respiratory Distress Chest Pain Syncope Seizures Stroke Allergy-Related Emergencies Hypoglycemia Learning Objectives Knowledge & Und...

Medical Emergencies in the Dental Practice Dr. Muhammad Reihan, MD Associate professor Internal Medicine Department  Respiratory Distress Chest Pain Syncope Seizures Stroke Allergy-Related Emergencies Hypoglycemia Learning Objectives Knowledge & Understanding Discuss medical emergencies, and their clinical management as applied to dental practice.  Emergency Preparation How can you be prepared for emergencies? Be certified in basic life support (BLS) Know the location and proper use of emergency equipment Know your patient Use good patient management techniques React to possible emergencies promptly Team approach and training is vital Documented office emergency plan Emergency call list  Respiratory Distress Asthma: When airways narrow and swell and may produce extra mucus which makes breathing difficult.  Respiratory Distress Manifestations: Shortness of breath Wheezing Cough Chest tightness Anxiety Cyanosis  Respiratory Distress Management of asthma attack Terminate the procedure Position the patient upright Use a beta-2 agonist inhaler (albuterol, etc.) Give one puff at a time, if needed, give another puff every 60 seconds (maximum of ten puffs) Administer O2 Summon assistance Call 997  Chest Pain Acute Myocardial Infarction (MI) Occlusion of a coronary artery causing cessation of blood flow and death (necrosis) of heart muscle  Chest Pain Manifestations: Sudden onset of severe pain Crushing chest pain, may radiate to the jaw and/or left arm Sweating, weakness, restlessness Sense/look of impending doom Dyspnea Some classic signs are not observed “silent MI”, particularly in o women o diabetics  Chest Pain Management: Call 997 Chew 1 regular aspirin (325 mg) or 4 baby aspirin (4 x 81 mg) Monitor vitals Relieve pain (morphine, nitrous oxide) O2 (As needed for SpO2 > 92%) BLS if needed  Syncope Definition: An abrupt transient loss of consciousness with rapid and spontaneous recovery, which is thought to be caused by cerebral hypoperfusion Causes: Cardiac Neurological Vasovagal  Syncope Management: Stop the procedure Place in Trendelenburg position Cold washcloth on forehead for comfort Ammonia ampule for complete loss of consciousness Check vital sign Call 997  Seizure Definition: An excessive and/or hypersynchronous activity of cortical neurons that results in transient neurological symptoms  Seizure Seizure triggers: (stimuli that can precipitate seizures) Excessive physical exertion Alcohol consumption Fever (febrile seizures) Sleep deprivation Flashing lights (e.g., strobe lights, video games) Music Hormonal changes (e.g., at different phases of the menstrual cycle) Medication-related issues in patients with known epilepsy: e.g., o Poor adherence, o Recent changes in drug doses or formulation, o New medication interactions  Seizure Causes of acute symptomatic seizures Traumatic brain injury Stroke Anoxic encephalopathy Intracranial surgery Acute CNS infections (e.g., meningitis, encephalitis) Electrolyte imbalance (e.g., hypoglycemia, hypocalcemia) Acute metabolic disturbances (e.g., uremia) Alcohol withdrawal Recreational drug use Prescription drug toxicity  Seizure Management: Try to stay calm Look around (remove dangerous items) Note the time the seizure starts Cushion their head with something soft if they have collapsed to the ground Don't hold them down Don't put anything in their mouth Try to stop other people crowding around After the seizure stops put them in recovery position Call 997  Seizure Postictal status Refers to a specific condition that occurs after a seizure, characterized by a period of: o Altered consciousness o Confusion o Various neurological symptoms as the brain recovers from the seizure activity. The duration and intensity of postictal status can vary widely depending on factors such as the type of seizure and the individual's overall health. In some cases, it may last only a few minutes, while in others, it can persist for hours. It’s important for caregivers to provide support and ensure safety during this recovery period.  Stroke Manifestations: Muscle weakness/paralysis Speech/vision problems Loss of balance Confusion Headache Loss of consciousness Management Call 997 Reassure the patient  Allergy-Related Emergencies The most common allergen dental clinic is latex Mild allergic reaction: Itching, hives, rash Severe allergic reaction (anaphylaxis): Respiratory distress Cardiac compromise Could lead to coma and death  Allergy-Related Emergencies Mild allergic reaction: Can be managed by oral antihistamine Severe allergic reaction (anaphylaxis): Use EpiPen if available (inject in the thigh) Or administer epinephrine as soon as possible (0.3-0.5 mg IM) Call 997 CPR if needed  Hypoglycemia Manifestations: Hunger Nausea Sweating Tachycardia Anxiety Diaphoresis Decreased ventilation May progress to loss of consciousness, seizures, and/or coma  Hypoglycemia Management of the conscious patient: Assess vitals and blood glucose Give oral carbohydrates (orange juice, candy, dextrose gel) Unresponsive/unconscious patient: Assess vitals and blood glucose CPR as necessary If IV access, administer 25-50 mL of 50% dextrose If no IV access, administer 1 mg of glucagon IM Call 997  To Summarize Have emergency equipment readily available All office personnel should know where emergency equipment is located and how to use it Consider practice scenarios for emergency situations BLS Certification can save lives Always call 997  Practice questions A 16-year-old patient presents to clinic for routine dental check-up. After starting dental examination, the patient develops diffuse hives on his body. He states that he feels his throat closing, and he is having difficulty breathing. What is the best treatment for this patient’s condition? A. Administer epinephrine B. Administer norepinephrine C. Administer antihistamine D. Administer Oxygen via nasal cannula  Practice questions A 45-year-old diabetic man in the dental office develops nausea, sweating, tachycardia and blurry vision. His wife tells you he took his insulin but skipped lunch because he wanted his teeth clean for the dental appointment. What is the best agent to be administered for this patient’s condition? A. Oral glucose B. Intramuscular glucagon C. Intramuscular epinephrine D. Sublingual nitroglycerin  American Dental Association Royal College of Dental Surgeons of Onatrio Jevon, P. Medical emergencies in the dental practice poster: revised and updated. Br Dent J 229, 97–104 (2020). https://doi.org/10.1038/s41415-020-1789-y References & Further Reading Thank You