Cpr introduction and prevention


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Cpr introduction and prevention

  1. 1. CPR Course Introduction Prevention of Medical Complications During Dental Treatment Dr. Adel I. Abdelhady BDS, Msc, (Tanta,EG.), Phd (EG.USA) Oral and maxillofacial surgery dept. College of dentistry, King Faisal university, KSA
  2. 2. Student Assessment Continuous Assessment (quiz 30% + Attendance) Midterm Exam 25% Final Written Exam. 45%
  4. 4. Life Threatening Emergencies (L.T.E.) LTE can and do occur in the practice of dentistry. This can happen to the patient to the Dr., office staff, or to a person accompanying the patient Factors leading to increasing number of patients complaining of LTE in dental office: 1-The increasing number older persons 2-The therapeutic advances in the medical profession 3-Growing trend toward longer dental appointments 4-The increasing use of administration drug s in dentistry
  5. 5. Morbidity In spite of most meticulous protocols designed to prevent the development of life threatening situations, emergencies still occur. Sudden unexpected death can happen of young, well-conditioned athletes. Overwhelming majority of situations involve a lot a medical emergencies starting from syncope (fainting, benign be aware of word benign might be lead to catastrophe if not properly managed) to acute MI and cerebrovascular accident …… Most situations occur either during treatment ,or in waiting area.
  6. 6. The type of dental care being administered more than 65% of cases developed during two types of dental care tooth extraction 39% and pulp extirpation 27% . The sudden unexpected pain triggered release the endogenous of catecholamine, which in turn added to the creation of an emergency, thus proper and adequate pain control in safe dental care cannot be overstated
  7. 7. Death Most emergency situations that occur in dental practice potentially can threaten the patient’s life. However, only in rare occasions does a patient actually die in a dental office. Patient has heart attack, Dies; Dentist also Stricken Three deaths from appliance aspiration Failure to properly recognize and treat clinical signs and symptoms can turn innocuous situation into an office tragedy.
  8. 8. Pre-Treatment Evaluations Adequate pretreatment evaluation combined with pain and anxiety control can help to prevent many emergencies and deaths Unfortunately, the most stringent precautions cannot prevent the occurrence of death. The usual cause of death is lethal cardiac dysrhythmia, most often ventricular fibrillations preventive measure cannot entirely eliminate this events
  9. 9. Risk Factors 1-Increased Number of Older Patients Many older patients appear to be in good health in practitioner must always lookout of subclinical diseases( cardiovascular, renal, pulmonary, endocrine and CNS) must be monitored in older patients 2-Medical advances With age, the incidence of disease rises, diabetic and cardiovascular disease significantly have long life expectance today than they did 20 or 30 years ago 3-Longer Appointments stressful and create more hazard to the patient 4-Increased drug used LA, Antibiotics can be lethal when interact with other drugs received by patient the dentist have to be cautious Goldberger Wrote ‘ WHEN YOU PREPARE FOR AN EMERGENCY, THE EMERGENCY CEASES TO EXIST’
  10. 10. Prevention  According to McCarthy a complete system of physical evaluation for all prospective dental patients can prevent approximately 90% of life threatening situations
  11. 11. Evaluation Goals 1-Determine the patient’s ability to physically tolerate the stress involved in the planned treatment 2-Determine the patient’s ability to psycologically tolerate the stress involved in the planned treatment 3-Determine whether treatment modifications are required to enable the patient to better tolerate the stress of the planned treatment 4-Determine whether the use of psycho-sedation is warranted, and which sedation technique is most appropriate and the contraindications if exist to any drug to be used in the planned treatment
  12. 12. Physical Evaluation Physical evaluation describes the steps involved in the fulfillment of the goals Medical history questionnaire
  13. 13. Physical Examination Heart failure Heart disease or attack Angina pectoris High blood pressure Heart murmur Rheumatic fever Congenital heart disease Asthma Sinus trouble Allergies Prosthetic heart valve Heart pacemaker Implant defibrillator Heart surgery Prosthetic joint repl. Anemia Stroke Kidney dysfunction Emphysema TB
  14. 14. Physical Examination Aids Diabetes Radiotherapy Chemotherapy Hemophilia Epilepsy Fainting or dizzy Nervousness Psychiatric treatment Sickle cell disease Bruise easily Do you loss weight Are you a pregnant
  15. 15. Clinical Examination Vital Signs Blood pressure Heart rate (pulse) and rhythm Respiratory rate Temperature Height Weight
  17. 17. ASA I Healthy, normal patient Physiologically able to tolerate the stress Without psychological problems No treatment modifications are indicated
  18. 18. ASA II Mild systemic disease Can perform normal activity without experiencing distress Healthy patient with more extreme anxiety May need modification in treatment
  19. 19. ASA III Severe systemic disease Limited activity but not incapacitated Need stress reduction method during dental treatment May need to alter treatment
  20. 20. ASA IV Has an incapacitating disease that is life threatening Patient is in distress at rest No elective dental therapy Emergency treatment should be in hospital setting
  21. 21. ASA V Moribund patient - not expected to live 24 hours with or without operation
  22. 22. Guideline for blood pressure in adult Blood pressure (mm hg) ASA classification Dental Therapy Considerations > 140 and > 90 ASA I Observe, routine treat. 140-159 or 90-94 ASA II Recheck Bp , medical consultation, MC implement stress red. protocol 160-199 or 95-114 ASA III Recheck every 5 minutes,MC, stress reduction protocol < 200 and/ or <115 Recheck every 5 minutes,MC, stress reduction protocol emergency treatment ASA IV
  23. 23. Medical emergencies commonly provoked by anxiety in dental unit • • • • • • • • • • Fainting/ syncope Angina pectoris Myocardial infarction Asthmatic bronchospasm Adrenal insufficiency (acute) Severe hypertension Thyroid storm Insulin shock Hyperventilation Epilepsy
  24. 24. Prior to Treatment  Complete review of medical status  (including vital signs)  Anxiety / Fear should be assessed and managed before administering anesthetic
  25. 25. Prevention and management of medical emergencies  Prevention  Preparation Personal continuing education in emergency recognition and management Auxiliary staff education in emergency recognition and management Establishment and periodic testing of readily access medical assistance. Equipping office with supplies necessary for emergency care.
  26. 26. Church of Selva Di Cadore, Colle Santa Lucia
  27. 27. Patient Evaluation Enables one to accurately assess the potential risk presented by a patient, prior to the start of treatment
  28. 28. Goals of Physical Examination To determine patient's ability to physically tolerate the dental treatment To determine patient's ability to psychologically tolerate the dental treatment
  29. 29. Goals of Physical Examination To determine whether treatment modifications are required To seek medical consultation if indicated
  30. 30. Routine Pre-operative Monitoring Blood pressure - BP Heart rate / rhythm - P Respiratory rate - R
  31. 31. Respiration  Monitor respiratory rate  Observe movement of chest wall
  32. 32. Recognition of Anxiety History Observation
  33. 33. Moderate Anxiety Usually try to hide their fears Cold and sweaty palms Nervous appearance
  34. 34. Severe Anxiety Usually does not hide their fear Appears with severe infection or toothache Increased heart rate and blood pressure Excessive sweating, trembling Dilated pupils
  35. 35. Medical History Questionnaire  1. Are you having pain or discomfort at this time?  2. Do you feel nervous about having dentistry?  3. Have you ever had a bad experience in the dental office?
  36. 36. Systemic Problems  Heart failure  Heart disease or attack  Angina pectoris  High blood pressure
  37. 37. Systemic Problems  Dysrhythmia  Congenital heart lesions  Rheumatic fever / Scarlet fever  Pacemaker
  38. 38. Systemic Problems  Renal disease  Stroke  Ulcers  Emphysema
  39. 39. Systemic Problems  Tuberculosis  Asthma  COPD  Hay fever
  40. 40. Systemic Problems  Sinus trouble  Diabetes  Thyroid disease  Chemotherapy or Radiation therapy