Management of Medical Emergencies in Dental Clinics

1. Management of Medical Emergencies
Dr. Hadi Munib
Oral and Maxillofacial Surgery Resident

2. Outline
• Introduction
• Vasovagal Syncope
• Hypoglycemic Shock
• Hypersensitivity Reaction
• Angina and MI
• Adrenal Insufficiency
• Foreign Body Aspiration
• References

3. Introduction

4. Prevention

5. Vasovagal Syncope
• The most common cause of a transient loss of consciousness in the dental
office.
• Horizontal position with the feet elevated.
• Once consciousness is regained, pallor, nausea, and weakness for several
minutes.
• The patient is treated in a semi-supine or fully supine position.

7. Hypoglycemic Shock
• Diabetics and Healthy patients
• Missed meal or excess insulin
• Oral Sugary intake
• 50% Dextrose IV
• 1 gm Glucagon IM

8. Hypersensitivity Reaction
• Type I (immediate hypersensitivity) can cause an acute, life-threatening
condition.
• The least severe manifestation of type I hypersensitivity is Skin or mucosal
• The patient will complain of dyspnea and may eventually become cyanotic.
• Generalized anaphylaxis is the most dramatic hypersensitivity reaction,
usually occurring within seconds or minutes

9. Clinical Features
• Malaise or a feeling of “impending doom.”
• Symptoms of respiratory compromise soon follow.
• Finally, total airway obstruction occurs.
• Blood pressure tends to fall because of decreasing cardiac output and
peripheral vasodilation, and cardiac dysrhythmias appear.
• Unconscious.

10. Management
• IV or IM antihistamine (Diphenhydramine hydrochloride 50 mg or
chlorpheniramine maleate 10 mg)
• Oral Antihistamine (diphenhydramine [Benadryl] 50 mg or chlorpheniramine
[Chlor-Trimeton] 8 mg) every 6 to 8 hours for 24 hours.
• Immediate, severe urticarial reactions  immediate parenteral administration
of 0.3 mL of a 1 : 1000 epinephrine solution, followed by an antihistamine..

11. Angina and MI
• Heavy, Crushing in nature, Radiating Chest Pain.
• Nitroglycerin and Aspirin
• Stable Angina and Unstable Angina
• IF Chest Discomfort is not relieved by Rest and Nitroglycerin  Consider
MI
• Orally administred Aspirin 300 mg Crushed

12. Seizure
• Fit, Convulsions, Epilepsy.
• Phenytoin (Dilantin), phenobarbital, or valproic acid.
• Degree of control over seizure and physician’s notes can help.
• Continuous or repeated seizures without periods of recovery between
them are known as status epilepticus.

14. Adrenal Insufficiency
• Stressed patients
• Adrenal suppression that results from exogenous corticosteroids may prevent
the normal release of endogenous glucocorticoids in amounts needed to help
the body meet the elevated metabolic demands.
• Patients at risk are generally those who take at least 20 mg of cortisol (or its
equivalent) daily for at least 2 weeks any time during the year preceding the
planned major oral surgical procedure

15. Management
• Terminate all dental treatment
• Vital Signs
• Hypotensive  head-down, legs-elevated position.
• Oxygen.
• 100-mg dose of hydrocortisone sodium succinate IV or IM
• IV fluids.

17. Foreign Body Aspiration
• Objects that fall into the hypopharynx are frequently swallowed.
• Occasionally, the foreign object is aspirated into the larynx, violent coughing may
expel the aspirated material.
• If the foreign body is large enough to block the airway then Oxygen should be
administered and hospital transportation is necessary for laryngoscopy or
bronchoscopy.
• The completely obstructed but awake adult patient should have abdominal thrusts
or Heimlich maneuvers performed until successful expulsion of the object occurs or
consciousness is lost.

20. References
• Chapter 2: Prevention and Management of Medical
Emergencies

21. THANK YOU