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  1. 1. DENTAL EMERGENCIES Assoc. Prof. (Dr) Rashidi Ahmad Dept. of Emergency Medicine
  2. 2. Objectives Common dental emergencies – What? When? How? Where? Who?. Basic approach to dental emergencies
  3. 3. Factors increasing risk during dental treatment Increased number of older patients Medical advances – drug therapy, surgical techniques Longer appointments Increased drug use – LA, sedatives, analgesics, antibiotics
  4. 4. Death Most emergency situations: potentially life threatening BUT death is rare. 8 deaths a/w GA in a 20-year period (1 death in every 673,000 GA administration) Lytle JJ, Stamper EP: The 1988 anesthesia survey of the Southern California Society of Oral Surgeons, J Oral Surg 32:739. 1974 “10% of all non-accidental deaths are classified as sudden, unexpected death & unpreventable.” McCarthy EM. J Am Dent Assoc. 1971 83:1091
  5. 5. STILL OK????
  6. 6. “When you prepare for an emergency, the emergency ceases to exist” “To be forewarned is to be forearmed” “Prevention is better than cure”
  7. 7. Important Rules Find and correct life threats If life-threat is present, CORRECT IT! If it can’t be corrected Support oxygenation, ventilation, perfusion GET HELP & TRANSPORT!!
  8. 8. Life threatening events Airway obstruction Ventilation-perfusion mismatch Circulatory compromised Dysfunction of CNS
  9. 9. APPROACH S: Stop Procedure & Observe R: Response P: Position A: Airway B: Breathing C: Circulation/Cardiac Monitor/Cardioversion D: Dysfunction Of CNS & Definitive Management
  10. 10. Stop procedure Avoid injuries Proper assessment and management Proper position
  11. 11. Response Ability to speak Appropriate orientation If unconscious -Loud voice & gentle tap/shake Call for HELP!!
  12. 12. Airway Anticipate airway problems with Decreased level of consciousness Oral bleeding Foreign body Return head to neutral position Head tilt, chin lift, jaw thrust
  13. 13. Triple Maneuver
  14. 14. Breathing Is oxygen getting to the blood? - Is air moving? - Is it moving adequately? - Is it moving at an adequate rate?
  15. 15. Breathing Oxygenate immediately if: Decreased level of consciousness Shock Severe hemorrhage Chest pain Dyspnea Respiratory distress If you think about giving oxygen, GIVE IT!!
  16. 16. Resuscitation trolley
  17. 17. Assisted ventilation Respirations <12 Respirations >24 Tidal volume decreased Respiratory effort increased
  18. 18. Circulation Is the heart beating? Is there serious external bleeding? Does patient have radial pulse? Absent radial = systolic BP < 80 Does patient have carotid pulse? Absent carotid = systolic BP < 60
  19. 19. Circulation Serious oral bleeding? Clear the airway/suction Treat the cause/stop the bleeding – bone wax, stitches ? Intubation GXM – blood transfusion Surgical intervention Is patient perfusing? Cool, pale, moist skin = shock UPO Capillary refill > 2 sec = shock UPO Restlessness, anxiety, combativeness = shock
  20. 20. Cardiac monitoring/defibrillator Heart rate Dysrythmias Ischemic changes Defibrillation
  21. 21. Disability (CNS dysfunction) Decreased LOC = Hypoxia Hypoglycemia Shock Acute stroke Think about drugs, alcohol, or personality
  22. 22. Definitive management Confirm the problem Treat the cause Treat the complication Disposition
  23. 23. Conclusion Be prepared – staffs, equipments, training Proper assessment – past medical history, history of allergy, & PE Intervene possible complication Emergency approach
  24. 24. APPROACH S: Stop Procedure & Observe R: Response P: Position A: Airway B: Breathing C: Circulation/Cardiac Monitor/Cardioversion D: Dysfunction Of CNS & Definitive Management
  25. 25. Important message Survival depends on assessment skills Good assessment results from An organized approach Clearly defined priorities Understanding available resources