CPR Course
Introduction
Prevention of Medical Complications
During Dental
Treatment
Dr. Adel I. Abdelhady
BDS, Msc, (Tanta...
Student Assessment
Continuous Assessment (quiz 30%
+ Attendance)
Midterm Exam
25%
Final Written Exam.

45%
Requirement for passing the course
EVERY STUDENT ERGENTLY HAVE TO
SUBMET A DOCUOMENTRY PROOF
FOR ATTENDANCE OF BASIC LIFE
...
Life Threatening Emergencies
(L.T.E.)
LTE can and do occur in the practice of dentistry. This
can happen to the patient to...
Morbidity
In spite of most meticulous protocols designed
to prevent the development of life threatening
situations, emerge...
The type of dental care being administered more
than 65% of cases developed during two types
of dental care tooth extracti...
Death
Most emergency situations that occur in
dental practice potentially can threaten the
patient’s life. However, only i...
Pre-Treatment Evaluations
Adequate pretreatment evaluation combined
with pain and anxiety control can help to prevent
many...
Risk Factors
1-Increased Number of Older Patients
Many older patients appear to be in good health in practitioner must
alw...
Prevention
 According to McCarthy a complete system

of physical evaluation for all prospective
dental patients can preve...
Evaluation Goals
1-Determine the patient’s ability to physically tolerate the
stress involved in the planned treatment
2-D...
Physical Evaluation
Physical evaluation describes the steps
involved in the fulfillment of the goals
Medical history quest...
Physical Examination
Heart failure
Heart disease or attack
Angina pectoris
High blood pressure
Heart murmur
Rheumatic feve...
Physical Examination
Aids
Diabetes
Radiotherapy
Chemotherapy
Hemophilia
Epilepsy
Fainting or dizzy

Nervousness
Psychiatri...
Clinical Examination
Vital Signs
Blood pressure
Heart rate (pulse) and rhythm
Respiratory rate
Temperature
Height
Weight
PATIENT’S CLASSIFICATION
According to AHA
ASA I
Healthy, normal patient
Physiologically able to tolerate the stress
Without psychological problems
No treatment modi...
ASA II
Mild systemic disease
Can perform normal activity without
experiencing distress
Healthy patient with more extreme a...
ASA III
Severe systemic disease
Limited activity but not incapacitated
Need stress reduction method during dental
treatmen...
ASA IV
Has an incapacitating disease that is life
threatening
Patient is in distress at rest
No elective dental therapy
Em...
ASA V
Moribund patient - not expected to live 24
hours with or without operation
Guideline for blood pressure in adult
Blood pressure
(mm hg)

ASA
classification

Dental Therapy
Considerations

> 140 and...
Medical emergencies commonly
provoked by anxiety in dental unit
•
•
•
•
•
•
•
•
•
•

Fainting/ syncope
Angina pectoris
Myo...
Prior to Treatment
 Complete review of medical status


(including vital signs)

 Anxiety / Fear should be assessed and...
Prevention and management of
medical emergencies
 Prevention
 Preparation
Personal continuing education in emergency
rec...
Church of Selva Di Cadore, Colle Santa Lucia
Patient Evaluation
Enables one to accurately assess the
potential risk presented by a patient, prior
to the start of treat...
Goals of Physical Examination
To determine patient's ability to physically
tolerate the dental treatment
To determine pati...
Goals of Physical Examination
To determine whether treatment
modifications are required
To seek medical consultation if in...
Routine Pre-operative
Monitoring
Blood pressure - BP
Heart rate / rhythm - P
Respiratory rate - R
Respiration
 Monitor respiratory rate
 Observe movement of chest wall
Recognition of Anxiety
History
Observation
Moderate Anxiety
Usually try to hide their fears
Cold and sweaty palms
Nervous appearance
Severe Anxiety
Usually does not hide their fear
Appears with severe infection or toothache
Increased heart rate and blood ...
Medical History Questionnaire
 1. Are you having pain or discomfort

at this time?
 2. Do you feel nervous about having
...
Systemic Problems
 Heart failure
 Heart disease or attack
 Angina pectoris
 High blood pressure
Systemic Problems
 Dysrhythmia
 Congenital heart lesions
 Rheumatic fever / Scarlet fever
 Pacemaker
Systemic Problems
 Renal disease
 Stroke
 Ulcers
 Emphysema
Systemic Problems
 Tuberculosis
 Asthma
 COPD
 Hay fever
Systemic Problems
 Sinus trouble
 Diabetes
 Thyroid disease
 Chemotherapy or Radiation therapy
Cpr introduction and prevention
Cpr introduction and prevention
Cpr introduction and prevention
Cpr introduction and prevention
Cpr introduction and prevention
Cpr introduction and prevention
Cpr introduction and prevention
Cpr introduction and prevention
Cpr introduction and prevention
Cpr introduction and prevention
Cpr introduction and prevention
Cpr introduction and prevention
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Cpr introduction and prevention

  1. 1. CPR Course Introduction Prevention of Medical Complications During Dental Treatment Dr. Adel I. Abdelhady BDS, Msc, (Tanta,EG.), Phd (EG.USA) Oral and maxillofacial surgery dept. College of dentistry, King Faisal university, KSA
  2. 2. Student Assessment Continuous Assessment (quiz 30% + Attendance) Midterm Exam 25% Final Written Exam. 45%
  3. 3. Requirement for passing the course EVERY STUDENT ERGENTLY HAVE TO SUBMET A DOCUOMENTRY PROOF FOR ATTENDANCE OF BASIC LIFE SUPPORT (BLS) THIS IS MANDATORY PRIOR ENTRY TO THE FINAL EXAM.
  4. 4. Life Threatening Emergencies (L.T.E.) LTE can and do occur in the practice of dentistry. This can happen to the patient to the Dr., office staff, or to a person accompanying the patient Factors leading to increasing number of patients complaining of LTE in dental office: 1-The increasing number older persons 2-The therapeutic advances in the medical profession 3-Growing trend toward longer dental appointments 4-The increasing use of administration drug s in dentistry
  5. 5. Morbidity In spite of most meticulous protocols designed to prevent the development of life threatening situations, emergencies still occur. Sudden unexpected death can happen of young, well-conditioned athletes. Overwhelming majority of situations involve a lot a medical emergencies starting from syncope (fainting, benign be aware of word benign might be lead to catastrophe if not properly managed) to acute MI and cerebrovascular accident …… Most situations occur either during treatment ,or in waiting area.
  6. 6. The type of dental care being administered more than 65% of cases developed during two types of dental care tooth extraction 39% and pulp extirpation 27% . The sudden unexpected pain triggered release the endogenous of catecholamine, which in turn added to the creation of an emergency, thus proper and adequate pain control in safe dental care cannot be overstated
  7. 7. Death Most emergency situations that occur in dental practice potentially can threaten the patient’s life. However, only in rare occasions does a patient actually die in a dental office. Patient has heart attack, Dies; Dentist also Stricken Three deaths from appliance aspiration Failure to properly recognize and treat clinical signs and symptoms can turn innocuous situation into an office tragedy.
  8. 8. Pre-Treatment Evaluations Adequate pretreatment evaluation combined with pain and anxiety control can help to prevent many emergencies and deaths Unfortunately, the most stringent precautions cannot prevent the occurrence of death. The usual cause of death is lethal cardiac dysrhythmia, most often ventricular fibrillations preventive measure cannot entirely eliminate this events
  9. 9. Risk Factors 1-Increased Number of Older Patients Many older patients appear to be in good health in practitioner must always lookout of subclinical diseases( cardiovascular, renal, pulmonary, endocrine and CNS) must be monitored in older patients 2-Medical advances With age, the incidence of disease rises, diabetic and cardiovascular disease significantly have long life expectance today than they did 20 or 30 years ago 3-Longer Appointments stressful and create more hazard to the patient 4-Increased drug used LA, Antibiotics can be lethal when interact with other drugs received by patient the dentist have to be cautious Goldberger Wrote ‘ WHEN YOU PREPARE FOR AN EMERGENCY, THE EMERGENCY CEASES TO EXIST’
  10. 10. Prevention  According to McCarthy a complete system of physical evaluation for all prospective dental patients can prevent approximately 90% of life threatening situations
  11. 11. Evaluation Goals 1-Determine the patient’s ability to physically tolerate the stress involved in the planned treatment 2-Determine the patient’s ability to psycologically tolerate the stress involved in the planned treatment 3-Determine whether treatment modifications are required to enable the patient to better tolerate the stress of the planned treatment 4-Determine whether the use of psycho-sedation is warranted, and which sedation technique is most appropriate and the contraindications if exist to any drug to be used in the planned treatment
  12. 12. Physical Evaluation Physical evaluation describes the steps involved in the fulfillment of the goals Medical history questionnaire
  13. 13. Physical Examination Heart failure Heart disease or attack Angina pectoris High blood pressure Heart murmur Rheumatic fever Congenital heart disease Asthma Sinus trouble Allergies Prosthetic heart valve Heart pacemaker Implant defibrillator Heart surgery Prosthetic joint repl. Anemia Stroke Kidney dysfunction Emphysema TB
  14. 14. Physical Examination Aids Diabetes Radiotherapy Chemotherapy Hemophilia Epilepsy Fainting or dizzy Nervousness Psychiatric treatment Sickle cell disease Bruise easily Do you loss weight Are you a pregnant
  15. 15. Clinical Examination Vital Signs Blood pressure Heart rate (pulse) and rhythm Respiratory rate Temperature Height Weight
  16. 16. PATIENT’S CLASSIFICATION According to AHA
  17. 17. ASA I Healthy, normal patient Physiologically able to tolerate the stress Without psychological problems No treatment modifications are indicated
  18. 18. ASA II Mild systemic disease Can perform normal activity without experiencing distress Healthy patient with more extreme anxiety May need modification in treatment
  19. 19. ASA III Severe systemic disease Limited activity but not incapacitated Need stress reduction method during dental treatment May need to alter treatment
  20. 20. ASA IV Has an incapacitating disease that is life threatening Patient is in distress at rest No elective dental therapy Emergency treatment should be in hospital setting
  21. 21. ASA V Moribund patient - not expected to live 24 hours with or without operation
  22. 22. Guideline for blood pressure in adult Blood pressure (mm hg) ASA classification Dental Therapy Considerations > 140 and > 90 ASA I Observe, routine treat. 140-159 or 90-94 ASA II Recheck Bp , medical consultation, MC implement stress red. protocol 160-199 or 95-114 ASA III Recheck every 5 minutes,MC, stress reduction protocol < 200 and/ or <115 Recheck every 5 minutes,MC, stress reduction protocol emergency treatment ASA IV
  23. 23. Medical emergencies commonly provoked by anxiety in dental unit • • • • • • • • • • Fainting/ syncope Angina pectoris Myocardial infarction Asthmatic bronchospasm Adrenal insufficiency (acute) Severe hypertension Thyroid storm Insulin shock Hyperventilation Epilepsy
  24. 24. Prior to Treatment  Complete review of medical status  (including vital signs)  Anxiety / Fear should be assessed and managed before administering anesthetic
  25. 25. Prevention and management of medical emergencies  Prevention  Preparation Personal continuing education in emergency recognition and management Auxiliary staff education in emergency recognition and management Establishment and periodic testing of readily access medical assistance. Equipping office with supplies necessary for emergency care.
  26. 26. Church of Selva Di Cadore, Colle Santa Lucia
  27. 27. Patient Evaluation Enables one to accurately assess the potential risk presented by a patient, prior to the start of treatment
  28. 28. Goals of Physical Examination To determine patient's ability to physically tolerate the dental treatment To determine patient's ability to psychologically tolerate the dental treatment
  29. 29. Goals of Physical Examination To determine whether treatment modifications are required To seek medical consultation if indicated
  30. 30. Routine Pre-operative Monitoring Blood pressure - BP Heart rate / rhythm - P Respiratory rate - R
  31. 31. Respiration  Monitor respiratory rate  Observe movement of chest wall
  32. 32. Recognition of Anxiety History Observation
  33. 33. Moderate Anxiety Usually try to hide their fears Cold and sweaty palms Nervous appearance
  34. 34. Severe Anxiety Usually does not hide their fear Appears with severe infection or toothache Increased heart rate and blood pressure Excessive sweating, trembling Dilated pupils
  35. 35. Medical History Questionnaire  1. Are you having pain or discomfort at this time?  2. Do you feel nervous about having dentistry?  3. Have you ever had a bad experience in the dental office?
  36. 36. Systemic Problems  Heart failure  Heart disease or attack  Angina pectoris  High blood pressure
  37. 37. Systemic Problems  Dysrhythmia  Congenital heart lesions  Rheumatic fever / Scarlet fever  Pacemaker
  38. 38. Systemic Problems  Renal disease  Stroke  Ulcers  Emphysema
  39. 39. Systemic Problems  Tuberculosis  Asthma  COPD  Hay fever
  40. 40. Systemic Problems  Sinus trouble  Diabetes  Thyroid disease  Chemotherapy or Radiation therapy

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