Dental

1. Dental emergencies
Dr. kibe
In dental practice, emergences though uncommon do occur
Your knowledge and having right equipment and drugs determine the
outcome

2. Useful emergency kit
• Every practice should posses 02 delivery apparatus or at least air
• The following should be readily available
Oral airway-eg ambu-bag
High vacuum suction
Disposable syriges, needles
• Drugs
Adrenaline, 1mg adrenln in 1 ml saline
Hydrocortisone=100mg and h02 for inj

3. Glucose=dextrose 20 or 50%
Chlorpheniramine 20mg inj
Flumazenil 100microgram/5ml ampoule

4. fainting
Commonest cause of loss of consciousness-appr 2% before or during
rx
Predisposed by pain, anxiety, fatigue, hyperthermia, fasting
Characteristics=dizziness, nausea, pale, cold and clammy skin, a slow
thin pulse, then radip and unconscious and collapse
Prevention
 Avoid predis factrs
 Rx pt in supine position unless contrind in heart failure, pulmo
oedema

5. management
Lower head below or at heart positn-lay flat
Loosen clothing
Monitor pulse. If no rapid recover, reconsider dx
Determine and avoid pred factrs in future

6. Collapsed and in doubt
• Don’t panic
• Collapsedin absence of dx, follow steps
Place in supine. If simple fait recover immediately
No breathing- begin cpr
Maintain airway, provide oxygen
Feel pulse. Absent cardiac arrest-cpr
Iv 20ml 20-50 dextrose
Iv hydrocortisone 200mg
These meaures resolve most cases. Ensure some body has requested for
ambulance

7. hypoglycaemia
• Is acute diabetic emergency
• May result from
 missed mea
Excess insulin
Increased caloric demand due to stress or exercise
Assume hypoglycaemia unless otherwise
Dx
 Disorientation, irritability, incrsd drowsnes, excitability, appear drunk

8. mx
• Concious= glucose po
• Unconscious
Protect airway
Recovery position
Iv 50ml 20-50% dextrose
Alter=1mg glucagon IM

9. fits
• majorit fits need no active intervention as recovery is spontaneous
• Avoid pt injury
• Fits in epileptic may be precipitated by starvation, flicking light,
alcohol, drugs, menses or follow dip faint, stress
• Dx= aura, loss of consciousness, rigid appearance, jerking movesmts,
incontinent urine, tongue bite
• Slow recovery wt sleepy feel and dazed

10. mx
Simple major fit,place in recovery posit
If fits repeated=status epilepticus=emergency
 Iv diazepam 10-20mg
 Assess cardiores function, maintain airway, give 02
 Status not allowed to continue for more than 20 mints=brain damage
and mortality
 If fits not controlled use phenytoin infusion or induce anaesthesia wt
thiopentone and ventilate
 Sort help

11. Corticosteroid use collapse
• Use suppress adrenal response to stress
aim=Prevent collapse stress induced therefor cover stressful
procedure wt 100mg im 30 mints before
If collapse occur=pallor, rapid thin pulse, sudden drop bp, loss of
conscious
Mx
Supine posit
500mg iv hydrocortisone
Ask help-ambulance, exclude other causes

12. Acute chest pain
• Due to myocardium ischaemia
• Differentiate btw angina and myocardial infarction
• Signs=retrosternal pain described as heavy, crushing. Preceded by
effort,emotion,excitement and may radiate to arm, neck, jaw
• Angina rapidly relieved by rest and GTN 0.5 mg sublingual.
• If no relieveof pain, breathlessness, nausea, vomiting, loss of
consciousness, weak irregular pulse=infarct

13. mx
In dental
• Upright suppoterd position
• Summon help-ambulance
• Administer analgesia=nitrous oxide/02 mixture
• Give asprin 75-150mg po
• Prepare if cardiac arrest occur
• In hosp
• Iv 2.5mg diamorphine. Ask help

14. Anaphylactic shock and other drug reaction
• Penicillin commonest offender, 10% cross over wt cephalosporins
• Starts afew minutes after parental
• Sign=
Facial flushing,itching,numbness, cold extremities,nausea, abdominal
pain,, wheezing, facial swelling, rash, cold clummy skin, thin pulse.
Loss of conscious may occur progressing to cyanosis and resp failure
Mx
 Supine post
 Iml of 1 in 1000adrenaline in/sc. Repeat every 15 minutes until
improve

15. • Up to 500mg hydrocortisone iv
• Up to 20mg of chlorpheniramine iv
• 02 by mask

16. Cardiac arrest
• Don’t wait expertise=ACT
• major cause ischaemic heart disease bt others eg acute asthma,
hypothermia, drug overdose
• Dx=sudden loss of consciousness, no breathing, no pulse
• Mx
Call for help
Witnes arrest-a single sharp blow over the heart is worthwhile
Airway-extend neck, clear airway
Listen for breath sounds and feel breath by back hand. If none mouth to
mouth. Begin wt 2 expirations to expand chest

17. • No palpable carotid pulse, then external cardiac massage
• Rate compres/vent
Cpr single rescuer 15 compr to 2 ventilations, Two rescu-5 comp/1
ventilation
Aim 60-8- compr/min

18. Acute asthma
• Allergens, infection, cold, axiety
• Characteristics-chest tight, breathlessness, wheexing expiration
• Unable to talk=potential fatal episode
• Mx
Upright posit
Pt salbutamol
Give 02
Give steroids