Medical Emergencies training for paramedical Staff of poly trauma unit

1. Medical Emergencies
Prof. Dr. Lokendra Sharma
Contributors
Dr. Kopal Sharma (Ph.D Scholars)
Dr. Deepshikha Yadav (Ph.D Scholars)
Mrs. Meenu Rani (Ph.D Scholars)

2.  A sudden, urgent, usually unexpected
occurrence or occasion requiring immediate
action.
 It could be life- threatening.

3. 1) Higher percentage : elderly patients
 Altered pharmacokinetics with physiological and
pathological changes associated with aging.
 Co morbid conditions like angina, CHF, MI or
asthma, which may aggravate during the
procedure.

4. 2) Medical Advances
 Dental clinics patients : stabilized on medical
gadgets like pacemakers, implanted defibrillators
or having stents in their coronaries.
 Organ transplanted like kidney, cardiac valves or
liver.

5. 3) Concomitant drug therapy
 Patients receiving analgesics, antianxiety,
antidepressants, antiplatelets, antidiabetic,
antihypertensive drugs.
 Alterative medicine like homeopathy, ayurvedic or
herbal supplements.
 Drug-drug interactions and side effects .

6. 4) Drug Abuse
 Premedicated himself with the abusing drug before
coming for dental therapy.
 Interact with the drugs prescribed by the dentist.

7. Take patient’s history –
 baseline history
 medications the patient is taking
 any past or current medical morbidity
 results of laboratory tests
 Any need for medical consultation
 Any allergic reaction history
 Vital parameters like BP, temperature and
respiratory rate.

8.  Syncope
 Angina
 MI
 Hypertension
 Hypotension
 Hypoglycaemia/hyperglycaemia
 Epilepsy
 Asthma
 Hyperventilation
 Haemorrhage
 Cerebrovascular accidents
 Allergic reactions

9.  Every dental clinic must contain an emergency kit,
which should contain drugs for critical emergency.
 Without prompt attention to ABCDs (airway,
breathing, circulation and defibrillation) of
cardiopulmonary resuscitation (CPR) drugs are
of little value.
 Dentist must know reflexively when, how and in
what doses these drugs are to be used in clinical
dentistry.

10.  Oxygen is indicated for every emergency except
hyper-ventilation.Steel cylinders with perfect
valves and masks should be available for use in all
medical emergencies in which hypoxaemia is
present.
 For spontaneous breathing through nasal cannula
or face mask its concentration should remain 25-
45% and 40-60% respectively.

11.  It is the most important drug for the management of
cardiovascular and respiratory complications of acute
allergic manifestations.
 Usual s.c. or i.m. dose is 0.5 ml of 1:1000 solution.
 It may also be instilled directly into the
tracheobronchial tree by an endotracheal tube with
good results.

12.  Important drug to treat anginal pain or to prevent
impending MI during dental procedure.
 Sublingual tablets or translingual spray should
remain available for emergency use.
 Usual dose of 0.4 mg sublingual tab immediately;
repeated twice at 5-10 min interval.
 Systolic blood pressures below 90 mmHg
contraindicate the use of this drug.

13.  Antidysrhythmic
Indicated for:
 Prophylaxis of VF and unstable VT refractory
to other therapy
Dose:300 mg i.v. over 1-2 sec. 540 mg
maintenance infusion over 18 hr
Contraindicated
Pulmonary congestion
 Cardiogenic shock
 hypotension

14.  Anticholinergic
Indications:
 Symptomatic bradycardia
 Asystole
 Bronchospastic disorders
Contraindication:
 Tachycardia
 Obstructive disease of GI tract
 Unstable cardiovascular status in the context
of cardiac ischemia and hemorrhage

15. Dose:
 Bradydysrhymia’s: 0.5-1.0mg 5 min to a max
of 0.03-0.04 mg/kg.
 Asystole: 1.0 mg IV or ETT(dilute to 10 ml)
0.1 mg/mI (Adult), 0.05 mg/mL (Pediatric)

16.  Loop Diuretic
Indications:
 Associated with CHF, hepatic or renaldisease
Contraindications:
 Anuria
 Hypovolemia/dehydration
 Electrolyte depletion
 Dose:20-40 mg slow IV (1-2min)

17.  Calcium channel blocker
Indications:
 PSVT
 A flutter with rapid response
 A fib with rapid response
 Vasospastic and unstable angina
 Chronic stable angina
Contraindications:
 2nd& 3rddegree AV block
 Hypotension/Cardiogenic shock
 Severe CHF

18.  Dose:2.5-5 mg IVP over 1-2 minutes
 Repeat 5-10 mg 15-30 mins after initial dose
Max dose 30mg

19.  Benzodiazepine sedative
 hypnotic,anticonvulsant
Indications:
 Acute anxiety states/alcohol withdrawal
 Skeletal muscle relaxation
 Seizure activity
 Premedication prior to cardioversion
Contraindications
 in coma (unless there is seizure activity)
 CNS depression as a result of head injury
 Shock

20.  Dose:
Seizure activity:
 Adult: 5-10 mg IV q 10-15 min (maximum
dose30 mg)Pediatric: 0.2-0.3 mg/kg/dose
IV(< = 1 mg/min) q 2-5 min (maximum total
dose10 mg)
 Amnesia for cardioversion
 Adult: 5-15 mg IV, 5-10 min before procedure

21.  Opiod antagonist
Indications:
 Narcotic
 Coma unknown origin
Contraindications:
 Use with caution in addicted pts
may precipitate violent withdrawal issues.
 Dose:0.4-2mg IV, IM or ETT (dilute)

22.  Opiod analgesic
Indications:
Chest pain associated with MI
Pulmonary edema .
Moderate to severe acute or chronic pain
Contraindications:
 Head injury or undiagnosed abdom. Pain
 Increased ICP
 Severe respiratory depression

23.  Naturally occuring hormone (ADH)
Indications:
 May be used as an alternate vasopressor in
cardiac arrest
 May be useful in hemodynamic supportof
dilatory shock
Contraindications:
Not recommended for responsive pts withCAD
Dose:40 U IV push- one dose only ( about
10min)

24.  Cardiac Glycoside
Indications:
 SVT
 CHF
 Cardiogenic shock
Contraindications:
 VF/FT
 AV Block
 Dig toxicity

25.  Usually β2 agonist like salbutamol as aerosol is
more preferred.
 Provides fast relief in bronchospasm and has fewer
cardiovascular and CNS side effects.

26.  Used to manage hypoglycaemic episodes.
 Alternatively orange juice, chocolate bar or cola
drink can also be used.
 For an unconscious patient, 50% dextrose solution
can be infused IV.

27.  Analgesic, anti-inflammatory, antiplatelet
Indications
 AMI: Decrease MI risk dramatically when administered
as dispersible or chewable tablet to patients during
procedure
 Dose:160-325 mg .

28.  They are not critical emergency drugs.
 These are useful in conditions with which the
dentist is familiar but the immediate medical
services are not available.
Anticonvulsants
 Management of seizures of any origin
(hypoglycaemia, epilepsy, or local anesthetic
overdose) require slow IV administration of
diazepam or midazolam.

29. Glucocorticoids
 Hydrocortisone sodium succinate or prednisolone
are useful to halt the progression of acute
anaphylactoid reaction.
 An initial syncopal attack sometimes is a
consequence of more serious adrenal insufficiency
in a patient taking long-term corticosteroids.
 For this life threatening emergency, IV infusion of
glucocorticoids is needed.

30.  H1 antagonist like diphenhydramine is used as an
adjunct to epinephrine and glucocorticoid in
managing allergic reactions

31.  They are called “general arousal agents” during
syncopal attacks.
 E.g. spirit ammonia aromaticus.
 Its pungent action stimulates respiratory and
vasomotor centre of medulla.

32.  They are used to stop bleeding resulting from
dental procedures.
-Fibrin sealants
-Gelatin foams soaked with fibrin
-Cotton gauze soaked with Epinephrine