Lecture 7: Dental Emergencies - Obstructed Airway - PDF

DH 410 EMERGENCIES IN DENTAL PRACTICE LECTURE 7: OBSTRUCTED AIRWAY, ASPIRATION, OR INGESTION, OF A FOREIGN OBJECT Objectives  Discuss and understand etiology of obstructed airway in the dental office  Recognize the signs and symptoms associated with obstructed airway,...

DH 410 EMERGENCIES IN DENTAL PRACTICE LECTURE 7: OBSTRUCTED AIRWAY, ASPIRATION, OR INGESTION, OF A FOREIGN OBJECT Objectives  Discuss and understand etiology of obstructed airway in the dental office  Recognize the signs and symptoms associated with obstructed airway, and foreign body aspiration  Determine emergency treatment modalities for obstructed airway and foreign body aspiration Ingestion of Foreign Object  Aspiration  Accidental inhalation of food, fluid, or foreign objects into the lung  Most commonly the right lung  Airway obstruction  Accidental swallowing of an object that gets lodged in the upper airway and inhibits or blocks breathing Introduction  Most common:  Food Grapes, Hot dogs, popcorn (children)  Dental appliances  Obstructed airways or aspiration likely, due to:  Small size of objects being placed in mouth  Patients in supine position Aspiration of Foreign Object  Types of dental objects aspirated:  Teeth (primary and secondary)  Dental impression material  Orthodontic retainers, wires, brackets  Fixed prosthetics (crown, bridge)  Removable prosthetics (small partial dentures)  Implants, Implant screwdriver  Anesthetic needles, endodontic files  Gauze, cotton rolls, cotton pellets  Ultrasonic scaler tips  Broken instrument tips Ingestion of Foreign Object  Aspiration or ingestion often associated with children  Tend to place small objects in their mouth  600 U.S. children die each year due to aspiration (Clinical Pediatrics 2020)  Who?  Geriatrics (decreased gag reflex, neurolgic disorders, etc.)  Psych (abnormal thinking and perceptions)  Alcohol/drug abusers (syncope, delirium)  Intellectual/developmental disabilities  Hyperactive individuals  Individuals with an excessive gag reflex  Patients under sedation (medical procedures) Ingestion of Foreign Object  90% pass through GI tract  Excreted within 2-12 days  10% cause impaction, abscesses, or perforation of GI tract  Most incidences occur in a supine or sem isupine position  Dentistry https://www.semanticscholar.org/paper/Aspiration-of-Broken-Portion-of-a-Dental- Clamp%3A-An-Ahmeto%C4%9Flu-Evcil/29863335a76b535a439b44a27de4c40230fc66cb An X-ray reveals a dental implant screwdriver swallowed by a patient. American Dental Association Figure Posteroanterior chest radiograph shows a densely radiopaque foreign body located in the left mainstem bronchus (panel A). Rigid bronchoscopy allowed removal of the foreign body, confirmed to be an 8 cm long metal air-water dental syringe tip (panel B) that had been aspirated earlier in the day during a dental procedure Can J Anesth/J Can Anesth (2019) 66:111–112 https://doi.org/10.1007/s12630-018-1158-3 Aspiration of Foreign Object  Object enters lung and GI tracts  Can be very serious  Can cause infection  Can cause death  Removal imperative  Prevention  Prevention Techniques  Rubber dam – BEST OPTION  Floss (quick retrieval)  Other isolation options Isolite  Additional illumination  NEVER leave patient unattended with objects/items in mouth!!  Signs and Symptoms of PARTIALLY Obstructed Airway  Coughing (forceful)  Ability to breath  Wheezing between coughs  Hands around throat (universal sign for choking)  Fearful (panic)  Cyanosis Emergency Management – PARTIALLY Obstructed Airway  Turn patient on their side and leaned into a head-down position, head hanging over chair  Trendelenburg  Encourage coughing until object expelled  Back blows no longer recommended  When object is expelled, patient needs to be upright or standing  If patient ceases coughing and cannot speak treat for complete airway obstruction  Signs and Symptoms of COMPLETELY Obstructed Airway  Distress  Grip throat (universal sign for choking)  Unable to speak, cough, or breathe  Panic  Eventual loss of consciousness  very poor air exchange (crowing or stridor) Partialobstruction Treat as a complete airway obstruction Emergency Management – COMPLETELY Obstructed Airway  If CONCSIOUS  Good airway exchange: Do not interfere Allow victim's own efforts to remove object Monitor condition Emergency Management – COMPLETELY Obstructed Airway  If CONCSIOUS  Poor airway exchange: Heimlich maneuver Until object expelled or consciousness lost  Obtain consent Askthe patient is they are choking Nod “yes”, proceed Emergency Management – COMPLETELY Obstructed Airway  If UNCONSCIOUS  Patient supine (hard surface, floor)  Contact EMS (9-1-1 or WLAC Sheriff)  Retrieve AED  Begin BLS Check for pulse & breathing (C) Chest compressions 30 (A) Check for object (B) Breathing 30:2 Emergency Management – COMPLETELY Obstructed Airway WLAC Sheriff # 310 – 287 – 4314 Emergency Management – COMPLETELY Obstructed Airway  Everyone MUST be BLS certified to treat patients in the dental hygiene program Emergency Management – COMPLETELY Obstructed Airway  DEPTH: 2 inches  RATE: 100-120 per minute  2 MINUTES Aspiration  Object enters into the lung  Can be very serious  Needs to be removed to avoid infection & possibly death Signs and Symptoms of Airway ASPIRATION  Range from non-existent to severe dyspnea (labored breathing)  Dependent upon location in airway Signs and Symptoms of Airway ASPIRATION  Immediately following aspiration may present with: – Dyspnea – Decreased breath – Hoarseness (difficulty sounds or unable to speak) – Stupor (lethargic) – Wheezing – Excessive sputum – Coughing production – Cyanosis – Possibly suffocation Signs and Symptoms of Airway ASPIRATION  Usually present to ER 1 week after aspiration with symptoms:  Fever  Sounds when  Pain in chest or breathing or lungs coughing  Tachypnea (rapid  Weight loss breathing)  Death can result if  Loss of strength left untreated Treatment of ASPIRATED Object  Contact EMS  If difficulty breathing  Requires chest radiograph  If located on radiograph, bronchoscopy will likely be performed to remove object  If left untreated, it can cause inflammation, infection, ulceration, granulation tissue formation  Possible death References Malamed, S. F. (2022). Medical emergencies in the dental office. Elsevier. Little, J. W., Miller, C., & Rhodus, N. L. (2017). Little and Falace’s dental management of the medically compromised patient. Mosby. Grimes, E. B. (2014). Medical emergencies: Essentials for the Dental Professional. Prentice Hall