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Emergency Lecture 2014
 

Emergency Lecture 2014

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CPR & Medical Emergencies in the Dental Office presentation by Neil Gajjar, DDS.

CPR & Medical Emergencies in the Dental Office presentation by Neil Gajjar, DDS.

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  • The Adult BLS Healthcare Providers algorithm incorporates changes designed to simplify lay-rescuer training and to continue to emphasize the need to provide early chest compressions delivered to the victim of a sudden cardiac arrest.  The circle design has been developed place the emphasis on continuous chest compressions with minimal interruptions.

Emergency Lecture 2014 Emergency Lecture 2014 Presentation Transcript

  • Dr. Neil J. Gajjar, BSc, DDS, MAGD, FADI, FPFA, FICD, FACD, Cert. IV Sedation Private Practice Mississauga, Ontario
  • Dr. Neil J. Gajjar, BSc, DDS, MAGD, FADI, FICD, FPFA, FACD, Cert. IV Sedation Private Practice: 16-735 Twain Avenue, Mississauga, ON L5W 1X1 Email: personal@drgajjar.com 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 2
  • 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 3
  •      AIRWAY BREATHING CIRCULATION DEFIBRILLATION EMERGENCY DRUGS 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 4
  •   A change in the order of sequence! From A-B-C to C-A-B 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 5
  •    Make it easier for lay rescuers. If you don’t know anything than do compressions. It has been found that compressions are more important and need to be delivered first. 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 6
  • The Heart: • Pumps blood (Deoxygenated & Oxygenated) • Size of a fist • Weighs 250 to 300 grams • Located in the centre of the chest between the breastbone and backbone • 4 chambers •Sinoatrial node creates electrical activity to generate heart beat 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 7
  • The Lungs: • Clusters of air sacs (alveoli) • Alveoli site of Oxygen and Carbon Dioxide exchange • Air entering lungs contains 21% oxygen, little Carbon Dioxide •Air leaving the lungs contains 16% oxygen and 5% Carbon Dioxide • Air we breathe out has enough Oxygen to help someone who has stopped breathing 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 8
  •     Sensation of pressure, tightness, fullness, squeezing, or pain Localized behind the sternum or throughout from of chest May radiate to shoulders, arms, neck jaw, back of chest, upper abdomen Steady, usually lasting from a few minutes up to 10-15 minutes 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 9
  •  Precipitating factors  Any factor that will increase myocardial oxygen demand beyond available supply  Increased heart rate  Increased blood pressure 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 10
  •  Relieving factors  Reversal of precipitating factors  Rest  Nitroglycerin 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 11
  •  Death of part of the heart muscle due to inadequate blood oxygen supply 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 12
  •  Causes  Coronary atherosclerosis  Blood clot formation 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 13
  •  Precipitating events  Can occur at rest  Can occur with mild to moderate exertion 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 14
  •  With known coronary disease  Chest pain or discomfort not relieved by 1 nitroglycerin tablet at 3-5 minute intervals to a maximum dose of 3 tablets  Without previously know cardiac disease  Chest pain or discomfort lasting more than a few minutes. 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 15
  •  Importance of prompt emergency medical care during the first symptom hour  Ventricular fibrillation very frequent during first symptom hour  Blood clot-dissolving medications, if appropriate, should be given ASAP  Average delay between onset of symptoms and decision to seek medical assistance: 3 hours 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 16
  • Brain Death No Oxygen 10-12 Minutes 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 17
  • For each minute that defibrillation is delayed Survival is reduced by 10% Survival Rate (percent) 100 80 60 40 20 0 5 10 15 20 25 30 Time to Defibrillation (minutes) 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 18
  • • CPR (only) ……………………… 0-2% • EMS/ER …………………… 5-15% • CPR+AED…….. 30-75% 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 19
  •      DEFIBRILLATION CIRCULATION AIRWAY BREATHING EMERGENCY DRUGS 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 20
  •      DEFIBRILLATION CIRCULATION AIRWAY BREATHING EMERGENCY DRUGS 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 21
  • Chest Compressions Video 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 22
  •  Assessment: Determine pulselessness 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 23
  •  Locate correct hand position  Landmarks  Hand positioning 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 24
  •  Begin chest compressions  Depress minimum 2 inches (5cm) 1/3 AP  Rescuers must provide compressions of adequate rate and depth and allow adequate chest recoil with minimal interruptions in chest compressions. 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 25
  • Compression-ventilation ratio 30:2  Check for return of pulse and spontaneous breathing after five cycles  Resume cycles with compressions  (if no pulse; if pulse than rescue breaths, 1/6-8 or 1/3-5secs) 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 26
  •      DEFIBRILLATION CIRCULATION AIRWAY BREATHING EMERGENCY DRUGS 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 27
  •   Assessment: Determine unresponsiveness Call for help   1/18/2014 “Phone first” and get the AED and return to start CPR and use the AED for all adults and any children with out-of hospital sudden collapse. “CPR first” (provide about 5 cycles or 2 minutes of CPR before activating the emergency response number) for unresponsive infants and children (except infants and children with sudden, witnessed collapse) and for all victims of likely hypoxic (asphyxial) arrest (eg, drowning, injury, drug overdose). (c) 2014 Neil J. Gajjar, DDS 28
  •   Position the victim Open the airway:  Opening the airway remains a priority for an unresponsive trauma victim with suspected cervical spine injury; if a jaw thrust without head extension does not open the airway, healthcare providers should use the head tilt–chin lift maneuver. 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 29
  • 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 30
  • 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 31
  •     Large pieces of food Alcohol Dentures Other foreign objects 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 32
  •    Forceful coughing Wheezing Do not interfere 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 33
  •     Weak, ineffective cough High-pitched breath sounds Blueness of skin Manage as complete airway obstruction 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 34
  •    Unable to speak, breath, or cough Clutches neck (universal distress sign) Bluish colour 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 35
  •  If the person can cough, speak, or breath, do not interfere 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 36
  •  Abdominal thrusts 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 37
  •  Chest thrusts (late pregnancy and obesity) 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 38
  •  Abdominal thrusts  Victim standing  Chest compressions  Victim lying down  Chest compressions in late pregnancy  Victim standing  Victim lying down 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 39
  • Adult Choking Video 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 40
  •  Position victim Activate EMS (911) Perform up to 30 chest compressions Attempt ventilation; reattempt ventilation  Repeat last three steps until successful    1/18/2014 (c) 2014 Neil J. Gajjar, DDS 41
  •  Determine unresponsiveness Activate EMS (911) Position victim Perform up to 30 chest compressions Attempt ventilation  Repeat last three steps until successful     1/18/2014 (c) 2014 Neil J. Gajjar, DDS 42
  •      DEFIBRILLATION CIRCULATION AIRWAY BREATHING EMERGENCY DRUGS 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 43
  •   Assessment: Determine breathlessness If victim is unresponsive but obviously breathing, place in recovery position 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 44
  •  If victim is not breathing, give two slow rescue breaths (2 seconds)  Excessive ventilation (too many breaths per minute or breaths that are too large or too forceful) may be harmful and should not be performed.  Mouth to mouth rescue breathing  Mouth to nose rescue breathing  Mouth to stoma rescue breathing 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 45
  • 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 46
  •   Infant: < 1 year Child: 1 – 8 years  Healthcare provider “child” CPR guidelines now apply to victims 1 year to the onset of puberty. 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 47
  •      DEFIBRILLATION CIRCULATION AIRWAY BREATHING EMERGENCY DRUGS 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 48
  •      DEFIBRILLATION CIRCULATION AIRWAY BREATHING EMERGENCY DRUGS 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 49
  •  Assessment: determine pulselessness 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 50
  •   Finger/hand position for compressions Begin compressions 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 51
  •  Infant: Depth minimum 2 inches (5cm) 1/3AP  Rate of at least 100 per minute  Child: Depth minimum 1.5 inches (4cm) 1/3AP  Rate of at least 100 per minute   Compression to ventilation ratio of 30:2 Active chin lift is often needed during ventilation of the child 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 52
  •      DEFIBRILLATION CIRCULATION AIRWAY BREATHING EMERGENCY DRUGS 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 53
  •    Assessment: determine unresponsiveness Position the victim Open the airway: head tilt-chin lift 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 54
  • 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 55
  •    Determine airway obstruction Perform abdominal thrusts Repeat until:  Good air exchange is resumed (foreign body is expelled)  Victim becomes unconscious 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 56
  • Infant Choking Video 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 57
  •  Determine unresponsiveness; call for help; position victim Perform up to 30 chest compressions Open the airway; determine breathlessness Attempt ventilation; reattempt ventilation  Repeat last 3 steps until successful    1/18/2014 (c) 2014 Neil J. Gajjar, DDS 58
  •  Determine unresponsiveness; call for help; position victim Perform 30 chest compressions Open the airway; determine breathlessness Attempt ventilation; reattempt ventilation  Repeat last 3 steps until successful    1/18/2014 (c) 2014 Neil J. Gajjar, DDS 59
  •      DEFIBRILLATION CIRCULATION AIRWAY BREATHING EMERGENCY DRUGS 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 60
  •   Assessment: determine breathlessness Ventilate twice 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 61
  • Infant BLS Video 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 62
  •          Mandatory for healthcare providers Ventilator assesses victim Compression to ventilation ratio 30:2 Adult Compression to ventilation ratio 30:2 Child/Infant No Pause for ventilations when airway in place Need for switch every 2 minutes (5 Cycles) Ventilator delivers breath Rescuers change places New cycle begins 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 63
  • 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 64
  • Adult CPR-2 Video 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 65
  • 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 66
  •  The most probable victim on whom you will be required to perform CPR will be either a family member or friend. 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 67
  •    Transparent mask Oxygen inlet One-way valve 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 68
  •    Provides adequate ventilation Supplemental oxygen is possible Aesthetically more acceptable 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 69
  • 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 70
  • 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 71
  • Adult Child Infant Age > 8 years 1 –8 years < 1 year Help Call 911 ? 2 Cycles 2 Cycles Breath 1.5-2 sec 1-1.5 sec 1-1.5 sec Depth 2 inches 2 inches 1.5 inches Rate 100 100 100 Cycle 5:30:2 5:30:2 5:30:2 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 72
  • Dr. Neil J. Gajjar, BSc, DDS, MAGD, FADI, FPFA, FICD, Cert. IV Sedation Private Practice Mississauga, Ontario
  • Ventricular Fibrillation Chaotic Quivering but NO Heartbeat NO Breathing 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 74
  • 80-90% of sudden deaths are caused by V-fib 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 75
  • The Only Correction for V-fib De-fib 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 76
  • If you see patient collapse or you find him down… …you don’t know if it’s Sudden Death or a Heart Attack 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 77
  • Is Help Needed? • Recognize that someone needs emergency medical help • Check The Area for personal dangers 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 78
  • Prepare the Chest for Electrodes  Expose the patient’s bare chest 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 79
  • Prepare the Chest for Electrodes (if necessary)  Shave hair at pad sites  Wipe/dry pad site area  Remove Bra ZOLL AED Plus units come with potentially needed accessories: Scissors Razor Towel Gloves CPR Face Shield 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 80
  • CPR-D Padz Placement 1. • Open the foil Padz pouch • Unfold CPR-D Padz • Position center “puck” ( as shown) 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 81
  •  Don’t Touch Patient During Analysis 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 82
  •  Stay Clear of Patient During Shocks  Verbal Command to Clear  Visually Confirm All Are Clear 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 83
  • 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 84
  • AED Plus ONLY Advises Treatment If there is a Shockable Rhythm Push Shock Button 1/18/2014 No Shock Needed (c) 2014 Neil J. Gajjar, DDS 85
  • • Delivers an electrical charge to the heart • Momentarily stop the hearts electrical activity • Hopefully the heart starts beating normally after the shock is delivered 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 86
  • Normal Sinus Rhythm Ventricular Fibrillation Ventricular Tachycardia Asystole 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 87
  • Transfer of Care • Verbal Report  Initial Condition  Care Delivered (including # of shocks)  Estimated “Down Time”  Any Changes in Patient’s Condition  Any available Medical History • Cooperate and Assist (as necessary & requested) 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 88
  • Precautions & Concerns Avoid Placing the Electrode Directly Over Implanted Heart Devices R Pacemaker 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 89
  • Implanted Heart Devices Pacemaker Defibrillator If scar or “bulge” on right side of chest Slightly “Rotate” Padz Medication Patches Remove Patch – Wipe Chest Clean 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 90
  • Additional Factors When using an AED Personal Safety Sensitivity to Family Crowd Control Periods of “Inactivity” Talk to the Patient 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 91
  • Patient is less than 8 yrs of age Patient is under 80 pounds Explosive environment Patient is immersed in water Following serious trauma 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 92
  • Drug Guidelines Dr. Neil J. Gajjar, BSc, DDS, MAGD, FADI, FPFA, FICD, Cert. IV Sedation Private Practice Mississauga, Ontario
  •   Known disorders Current medications  Prescription  Over the counter (OTC)  Herbal Medicines  Ginkgo—inhibits platelet activating factor. 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 94
  •   General appearance Vital signs  Ideally taken at initial visit and recalls  Response to exertion 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 95
  •   Pre-operative blood pressure and heart rate Stress reduction  Chairside manner  Profound local anasthesia  Conscious sedation   Monitor BP and HR 5 minutes post injection Be aware of orthostatic hypotension 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 96
  •   Pre-operative blood pressure and heart rate Stress reduction  Chairside manner  Profound local anasthesia  Conscious sedation   Monitor BP and HR 5 minutes post injection Consider  Prophylactic nitroglycerin  Oxygen by nasal cannula  Avoiding elective treatment within 6 months of MI 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 97
  •  Physiologic release about 25mg daily Stress can increase release to 300mg  Management   Double daily dose pre-operatively 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 98
  •  Hypoglycemia  Rapid onset, cool, wet, pallor, weak, dizzy, hunger, nausea, ment al confusion, lethargy, increase HR, decrease in BP, LOC, seizure  Hyperglycemia  Slow onset, hot, dry, flushed, malaise, nausea, vomiting, drowsy , irritable, headache, acetone odor, increase HR, decrease in BP, LOC 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 99
  • 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 100
  •    AIRWAY BREATHING CIRCULATION 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 101
  •  Most common emergency!  Position ABC’s Oxygen Consider oral glucose when conscious If blood pressure low and heart rate < 60      Atropine 0.6mg, 1 mL intra-muscular 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 102
  •  Major signs  Bronchospasm  Hypotension  Laryngeal edema  Minor signs     1/18/2014 Urticarial rash Generalized flush Nausea Abdominal pain (c) 2014 Neil J. Gajjar, DDS 103
  •     ABC’s Oxygen Call 911 Epinephrine 1:1000, 0.5 mL intra-muscular  Repeat epinephrine q10 min prn  Diphenhydramine 50 mg 1 mL intra-muscular 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 104
  • OPA: • semicircular • frequently plastic and disposable • used to hold tongue away from back of throat • variety of sizes 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 105
  •  Diphenhydramine 50 mg 1 mL intra-muscular 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 106
  •  Salbutamol inhaler, 2 puffs  Repeat as necessary  Oxygen If symptoms worsen than add:  Epinephrine 1:1000, 0.5 mL intra-muscular  Repeat epinephrine q10 min prn 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 107
  •      Call 911 CPR 100% oxygen AED if available Epinephrine 1mg iv as long as CPR not interrupted 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 108
  • 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 109
  •         ABC’s Oxygen Nitroglycerin, allow 3 minutes If no relief repeat Nitro, allow 3 minutes If no relief repeat Nitro, allow 3 minutes If no relief after 3 doses, call 911 ASA 325 mg Consider morophine or Nitrous Oxide 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 110
  •          Call 911 ABC’s Oxygen Nitroglycerin, allow 3 minutes If no relief repeat Nitro, allow 3 minutes If no relief repeat Nitro, allow 3 minutes If no relief after 3 doses, call 911 ASA 325 mg Consider morophine or Nitrous Oxide 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 111
  •    Systolic BP >210 or diastolic BP>120 Transfer to physician immediately Consider nitroglycerin 0.3 or 0.4mg sublingually 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 112
  •      Systolic BP <90 or BP drops by 15-20% Position ABC’s Oxygen If blood pressure low and heart rate < 60  Atropine 0.6mg, 1 mL intra-muscular 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 113
  •   Signs and symptoms include: sudden headache, dizziness, nausea and vomiting Transfer to hospital immediately! 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 114
  • History of steroid use combined with the following signs and symptoms: confusion, nausea and vomiting, abdominal pain, hypotension     Position ABC’s Oxygen If blood pressure low and heart rate < 60  Atropine 0.6mg, 1 mL intra-muscular  Hydrocortisone 100mg im 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 115
  •  If conscious  Oral carbohydrates  If unconscious     1/18/2014 ABC’s Oxygen Call 911 1mg glucagon im (c) 2014 Neil J. Gajjar, DDS 116
  •  If conscious  Hospitalize  If unconscious  ABC’s  Oxygen  Call 911 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 117
  •   Protect patient If seizure continues > 5 minutes  Call 911  Lorazepam (Ativan) 4mg im  Midazolam (Versed) 5mg im 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 118
  •   Calm the patient Correct alkalosis (re-breathe into paper bag) 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 119
  •  Bisphosphonates   Fosamax®/Actonel®/Boniva® Anticoagulants  Plavix/Aspirin/Coumadin/Heparin 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 120
  •  The consensus from reviews on the management of dental patients taking warfarin is that patients requiring dental surgical procedures in primary care and who have an International Normalised Ratio (INR) below 4.0 should continue warfarin therapy without dose adjustment.  Continuing warfarin during dental surgical procedures may increase the risk of postoperative bleeding requiring intervention.  Most cases of postoperative bleeding are easily treated with local measures such as packing with a haemostatic dressing, suturing and pressure.  Stopping warfarin increases the risk of thromboembolic events; the risk of thromboembolism after withdrawal of warfarin therapy outweighs the risk of oral bleeding as bleeding complications, while inconvenient, do not carry the same risks as thromboembolic complications.  Stopping warfarin is no guarantee that the risk of postoperative bleeding requiring intervention will be eliminated as serious bleeding can occur in non-anticoagulated patients. 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 121
  •     Up to 1 out of every 2 women over 50 will break a bone (such as wrist, spine or hip) due to osteoporosis in their lifetime. Each year, about 250,000 will break a hip due to osteoporosis. Of these, up to 24% will die, and less than 25% regain full function. Vertebral (spine) fractures, which occur twice as often as hip fractures, also cause back pain and increased mortality. Up to 1 out of 4 men over 50 will break a bone due to osteoporosis in their lifetime. Each year, about 80,000 men will break a hip. Oral or IV bisphosphonates have been shown to prevent 50-70% of vertebral fractures in postmenopausal women and 40-50% of hip fractures in clinical trials. Denosumab (Prolia) has been shown to reduce vertebral fractures in 70% of postmenopausal women and 40% of hip fractures. Given the risk of osteoporotic fracture, and the low risk of ONJ associated with potent antiresorptive therapy use, the benefit of preventing osteoporotic fracture clearly far exceeds the risk of ONJ. 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 122
  •        Key office staff should have CPR! Know your drugs! Know where they are! Review protocols! Have in office drills! Know your role! Check expiry dates! 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 123
  • For Your Commitment To Safety, Health & Life 1/18/2014 (c) 2014 Neil J. Gajjar, DDS 124