Medical emergencies in dental practice

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Medical emergencies in dental practice

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Medical emergencies in dental practice

  1. 1. Good morning 4/17/2014 1
  2. 2. MEDICAL EMERGENCIES IN DENTAL PRACTICE Presented By Deepika Jasti 1st year PG Public Health Dentistry 4/17/2014 2
  3. 3. Contents • Introduction • Classification of medical emergencies • ASA physical status classification system • Dental office emergency team • Basic action for every emergency • Most common emergencies and their Management • Syncope • Postural hypotension • Acute adrenal insufficiency • Hyperventilation • Status asthmatics • Diabetic emergencies • Epilepsy • Anaphylactic reactions • Angina pectoris • Myocardial infarction • Cardiac arrest • Basic emergency kit • Basic emergency drugs • Emergency management at camps • Conclusion • Recent studies conducted in India • References 4/17/2014 3
  4. 4. Introduction The emergency is derived from the Latin, meaning to dip, Plung, Indundate, engulf or to bury. Definition: A serious and unexpected situation requiring immediate action. 4/17/2014 4
  5. 5. WHY WE SHOULD READ THIS SEMINAR 4/17/2014 5 “When you prepare for an emergency, the emergency cease to exist”
  6. 6. Classification of medical emergencies 4/17/2014 6
  7. 7. ASA Physical Status Classification System 4/17/2014 7
  8. 8. Dental Office Emergency Team 4/17/2014 8
  9. 9. Basic action for every emergency t/B RR UNCONSCIOUS - Look-Listen-Feel4/17/2014 9
  10. 10. Most common emergencies • Syncope • Postural hypotension • Acute adrenal insufficiency • Hyperventilation • Status asthmatics • Diabetic emergencies • Epilepsy • Anaphylactic reactions • Angina pectoris • Myocardial infarction • Cardiac arrest 4/17/2014 10
  11. 11. Syncope Syncope is defined as a transient loss of consciousness and postural tone due to reduced cerebral flow and is associated with spontaneous recovery Temazepam 5mg orally 4/17/2014 11
  12. 12. Postural Hypotension/ • Definition: postural hypotension is defined as a drop in systolic blood pressure of 30 mm Hg or greater or a 10 mm Hg or greater fall in diastolic blood pressure that occurs on standing. 4/17/2014 12
  13. 13. •Risk factors •Clinical features - %BP angina, lethargy, low back ache •Diagnosis •Management Assessment of consciousness P-A-B-C-D Fludrocortisone – to raise BP Discharge- Chair position Postural Hypotension 4/17/2014 13
  14. 14. Acute Adrenal Insufficiency • 25 steroids • Cortisole regulates BP and glucose utilisation. K,ca • Signs and symptoms- how to diagnose • Management – 5-10l/min oxygen mix-o-vial 100 mg 2ml liquid Hydro cortisone 4/17/2014 14
  15. 15. Foreign Body Obstruction 4/17/2014 15 Universal choking sign Heimlich manever
  16. 16. Hyperventilation Definition : Hyperventilation is defined as ventilation in excess of that required to maintain normal blood oxygen and carbon dioxide partial pressures. 4/17/2014 16
  17. 17. Respiratory alkalosis – Hypocapnia Vasoconstriction in cerebral blood vessels Feeling of tightness in chest Release of catecholamines due to anxiety Respiratory alkolosis – change in blood pH – alters calcium. Management P-A-B-C-D Calm the patient Breath 4-5 times Co2 -02 Paper bags Diazepam/ midazolam4/17/2014 17
  18. 18. Status Asthmaticus Hypercapnea –acidosis-respiratory failure 4/17/2014 18
  19. 19. Status Asthmaticus Salbutamol -250mg iv 4/17/2014 19
  20. 20. Diabetic Emergencies 25-50 ml 1mg 4/17/2014 20 15 grms
  21. 21. EPILEPSY • Definition: disorder of brain characterized by an enduring predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological and social consequences of this condition.4/17/2014 21
  22. 22. Classification Partial seizure Simple partial seizure Complete partial seizure Partial seizure with secondary generalization Primarily generalized seizures Absence seizure (petitmal seizure) Tonic clonic seizure (grandmal seizure) Tonic seizure Atonic seizure Myoclonic seizure Unclassified seizures Neonatal seizures Infantile seizures 4/17/2014 22
  23. 23. Precipitating factors Signs Management Status epilepticus – 15 min D/M= 10/5 4/17/2014 23 Tonic phase Clonic phase Flaccidity Incontinence
  24. 24. Anaphylactic Reactions 10-20 Mg 10ml blood 4/17/2014 24
  25. 25. Myocardial Infarction 50/50 Nitrous oxide and oxygen 4/17/2014 25
  26. 26. Cardiac Arrest 4-5cm 80/min 50kgs 4/17/2014 26
  27. 27. Basic emergency kit 4/17/2014 27
  28. 28. Basic emergency kit 4/17/2014 28
  29. 29. Basic emergency drugs • Oxygen • Epinephrine • Nitroglycerin • Injectable antihistamine • Salbutamol • Aspirin • Oral carbohydrate • Glucagon • Atropine • Corticosteroid • Morphine • Naloxone • Nitrous oxide • Injectable benzodiaepine • Flumazenil • Aromatic ammonia 4/17/2014 29
  30. 30. Emergency Management At Camps 4/17/2014 30To be forewarned is to be forearmed
  31. 31. 4/17/2014 31 Medico legal considerations The standard of care can be defined as “what the reasonable, prudent person with the same level of training and experience would have done in the same or similar circumstances.” “Ignorance of the law does not constitute immunity from liability”
  32. 32. 4/17/2014 32
  33. 33. Recommendations • When an emergency arises call for EMS immediately • If there is a problem, such as a dental dam clamp falling into a patient’s throat, be honest with patients as to the nature of the problem. • Refer patients to medical professionals when necessary. Never attempt to treat situations which require physician or hospital management. • Be knowledgeable about state dental practice acts and your requirements for dealing with emergencies • Current basic life support certificate for all dental office staff 4/17/2014 33
  34. 34. • Take a complete health history for new patients and update it at each visit. Maintain adequate records. Document emergency treatment rendered; generally, courts have maintained that if it wasn’t written down, it wasn’t done. • Take vital signs, especially if an anesthetic is to be administered. • Having an emergency kit in the office does not prevent liability unless you know how to use it properly. 4/17/2014 34
  35. 35. Conclusion 4/17/2014 35
  36. 36. Recent studies conducted in India • Gupta et. al, preparedness of management of medical emergencies among dentists in Udupi and Mangalore, India. J. contemp dent practice 2008; 9(5); 92-9. • Praveen et al, evaluation of knowledge, experience and perceptions about medical emergencies amongst dental graduates of Bangalore city, India. J clin expt dent. 2012; 4(1); 14-8. • Mainak saha et al, emergency preparedness; a survey of dental practitioners in Indore: JIDA, vol. 5, no. 12, dec 2011. 4/17/2014 36
  37. 37. Recent studies conducted in India • Bhavana et al, a survey of medical emergencies in dental practice in India. Paper presentation at 9th world congress on preventive dentistry, 2009. • Mohan das et al, knowledge, attitude and practice in emergency management of dental injury among physical education teachers: a survey in banglore urban schools. Dent update, 2009, may, 36(4): 202-4. 207-8. 211. • Santa et al, awareness of basic life support among medical, dental , nursing students and doctors. Indian J. Anaesth. 2010, March-April; 54 (2); 121-126. 4/17/2014 37
  38. 38. 4/17/2014 38 • Gupta T et al, in 2008 conducted a study to assess the preparedness for management of medical emergencies among dentists in the cities of Udupi and Mangalore in India and found that Less than half (42.1%) of the dentists reported having received practical training in management of medical emergencies during their undergraduate and postgraduate education. Only about one- third of the respondents felt competent in performing mouth-to- mouth breathing (39.3%), cardiac compression (35.2%), foreign body obstruction relief (32.8%), and in administering IV drugs (34.5%) or supplemental oxygen (27.4%). The most commonly available emergency drugs in treatment areas were oral glucose (82.2%) and adrenaline (65.8%).
  39. 39. 4/17/2014 39 However, less than one-fourth of the respondents had the following on hand in their treatment facility: oxygen (24.0%), an AMBU bag (17.1%), pocket mask (13.0%), bronchodilator spray (24.7%), diazepam (20.5%), aspirin (20.5%), and glyceryl trinitrate (17.8%). Less than half (39%) of the respondents reported having clinical staff members trained to assist in emergency recognition and management and only 5.8% carried out emergency drills in their workplace.
  40. 40. 4/17/2014 40 Santa et al in 2010, conducted a cross sectional study to assess the awareness of Basic Life Support (BLS) among students, doctors and nurses of medical, dental, homeopathy and nursing colleges and found that no one among them had complete knowledge of BLS. Only two out of 1054 (0.19%) had secured 80 - 89% marks, 10 out of 1054 (0.95%) had secured 70 - 79% marks, 40 of 1054 (4.08%) had secured 60 - 69% marks and 105 of 1054 (9.96%) had secured 50 - 59% marks. A majority of them, that is, 894 (84.82%) had secured less than 50% marks. Thus it is concluded that awareness of BLS among students, doctors and nurses of medical, dental, homeopathy and nursing colleges is very poor.
  41. 41. References 1. Stanlet F. Malamed, Medical emergencies in dental office, 6th ed. page no: 12, 38, 60. 2. Medical emergencies in dentistry : Prevention and Preparation, dentistry Iq, articles, volume-2, issue -10 3. Haas DA et al., Preparing dental office staff members for emergencies: developing a basic action plan, J Am Dent Assoc, 2010 May;141 Suppl 1:8S-13S. 4. Harrison’s text book of principles of internal medicine, vol. 1, 18th ed. 5. www.dentallearning.org/course/fde0011- 10/coursebook_ch09.pdf 4/17/2014 41
  42. 42. 6. Phil Jevon et al., Postural hypotension: symptoms and management, nursing times, vol: 97, issue: 03, PAGE NO: 39. 7. Lapointe et al, Pocket guide to medical emergencies in dental office. www.faculty.ksu.edu.com 8. cowson’s text book of oral pathology and oral medicine , Emergencies in dental practice, – 7th ed. page no ; 385-390. 9. Burket’s text book of oral medicine: diagnosis and treatment, page no. 519. 10. Fisher et al., epileptic seizures and epilepsy: definitions proposed by International league against epilepsy (ILAE) and the international bureau for epilepsy (IBE), Epilepsia, Vol.46, No.4, 2005. 4/17/2014 42
  43. 43. 11. Harrison’s principles of internal medicine, volume II, 16th ed. page no: 2357. 12. Kenneth et al, Allergy & Anaphylaxis, Inside Dentistry, March 2011, Volume 7, Issue 3 13.Daniel A Haas et al., Management of Medical Emergencies in the Dental Office: Conditions in Each Country, the Extent of Treatment by the Dentist, Anesth Prog. 2006 Spring; 53(1): 20–24. 14.Rosenberg M et al., Preparing for medical emergencies. The essential drugs and equipment for the dental office JADA, Vol. 141, May 2010. 15.Roberson et al., Are You (and Your Staff) Prepared for a Medical Emergency?, fall 2009, vol 12, no.2 16.Office emergencies and emergency kits. JADA march 2002, vol 133. 4/17/2014 43
  44. 44. 4/17/2014 44
  45. 45. Thank you 4/17/2014 45

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