Unconsiousness

787 views
572 views

Published on

CPR
Forth Year

Published in: Health & Medicine
0 Comments
4 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
787
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
0
Comments
0
Likes
4
Embeds 0
No embeds

No notes for slide

Unconsiousness

  1. 1. UNCONSIOUSNESS IN DENTAL CLINIC AND ITS MANAGMENT Dr. Wael M. Talaat Assistant Professor of Oral and Maxillofacial Surgery
  2. 2. Objectives 1. 2. 3. 4. Diagnose Unconsciousness Know possible causes Be familiar with BLS Management
  3. 3. DEFINITION  UNCONSCIOUSNESS : lack of response to sensory stimulation.  Most common emergency situation reported in dental clinic is UNCONSCIOUSNESS
  4. 4. POSSIBLE CAUSES  1.Vasodepressor syncope  2.Drug Administration or ingestion  3.Orthostatic hypotension  4.Epilepsy  5.Hypoglycemic reaction
  5. 5. RARE CAUSES Acute adrenal insufficency Acute allergic reaction Acute myocardial infarction Cerebrovascular accident Hyperglycaemic reaction Hyperventilation
  6. 6. PATHOPHYSIOLOGY   1.INADEQUATE DELIVERY OF OXYGEN TO BRAIN OXYGEN BRAIN ACTIVITY UNCONSCIOUSNESS
  7. 7.  CLINICAL EXAMPLE : 1. Hypotension  2. Acute Adrenal insufficency  3.Vasodepressor Syncope  4. Orthostatic Hypotension 
  8. 8.    2.Systemic or local metabolic deficiencies Chemical or metabolic derangments Changes in Quality of blood reaching the brain
  9. 9. CLINICAL EXAMPLE Acute allergic Reaction Drug Ingestion And administration
  10. 10. 3- Direct or reflex effect on nervous system  Due to defect in brain itself
  11. 11.  CLINICAL EXAMPLE : Cerebrovascular accidents  Convulsive Episodes 
  12. 12.  4.Psychic Mechanisms  Emotional disturbances are most common cause of transient loss of consciousness in dental clinic
  13. 13. CLINICAL EXAMPLE  Emotional disturbances  Hyperventilation  Vasodepressor syncope
  14. 14. MANAGEMENT IMMEDIATE MANAGEMENT OF UNCONSIOUSNESS IS PRE-DICTATED ON TWO OBJECTIVES. 1.RECOGNITION OF UNCONSIOUSNESS 2.RECOGNITION OF POSSIBLE AIRWAY OBSTRUCTION AND MANAGMENT
  15. 15. 1.RECOGNITION OF UNCONSIOUSNESS
  16. 16. STEP ONE :ASSESSMENT OF CONSIOUSNESS  LACK OF RESPONSE TO SENSORY STIMULUS  TO CHECK WHETHER VICTIM LACK A RESPONSE TO SENSORY STIMULATION.
  17. 17.   GENTLY SHAKE VICTIMS SHOULDER AND SHOUT LOUDLY ‘ARE U ALL RIGHT’
  18. 18. Pain IS ANOTHER STIMULUS  APPLICATION OF PERIPHERAL PAIN PINCHING  EVOKES A MOTOR RESPONSE
  19. 19. STEP 2  TERMINATION OF DENTAL PROCEDURE
  20. 20. STEP 3 SUMMONING OF HELP  IF NO RESPONSE TO PERIPHERAL STIMULATION  Rescuer calls for assistance immediately by activating the dental office emergency system
  21. 21.  2.RECOGNITION OF POSSIBLE AIRWAY OBSTRUCTION AND MANAGMENT
  22. 22. STEP 4 P – POSITION VICTIM  SUPINE POSITION WITH BRAIN AT THE SAME LEVEL AS HEART AND FEET ELEVATED SLIGHTLY
  23. 23. OBJECTIVES  SUPINE POSITION INCREASED DELIVERY OF OXYGENATED BLOOD TO BRAIN O2 HEART BRAIN ELEVATED FEET Increase return of blood to heart OTHER BODY PARTS HEART Oxygenated blood
  24. 24. IN PREGNANT PATIENTS  TURN TO LEFT SIDE And tuck a pillow on right side because the inferior vena cava, which carries the blood from the lower body is on the right side and so if she is on the left it will not be compressed
  25. 25. STEP 5 A – Assess and open airway  Opening of airway and restoration of breathing are most basic and important steps of BLS
  26. 26. HEAD TILT CHIN LIFT  APPLYING DOWNWARD PRESSURE ON HEAD BY USING PALM APPLYING UPWARD PRESSURE ON MANDIBLE USING FINGERS
  27. 27. Head tilt–chin lift
  28. 28. JAW THRUST RESCUERS FINGERS ARE PLACED BEHIND POSTERIOR BORDER OF MANDIBLE DISPLACES MANDIBLE FORWARD ,DISLOCATING WHILE TILTING HEAD BACKWARD
  29. 29.  Response to jaw thrust maneuver tells the rescuer how deeply unconscious that victim is
  30. 30.  A movement or audible sound is considered positive
  31. 31. STEP 6a :assess airway patency and (B) Breathing   Assess the patency of breathing LOOK LISTEN AND FEEL TECHNIQUE At chest movements Feel and hear air at victims nose
  32. 32. NO RESPONSE     ADDITIONAL MANAGEMENT 1. administration of oxygen 2. monitoring of vital signs HEART RATE – BP – RESPIRATORY RATE
  33. 33. STEP 6b:Artifical Ventilation  VICTIM MAY RECEIVE ARTIFICAL VENTILATION IN ONE OF THE THREE WAYS  1.EXHALED AIR VENTILATION 2.ATMOSPHERIC AIR VENTILATION 3.O2 enriched Ventilation  
  34. 34. 1.EXHALED AIR VENTILATION  MOUTH TO MOUTH  MOUTH TO NOSE
  35. 35. 2.ATMOSPHERIC AIR VENTILATION  DEVICES TO DELIVER ATMOSPHERIC OXYGEN TO LUNGS AMBU BAG AND PULMONARY RESUSCICATOR
  36. 36. Ventilation Bag-Mask Ventilation 1 Person difficult, less effective 2 Persons easier, more effective
  37. 37. AIRWAY ADJUNCTS  AIRWAY ADJUNCTS USED  DEEPLY UNCONSCIOUS INDIVIDUALS
  38. 38. Open the Airway Oropharyngeal Airway
  39. 39. Open the Airway Nasopharyngeal Airway
  40. 40. Open the Airway Endotracheal Intubation
  41. 41. Open the Airway Laryngeal Mask Airway (LMA)
  42. 42. 3.O2 enriched Ventilation      E cylinder– 10 TO 15L for 30 minutes of oxygen It consists of 1.Portable E Cylinder 2.FACE mask CAPACITY A <B <C < D Type cylinder are also available
  43. 43. STEP 7 C - Circulation  Monitoring heart rate and blood pressure  Sites FOR Monitoring Heart rate 1.Brachial and Radial Arteries in Arm 2.Carotid Artery in Neck
  44. 44.  IF pulse not palpable within first 10 seconds
  45. 45. 2 mechanisms explaining the restoration of circulation by external cardiac massage  Cardiac pump Thoracic pump
  46. 46. Cardiac pump during the cardiac massage     Blood pumping is assured by the compression of heart between sternum and spine STERNUM HEART SPINE Between compressions thoracic cage is expanding and heart is filled with blood THORACIC CAGE BLOOD HEART
  47. 47. Thoracic pump at the cardiac massage     During the chest compression blood is directed from the pulmonary circulation to the systemic circulation. pulmonary circulation systemic circulation. blood
  48. 48. STEP 8 DEFENITIVE MANAGMENT  Which is specific for each condition
  49. 49. SUMMARY  RECOGNIZE THE PROBLEM  P - POSITION    A–B–C D – DEFENITIVE CARE
  50. 50. Thank You
  51. 51. VARIOUS UNCONSCIUOS CONDITIONS
  52. 52. VASODEPRESSOR SYNCOPE  Most common cause  Young fit adult males are more prone
  53. 53. Presyncope • Stress  increased release of Catecholamines  • peripheral vascular resistance  peripheral pooling of blood
  54. 54. blood to heart low BP decresed cerebral blood flow compensatory mechanism
  55. 55. compensatory mechanism   BARORECEPTOR REFLEXES CONSTRICT PERIPHERAL BLOOD VESSELS CAROTID & AORTIC REFLEX HEART RATE
  56. 56. compensatory mechanism FATIGUED   REFLEX BRADYCARDIA Heart rate less than 50 times per minute UNCONSIOUSNESS  CARDIAC OUTPUT
  57. 57. Signs & symptoms  1. 2. 3. 4. 5. 6. 7. Early Feeling of warmth Loss of colour :pale or ashen gray skin tone Heavy perspiration Complaints of feeling “bad” or “faint” Nausea Blood pressure at baseline Tachycardia
  58. 58.  Late 1. Dilated pupils Hypotension Dizziness, weakness or nausea Visual disturbances Cold moist skin Bradycardia 2. 3. 4. 5. 6.
  59. 59. Management of syncope  ASSESS CONSIOUSNESS  Activate office emergency team  P – Position patient supine with feet elevated
  60. 60. Provide definitive management of unconsciousness  Administer oxygen Monitor vital signs
  61. 61. Perform additional procedures Aromatic ammonia Atropine, if bradycardia persists delayed recovery POST PONE DENTAL TREATMENT Activate EMS
  62. 62. 2.POSTURAL HYPOTENSION BP
  63. 63. It is a disorder of the autonomic nervous system in which syncope occurs when the patient assumes an upright position Fall in systolic pressure by 20mm of Hg or greater or a 10mm Hg or greater fall in diastolic pressure that occurs on standing Failure of baroreceptor reflex mechanism POSITION VARIATION decrease constriction of peripheral blood vcssels return of blood to heart
  64. 64. Management of postural hypotension   Assess level of consciousness Activate office emergency team  Position patient supine with feet elevated  Assess & open airway
  65. 65.  Assess airway patency &breathing  Assess circulation  Administer oxygen  Monitor vital signs
  66. 66.  If patient recovers consciousnessslowly reposition the chair & discharge the patient
  67. 67.  Delayed recovery –  summon medical assistance- continue BLS as needed & discharge the patient
  68. 68. 3.SEIZURES
  69. 69. Definition   :A sudden change in behavior due to excessive electrical activity OF the brain Symptoms of seizures differ depending on what part of the brain is affected.
  70. 70. TYPES PARTIAL SEIZURES PRIMARILY GENERALISED SEIZURES
  71. 71. MANAGEMENT OF PARTIAL SEIZURES
  72. 72. RECOGNIZE PROBLEM (lack of response to sensory stimulation)     DISCONTINUE DENTAL TREATMENT ACTIVATE OFFICE EMERGENCY TEAM
  73. 73.  P-position patient in supine position with feet elevated Seizure ceases Allow patient to recover before discharge
  74. 74. IF SEIZURE CONTINUES (>5 min)   A B C Perform BLS as Needed
  75. 75. MANAGEMENT OF TONIC CLONIC SEIZURES
  76. 76. Aura  DIZZINESS HEADACHE  UPSET STOMACH
  77. 77.  PRODORMAL PHASE Recognize aura  Discontinue dental treatment  Activate office emergency team C-D  UNUSUAL FEELINGS P- A –B-
  78. 78. IF SEIZURE PERSISTS FOR MORE THAN 5 MINUTES  A-B-C-D if AVAILABLE      administer IV ANTICONVULSANT
  79. 79. Drug administration or ingestion
  80. 80. Drug administration or ingestion    Clinical signs and symptoms that result from overly high blood levels of a drug in various target organs and tissues Drug overdose reactions or toxic reactions Direct extension of normal pharmacologic actions of the involved drug.
  81. 81. Clinical manifestations of local anesthetic overdose SIGNS Low to moderate overdose levels 1. Confusion 2. Talkativeness 3. Apprehension 4. Excitedness 5. Slurred speech 6. Generalized stutter 7. Muscular twitching and tremor of the face
  82. 82. 9.Elevated blood pressure 10. Elevated heart rate 11.Elevated respiratory rate
  83. 83. Moderate to high blood levels 1.Generalized tonic-clonic seizure,followed by 2.Generalized central nervous system depression 3.Depressed blood pressure,heart rate & respiratory rate
  84. 84. Management of a severe LA overdose with slow or rapid onset  ASSESS CONSIOUSNESS  Activate office emergency team  P – Position patient supine with feet elevated
  85. 85.  Administer oxygen Monitor vital signs
  86. 86.    administer IV ANTICONVULSANT Activate EMS Medical consultation
  87. 87. 5.CEREBROVASCULAR ACCIDENT BLOCK
  88. 88.    Also known as Stroke Defined as any vascular injury that reduces cerebral blood flow to a specific region of the brain , causing neurologic impairment It is a focal neurologic disorder caused by destruction of brain substance as a result of intra-cerebral hemorrhage , thrombosis, embolism or vascular insufficiency.
  89. 89. PATHOPHYSIOLOGY OCCLUSIVE BLOCKED 1.thrombosis, 2.Embolism HAEMMORHAGIC
  90. 90. Diagnostic clues  Hypertension (blood pressure above 140/90mm Hg) Altered consciousness Hemiparalysis Headache and blurred vision Asymmetry of face and pupils of eyes
  91. 91.  ASSESS CONSIOUSNESS  Activate office emergency team  P – A –B - C
  92. 92.  Administer oxygen Monitor vital signs
  93. 93.  ESTABLISH IV ACCESS ( 5 % DEXTROSE)  TRANSPORT TO EMERGENCY MEDICAL CARE
  94. 94. Hyperglycemia
  95. 95.   Elevated blood glucose level Patients blood glucose level remain elevated for prolonged period due to lack of insulin BLOOD Glucose Insulin
  96. 96. SYMPTOMS
  97. 97. MANAGMENT  Step 1:Termination of dental therapy  Step 1a:Activation of dental office emergency Step 2: 2:Unconscious patients should be placed into the supine position with their legs elevated slightly
  98. 98. supine position
  99. 99.  Step 3:Removal of dental materials from mouth  Step 4:A-B-C(basic life support)as needed.
  100. 100. DEFINITIVE CARE  Step 5 :D(definitive care) Step 5a:summoning of medical assistance Step 5b:IV infusion(if available)of 5%dextrose and water or of normal saline
  101. 101. Dextrose
  102. 102.  Step 5c:Administration of oxygen  . Step 5d:Transportation of the patient to the hospital DentalClinic   Hospital
  103. 103. Hypoglycaemia
  104. 104.      Most dangerous complication of diabetes since the brain is starved of glucose Diagnosis Deepening drowsiness Disorientation Excitability or aggressiveness in a diabetic patient, especially if it is known that a meal has been missed
  105. 105. SYMPTOMS
  106. 106. Management of hypoglycaemia  Position the patient supine with legs elevated. Assess Airway  Breathing  Circulation.   Administer BLS as needed.
  107. 107.    4 lumps of sugar Give 150 ml glucose drink Reassure patient
  108. 108.     give sterile glucose IV (20ml of 20-50% of solution)or IM glucagon 1mg Call an ambulance Where possible, defer further immediate dental treatment until another day. If unconscious,
  109. 109. Management of sudden loss of consciousness in the absence of an obvious diagnosis  STEP 1 :Lay the patient flat . Recovery is almost instantaneous if the patient has simply fainted . Call for assistance
  110. 110.  STEP 2:Maintain the airway &give oxygen
  111. 111.    STEP 3:Take the pulseif absent CPR is immediately indicated.
  112. 112.  STEP 4 : If pulse is palpable give 4sugar lumps orally if the patient has not completely lost consciousness  or  20ml of 20-50%sterile glucose IV if unconscious. GLUCOSE
  113. 113.  STEP 5:  Still no improvement –medical assistance should be summoned.  Give hydrocortisone sodium succinate 200mgIV  Defer further immediate dental treatment until another day.
  114. 114. CONCLUSION  UNCONSCIUOSNESS IS THE MOST COMMON EMERGENCY CONDITION REPORTED IN DENTAL CLINIC  SO, as a Dentist we all should know how to manage unconsciousness condition in the dental clinic

×