Common Medical Emergencies in dental chair related to Unconsciousness.

1. Medical Emergencies in
Dental Chair
Related to Unconsciousness

2.  Sarosh Hussain
Complete By….

3.  Introduction
 Types of Emergencies
 Most Common Medical Emergencies
 Prevention
 Preparation
 Management
 Emergencies Related to Unconsciousness
 Conclusion
Contents

4. Introduction
Emergency is a serious and
unexpected situation
requiring an immediate
action.
It is an unforeseen
combination of
circumstances or the
resulting state that calls for
an immediate action.

5.  UNCONSIOUSNESS
 Syncope
 Hypotension
 Hypoglycemia
 SEIZURES
 RESPIRATORY EMERGENCIES
 Airway obstruction
 Asthma
Types of Emergencies

6.  CARDIOVASCULAR EMERGENCIES
 Angina pectoris
 Myocardial infarction
 DRUG-RELATED EMERGENCIES
 Overdose reactions
 Allergies
Types of Emergencies

7. Most Common Medical Emergencies
 Over 60% of the emergencies are SYNCOPE ,with
HYPERVENTILATION the next most frequent at 7%

8.  Comprehensive Medical History
 Detail History
 Past Medical History
 Familial Disease History
 Psychological/ Social Status
 Diet
 Vigilant observation & prompt
recognition of symptoms of an
emergency
Prevention

9.  Basic Life Support
 Primary response to all emergencies
 P-A-B-C-D (Position>Airway> Breathing> Circulation>
Defibrillation)
 Affiliation to Definitive Medical Care
Preparation

10.  Emergency Kit
 BP Apparatus
 Oxygen Delivering System
 Glucometer
 Syringes
 I.V Cannula
 Suction
 Oropharyngeal Equipments
 Emergency Drugs
Management

11.  Emergency Drugs
 Nitroglycerine
 Epinephrine
 Salbutamol
 Aspirin
 Diazepam
 Dextrose Water
 Insulin
 Glucagon
Management

12. Emergencies
Related To Unconsciousness

13.  Syncope is a short loss of consciousness and muscle
strength, characterized by a fast onset, short duration, and
spontaneous recovery.
Syncope

14.  Predisposing Factors
 Fear
 Anxiety
 Pain
 Fatigue
 Fasting
 Sign and Symptoms
 Cold and Moist Skin
 Pale Skin
 Dizziness
 Weakness
 Nausea
 Loss of consciousness
Syncope

15. Management
 Monitoring pulse
 Lowering head to improve cerebellar circulation
 Loosening of tight cloths at neck
 Smelling of salt of aromatic ammonia
 Reassurance of patient
 If not recovered other causes of collapse
 should be considered
Syncope

16.  It is a paroxysmal disorder of cerebral function
characterized by an attack, involving changes in the state of
consciousness, motor activity or sensory phenomena.
 Usually sudden in onset and of brief duration
 EPILEPSY: “A chronic disorder in which nerve cell activity in
the brain is disturbed, causing seizures”.
Seizures

17.  Common symptoms of seizures
Seizures

18. Prevention
 If a patient is known epileptic, make sure he/she has taken their
regular dose of anticonvulsant on the day of treatment.
 Instruct him/her to alert you as the aura of the impending seizure
manifests itself.
 Keep life support equipments ready, in case of an emergency
status epilepticus.
Seizures

19. Management
 Self limiting emergency
 Position: supine with patient placed on flat surfaces.
 Remove dangerous objects from the mouth and around the
patient ( eg. sharp instruments, needles, etc.)
 Loosen any tight clothing.
 Avoid restraining the patient.
 In case the ictus fails to subside within a maximum of 10 minutes,
declare status epilepticus and proceed with definitive care.
Seizures

20.  Definitive Treatment
Diazepam – 10 mg I.V. , (2mg/min) repeat every 10
minutes.
Pheno barbitone – 100-200 mg/min, I.V.
Carbamazepine
Phenytoin
Seizures

21.  Hypoglycemia is a clinical syndrome in which low serum (or
plasma) glucose levels lead to symptoms of
sympathoadrenal activation.
Hypoglycemia

22.  Sign and Symptoms
Hypoglycemia

23. Management
 Glucose and sugar-containing beverages administered orally to
conscious patients for rapid effect.
 Alternatively, milk candy bars, fruit, cheese, etc may be adequate
in mild cases.
 IV dextrose is indicated for severe hypoglycemia, in patients with
altered consciousness and during any restriction of oral intake.
Hypoglycemia

24.  Treatment
 20-25 ml of 50% dextrose should be given
immediately.
 Glucagon, 1mg i.m. (or s.c.)
 Metformin
 Sulfonylureas
Hypoglycemia

25.  Mainly caused by Angina pectoris, Myocardial
infarction
Angina pectoris – pain lasts for only a short duration
Myocardial infarction – pain persists for long duration
Chest pain

26.  Diagnosis
 Severe chest pain in retrosternal region
 Dyspnea
 Vomiting
 Weak pulse
 Irregular pulse (MI)
 Loss of consciousness
Chest pain

27. Management
 Sub Lingual 0.5mg Nitroglycerine, if pain is
not relieved by 3 min. MI
 Nitrous oxide & oxygen 50/50 ratio to relieve
pain & anxiety, immediate medical attention
Chest pain

28.  Sudden appearance of pallor & respiratory arrest
 Etiology – MI
 Anaphylactic reaction
 Severe hypotension
 Hypoxia
 Anesthetic overdose
Cardiac arrest

29.  Diagnosis
 Fainting or collapse
 Late signs – respiratory arrest, cyanosis, dialatation of pupil,
absence of pupillary response to light, absence of BP
 Management
 Immediate cardiopulmonary resuscitation
Cardiac arrest

30.  Usually occurs in
hypertensive patients
 Clinical features
 Depends on site & extend of
brain damage
 Loss of consciousness
 Weakness of arm & leg on one
side
 Drooping of one side of face
Cerebrovascular Accidents

31. Management
 Maintenance of airway hospitalization
Cerebrovascular Accidents

32.  Anaphylaxis
 Allergy to LA solution
 Hypotension due to interaction of i.v. barbiturates
with antihypertensive drugs
Drug Reactions

33.  Reaction due to LA
 Causes
 I. V. injection of LA
 Allergy to LA
 LA may cause cardiovascular effects & facial
palsy
Drug Reactions

34.  I.V. injection of LA is caused by – aspiration was not carried
out during injection & rapid infusion of LA
 Clinical features
 Drowsiness
 Agitation
 Loss of consciousness
 Management
 Make the patient lie down flat
 Maintain airway
 Recovery in 30 min.
Drug Reactions

35.  Allergy to LA – management similar to anaphylaxis
 Cardiovascular effects - Manifested as palpitation
 If MI – manage MI
 Facial palsy – temporary effect caused by tackling of LA to facial
nerve
 Management
 Wears of gradually
 Reassurance of patient
Drug Reactions

36.  Causes
 Foreign body (usually food)
 Infection or post traumatic hematoma
 Obstruction by the tongue
 Trauma
Airway Obstruction

37. Management
 Is directed at rapid relief of obstruction to prevent
cardiopulmonary arrest and anoxic brain damage.
 Perform the head tilt and chin lift maneuver if cervical spine
trauma is not suspected.
 Perform a jaw thrust if cervical spine trauma is suspected.
Airway Obstruction

38.  Perform the Heimlich
maneuver (sub
diaphragmatic abdominal
thrust) repeatedly until the
object is expelled from the
airway
 If the situation cannot be
managed, the patient should
be referred to a nearby
hospital or a health post
Airway Obstruction

39. As the saying goes, “PREVENTION IS BETTER THAN
CURE”.
 The first step in management of dental emergencies is to prevent
their Occurrence
 With proper knowledge medical emergencies and related
complication can be easily prevented
 “When you prepare for emergency, the emergency ceases to
exist”
Conclusion