CPR Forth Year

1. MEDICAL EMERGENCIES IN THE DENTAL OFFICE
Cardiopulmonary Resuscitation course

2. CPR COURSE CONTENTS
 INTRODUCTION AND PREVENTION OF MEDICAL
EMERGENCIES
 PREPARATION AND LEGAL CONSIDERATIONS
Dr Nallan Chytanya
Lecturer in Oral Medicine
Department of Biomedical Dental Sciences
College of Dental Sciences

3. CPR course
Assessment pattern:
 Continuous assessment ( Attendance, BLS certificate
and Quiz)
= 25 %
 Mid term exam
= 25 %
 Final exam
= 40 %
 OSCE
= 10 %

4. Requirement for passing the course!
EVERY STUDENT HAVE TO SUBMET A
DOCUMENTRY PROOF FOR ATTENDANCE OF
BASIC LIFE SUPPORT (BLS CERTFICATE)
THIS IS MANDATORY PRIOR ENTRY TO THE
FINAL EXAM.

5. 
MEDICAL EMERGENCIES CAN OCCUR IN DENTISTRY.

(LIFE THREATENING EMERGENCIES) INFREQUENT BUT
LIKELIHOOD DUE TO:
- Increasing geriatric patients
- Advances in medicine
- Long dental appointments
- Increased drug usage in dentistry
MORBIDITY:
-
Most common- Syncope > Allergic reaction > Cardiac
-
Even with most meticulous protocols emergencies still occur

6. -
Occur in both old & young
-
Stress in dental office – Pain, Fear & Anxiety, preexisting
conditions
-
Stress reduction protocols.
-
Drug related adverse effects add up – Local anesthesia, Drug
overdose and Allergy.
-
Pain---Release of Catecholamine- Triggering of Emergencies.
-
65% of cases developed during two types of dental care-- 39% in
tooth extraction and pulp extirpation (27%) .

7. Death :
 Deaths can occur in the dental office ( Patient, Doctor or Accompany)
 Again due to stress or drug overdose.
 Failure to recognize the symptoms can lead to deaths. With CPR 75%
survived. Most reported deaths- cardiac dys-arrythmias
 Unexpected accidental death inspite of preparedness
 Successful outcome- act quickly and recognize, manage effectively
 Stress – delayed deaths too.

8. Risk factors:
 Increased Elderly patients = greater risk for accidents
 Good health, may be subclinical disease. Evaluate all major
systems. CVS must.
 Age involves physiologic and pathologic –alter pt’s ability to
adapt to stress.
 Changes in renal function, drug usage
 Changes in lung elasticity

9. - Medical advances:
- Incidence of diabetes, CVS diseases- with long life expectancy.
-
Advanced effective, drug therapy and surgical techniques.
-
Challenge from these drug controlled patients.
-
Longer appointments:
-
Increased length of treatment. 1-3 hrs.---stressful
-
Increased drug usage:
-
For pain, fear and infection.
-
Drug adverse effects and interactions

10. Classification of emergencies
Systems- oriented classification:
 Infectious diseases: - immune system
Allergy, angioneurotic edema, contact dermatitis,
anaphylaxis
 Skin and appendages
 Eyes, nose and throat
 Respiratory system
Asthma, hyperventilation
 CVS
Arteriosclerosis, angina, MI, Heart failure
 Blood
 GI and liver

11. Classification of emergencies

Blood

GI and liver

Obstetrics

Nerves system
Unconsciousness
Vaso depressor syncope, hypotension
Convulsive disodres
Drug overdose
CVS
- Endocrine disorders:
- Diabetes- hyperglycemia . Hypoglycemia,
- Thyroid disorders- Hyper and Hypo
- Adrenal gland insufficiency

12. Common Emergencies in dental office:
 Unconsciousness: - Vaso Depressor syncope, Hypotension, Acute
Adrenal insufficiency
 Respiratory distress:- Airway obstruction, Hyperventilation,
Asthma, Heart failure and Pulmonary edema
 Altered consciousness - Diabetes, Thyroid gland disorders
 Cerebrovascular accidents & Seizures
 Drug related emergencies- Overdose, Allergy
 Chest pain- Angina, MI
 Cardiac arrest

13. Prevention
 A complete system of physical evaluation for all
prospective dental patients can prevent approximately 90%
of life threatening situations
McCarthy
 “When you prepare for an emergency, the emergency
ceases to exist”
Goldberger

14. Goals of Evaluation
Physically & psychologically
tolerate the stress
Psycho-sedation &
contraindications
If treatment
modifications

15. Physical evaluation  Medical history questionnaire:

16. Medical referral

17. Prophylactic regimes for dental procedures
1.
Standard prophylaxis – Amoxiciin- Adults 2g, child 50 mg/kg oral
1hr before.
2.
Inability for oral med- Ampicillin- 30 min before procedure.
3.
Allergy to penicillin- Clindamycin- Adults 600 mg, child 20 mg/kg
orally , or Cephalexin -Adults 2g, Child 50mg/kg or AzithromycinAdults 500mg, Child 15 mg /kg oral 1 hr before.
4.
Allergy to Penicillin & inability to take oral med- Clindamycin or
Cefazolin( 1gm) - Adults 600mg, Child 20 mg/kg IV 30 min before
procedure.

18. Dental drug interactions:

19. Clinical Examination
Vital Signs
 Blood pressure
 Heart rate (pulse) and rhythm
 Respiratory rate
 Temperature
 Height
 Weight

20. 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 ( 3 times) , 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
ASA IV
Recheck every 5 minutes, MC, stress
reduction protocol , only emergency
treatment , hospital referral.

21. ASA physical status classification
 ASA I : Normal healthy pt, without systemic disease.
 ASA II : Pt with mild systemic disease.
 ASA III : Pt with sev systemic disease that limits activity but is
not incapacitating.
 ASA IV : Capacitating systemic disease – threat
 ASA V : Pt not expected to survive 24 hrs with/ without operation
 ASA E: Emergency operation of any variety

22. Anxiety reduction
 Recognition of anxiety- history and observation.
Types:
 Moderate
• Usually try to hide their
fears
• Cold and sweaty palms
• Nervous appearance
Severe
•
•
•
•
•
Usually does not hide their fear
Appears with severe infection or toothach
Increased heart rate and blood pressure
Excessive sweating, trembling
Dilated pupils

23. Stress reduction protocol

24. Text book for Reference:
Medical Emergencies in Dental office by
Stanley Malammed – 6th edition