Most common emergencies encountered in a dental office

1. MEDICAL EMERGENCIES IN
DENTAL OFFICE
By-Sai Lakshmi Rao
III BDS
Geetanjali Dental & Research Institute, Udr

2. CONTENTS
 Introduction
 Types of Emergencies
* Prevention
* Preparation
* Management
 Summary
 Conclusion
 Reference

3. INTRODUCTION
◘ What is anemergency?
 A serious and unexpected situation requiring an
immediate action.
 It is an unforeseen combination of circumstances or the
resulting state thatcallsfor an immediate action.

4. TYPES OF EMERGENCIES
 UNCONSIOUSNESS
• Syncope
• Hypotension
• Hypoglycemia
 SEIZURES
 RESPIRATORY EMERGENCIES
• Airway obstruction
• Asthma

5.  CARDIOVASCULAR EMERGENCIES
• Angina pectoris
• Myocardial infarction
 DRUG-RELATED EMERGENCIES
• Overdose reactions
• Allergies

6. Most
common
Emergencies
Syncope
Seizure
Trauma
Asthmatic
attack
Chest
pain
Drug
toxicity
Airway
obstruction
Allergies
Hypoglycemia

7. SYNCOPE
• Syncope is a short loss of consciousness andmuscle strength,
characterized by a fast onset, short duration, and spontaneous
recovery.

8. Causes
H  Hypoxia / Hypoglycemia
E  Epilepsy
A  Anxiety
D  Disordersof brain stem
H  Heart attack
E  Embolism
A  Aortic stenosis
R  Arrhythmias
T  Tachycardia
CNS causes
CVS causes

9. V Vasovagal causes( common faint)
E  Electrolyte abnormalities (ex. hypercalcemia)
S  Situational(cough, sneeze, micturation)
S  Subclaviansteal syndrome
E  ENTcauses (glossopharyngeal neuralgia)
L Low systemic vascular resistance
S  Sensitive carotid sinus
Vascular and other causes

10. Symptoms
 Breathing – irregular, jerky & gasping
 Dilated pupils
 Convulsive movements
 Bradycardia (<50 beats per minute)
 Weak thready pulse
 Loss of consciousness
 Partial or complete airway obstruction

11. Management
 Position: supine position with brain and heart at same level with feet elevated
slightly (10 – 15 degrees).
 ABC: basic life support as needed.
 Definitive management: -monitor vital signs
-administer aromatic ammonia
-administration of atropine(0.1g/ml)

12. SEIZURE
• It is a paroxysmal disorder of cerebral function
characterized by an attack,involving changes in the
state of consciousness, motor activityor sensory
phenomena.
• Usuallysudden inonset and of brief duration.
• EPILEPSY: “A chronicdisorder in which nerve cell
activity in the brain is disturbed, causingseizures”.

13. Common symptoms of seizures

14. PREVENTION
 If a patient is known epileptic, make sure he/she has takentheir
regular dose of anti-convulsanton the day of treatment.
 Instruct him/her to alert you as the aura of the impending seizure
manifests itself.
 Keep life support equipments ready, in case of anemergency status
epilepticus.

16. MANAGEMENT
 Self limitingemergency
 Position: supinewith patientplaced on flatsurfaces.
 Remove dangerous objects from the mouthand around the patient.(ex.
sharp instruments, needles, etc.)
 Loosen any tight clothing.
 Avoid restraining thepatient.
 In case the ictusfails to subside withina maximum of 10 minutes,
declare statusepilepticus and proceed withdefinitive care.

17. DEFINITIVE TREATMENT
 Diazepam– 10 mg i.v. , (2mg/min) repeat every 10 minutes.
 Phenobarbitone– 100-200 mg/min,i.v.
 Carbamazepine
 Phenytoin

18. HYPOGLYCEMIA
• Hypoglycemia is a clinical syndrome in which low serum (or plasma)
glucose levels lead to symptoms of sympatho-adrenal activation.
Empty stomach/
Morning insulin
Low blood glucose
level
(<50mg/100ml)
Anxious
disposition
Weakness/
dizziness, pale skin,
depressed
respiration
Loss of
consciousness/
syncope

19. Common symptoms

20. MANAGEMENT
 Glucose andsugar-containingbeveragesadministeredorally to
conscious patientsforrapid effect.
 Alternatively,milkcandy bars, fruit,cheese,etcmaybe adequate
in mildcases.
 IV dextroseisindicatedforsevere hypoglycemia,in patientswith
alteredconsciousness and during any restriction oforal intake.

21. TREATMENT
 20-25 ml of 50% dextrose should begiven immediately.
 Glucagon, 1mg i.m. (or s.c.)
 Metformin
 Sulfonylureas

22. RESPIRATORY EMERGENCIES

23. Airway obstruction
◘ May occur due to:
o Pathology on theairway
o Dental instruments
o Tongue
◘ Patientdemonstrates symptoms ranging from coughing,
gurgling, gagging, to choking & gasping with pain.
◘ Aspired object may pass into the trachea or oesophagus.

25. PREVENTION
 Rubberdam
 Oral packing
 Chair position
 Dentalassistant
 Magill’sintubation
forceps

26. MANAGEMENT
◘ Re-establishment of airway:
Non-invasive procedures
 Forceful coughing
 Backblows
 Heimlich maneuver
 Chest thrust
 Finger sweeps

27. HYPERVENTILATION
• Excessiverate and depth of respiration leading to abnormal loss of
carbon dioxide from the blood primarily predisposed tostress and
anxiety.
• Characterized by:
 Rapid short strained breaths
 Cold sweats
 Palpitations
 Dizziness
 Chest muscle fatigue

28. PREVENTION
Exhaledair isinhaled-inagainusinga
paper bag.
Thepointofbreathingintoa bagisto“re-
breathe”yourexhaledCO2 tobringthe
bodybacktoa normalstate.
 Reducepatient’sstressand
anxiousnessbyanymeans.
Theoperatorshouldstaycalmandalso
make thepatientberelaxed.

29. MANAGEMENT
 Administration of Benzodiazepenes:
-Diazepam (2-5 mg i.m./i.v. every 3-4 hourly)
-Lorazepam (2-3 mg oral per day, BD/TD)
-Triazolam (0.25 – 0.5 mg)
-Alprazolam (0.25 – 0.5 mg oral TD)

30. ASTHMA
• A clinicalstate of hyper reactivity of the tracheobronchial tree,
characterized by recurrent paroxysms of dyspnea and wheezing.

31. MANAGEMENT
Position pt upright or bending forwards with arms straight ahead
Administer bronchodilators
Asthma terminates?
Yes No
Continue
dental
procedure
Declare status asthmaticus
Summon EMS
Recognize symptoms
Stop dental procedure

32. CARDIOVASCULAR EMERGENCIES

33. Myocardial infarction
• It is a clinicalsyndrome caused by deficient
coronary arterial blood supply resulting in
ischemia toa region of the myocardium and
causingcellular death and necrosis.
• Predisposing factors:
- atherosclerosis, coronary artery disease
- coronary thrombosis, occlusion and spasm
- undue stress

34. PREVENTION
 Avoid overstressing the patient
 Supplemental oxygen during the treatment
 Pain control during therapy (appropriate use of local anesthesia)
 Psychosedation
 Elective dental care is avoided until atleast 6 months after MI
 IA and PSA nerve blocks should be avoided due to high risk of
hemorrhage.

35. MANAGEMENT
 Antiplatelet agents
-Clopidogrel (75 mg oral OD)
-Ticlopidine (250 mg PO q12 hrs)
Dipyridamole (75-100 mg oral TD)
 Beta-blockers
-Propranolol(40 mg oral TD)
-Metoprolol (100 mg oral BD)
-Atenolol (50 mg oral BD or 100 mg oral OD)

36. Angina pectoris
• A condition marked by severe pain in the chest, often also spreading to
the shoulders, arms, and neck, owing to an inadequate blood supply to
the heart.
• Types:
- Stable
- Variant
- Unstable

37. PREVENTION
 Stress reduction
 Reassurance
 Psychosedation

38. MANAGEMENT
 Recognize the problem
 Discontinue dental treatment
 Activate office emergency team
 Position patient upright comfortably
 Assess and perform BLS
 Definitive management
 Use Beta-blockers

39. Drug-related
emergencies

40. Overdose reactions
• An overdose is when a person ingests or takesin more than normal of
recommended or prescribed amount of drug. It can be accidental or
intentional.
• In a dental practice, most common overdosage is by local anesthesia.

41. SYMPTOMS
 Confusion, talkativeness,blurred speech
 Musculartwitching, facialtremor
 Headache, tinnitus
 Drowsiness, disorientation
 Elevated BP, HR, RR
 If uncontrolled, generalized tonic clonic seizures, generalized CNS
carbopathy

42. MANAGEMENT
 Administer BLS as needed
 100% oxygen, anticonvulsants
 Allow recovery to occur
 In case of continuationof symptoms, summonEMS

43. allergy
• It is a hypersensitive state of skinand various mucosae acquired
through the exposure to a particular allergen, re-exposure to which
produces a heightened emergent capacity to react.
• Occurring via expression of IgE in response to allergen exposure.

44. Symptoms
 Red, itchy, watery eyes
 Sneezing, congestion, runny nose
 Itchy or sore throat, postnasal drip, cough

45. MANAGEMENT
 Reassure the patient
 Initiate the BLS as needed
 Administer antihistaminics(diphenhydramine 50mg),
epinephrine 0.123-0.3 ml of 1:1000 i.m. or s.c.
 Monitor vitals regularly

46. CONCLUSION
As the saying goes, “PREVENTION IS BETTERTHAN CURE”.
 ALWAYS BEPREPARED.
 Prompt recognition and efficient management of medical emergencies by a
well-prepared dental team that canincrease the likelihood of a safe & a
satisfactoryoutcome.
 Basiclife support training – A MUST.

47. REFERENCES
Stanley F. Malamed, Handbook of Local Anesthesia, 6th edition
James R. Hupp, Contemporary Oral and MaxillofacialSurgery, 6th
edition