Common medical emergencies and their management in Dental Practice

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Common medical emergencies and their management in Dental Practice

  1. 1. COMMON MEDICAL EMERGENCIES AND THEIR MANAGEMENT IN DENTAL PRACTICE CONDITION MEDICAL HISTORY SIGNS / SYMPTOMS ROUTE & DRUG + MANAGEMENT CAUTION ADRENAL Long term administration Hypotensive under IM 100mg Dose adjustment prior to INSUFFICIENCY of oral corticosteroids physiological stress, Hydrocortisone Sodium if major procedure. abnormal heart rate, vomiting more than Oxygen 15 litres per nausea, vomiting, once. minute. extreme weakness, Oral Glucose. Hospital transfer, if drowsiness, severe required. headache, abdominal tenderness. ANAPHYLAXIS Previous history of Rapidly developing life- IM 1:1000 Adrenaline ABCDE allergy. threatening airway and/ 12 years to adult: 0.5ml Manage airway, Drug or contact with or breathing and/or 6-12 years: 0.3ml breathing, substances such as circulation problems. <6 years: 0.15ml blood pressure (laying latex. Urticaria, erythema, (Repeat after 5 min if not the patient flat, raising rhinitis, conjunctivitis. better) the feet),oxygen (15 Abdominal pain, litres per minute) vomiting, diarrhoea and a sense of impending doom. Flushing or pallor. ANGINA Previous history of Pressure or squeezing in Sublingual Glyceryl Hospital Transfer if angina. the chest. The pain also Trinitrate spray worsening situation. can occur in shoulders, or tablets If cyanosed: oxygen (15 arms, neck, jaw, or back. litres per minute) Angina pain may even feel like indigestion.Adapted from The Resuscitation Council (UK) Resources COURTESY: DR NEIL PANDE (NEPAL)
  2. 2. COMMON MEDICAL EMERGENCIES AND THEIR MANAGEMENT IN DENTAL PRACTICE CONDITION MEDICAL HISTORY SIGNS / SYMPTOMS ROUTE & DRUG + MANAGEMENT CAUTION ASTHMA Known Asthmatics, Acute severe asthma: Salbutamol Inhaler Oxygen (15 litres per under oral and Inability to complete 100microgram per minute) inhalational therapy / sentences in one breath. actuation upto 10 Hospital Transfer, if nebuliser / steroid / Respiratory rate > 25 per actuation with a spacer, required. hospitalisation minute. every 10 mins. if Tachycardia (heart rate > required. 110 per minute). Life threatening Bronchospasm / Life asthma: threatening signs: Cyanosis or respiratory IM 1:1000 Adrenaline rate < 8 per minute. 12 years to adult: 0.5ml Bradycardia (heart rate < 6-12 years: 0.3ml 50 per minute). <6 years: 0.15ml Exhaustion, confusion, (Repeat after 5 min if not decreased conscious better) level. CARDIAC ARREST Heart condition Absence of pulse, AED ABCDE breathing. CHOKING & Iatrogenic Cough and splutter. Symptomatic treatment If any large pieces of ASPIRATION Loose prosthesis. Difficulty breathing. of wheeze with a foreign material have Local anaesthesia may Breathing may become salbutamol inhaler. been aspirated, chest x- diminish the normal noisy with wheeze Follow algorithm. ray may be warranted. protective pharyngeal (usually aspiration) or reflexes. stridor (usually upper airway obstruction). ‘Paradoxical’ chest or abdominal movements. Cyanosis and loss of consciousnessAdapted from The Resuscitation Council (UK) Resources COURTESY: DR NEIL PANDE (NEPAL)
  3. 3. COMMON MEDICAL EMERGENCIES AND THEIR MANAGEMENT IN DENTAL PRACTICE CONDITION MEDICAL HISTORY SIGNS / SYMPTOMS ROUTE & DRUG + MANAGEMENT CAUTION EPILEPTIC SEIZURE Epileptic with recent Aura If blood glucose <3.0 Must continue their change in medication/ Sudden loss of mmol per litre:oral/buccal normal dosage of precipitating factor and consciousness, rigid, glucose, or glucagon anticonvulsant drugs time of last attack to be falls, may give a 1mg IM. before attending for noted cry, and becomes Convulsive movements dental treatment. cyanosed (tonic phase) lasting 5 minutes or Check glucose level. followed by jerking longer) or recur in quick During a seizure try to movements of the limbs; succession: Midazolam ensure that the patient is the tongue may be bitten not at risk from injury but (clonic phase). Frothing, make no urinary incontinence. attempt to put anything Floppy, unconscious. in the mouth or between Conscious, confused. the teeth. Oxygen (15 Decreased BP, Pulse. litres per minute) HYPERVENTILATION Severe Anxiety and Light headedness or Reassurance Breathing faintness, spasm of muscles around the face and of the handsAdapted from The Resuscitation Council (UK) Resources COURTESY: DR NEIL PANDE (NEPAL)
  4. 4. COMMON MEDICAL EMERGENCIES AND THEIR MANAGEMENT IN DENTAL PRACTICE CONDITION MEDICAL HISTORY SIGNS / SYMPTOMS ROUTE & DRUG + MANAGEMENT CAUTION HYPOGLYCEMIA Insulin treated diabetics Shaking and trembling. Early stages - where the ABCDE if no sign of life. more prone / Poorly Sweating. patient is co-operative controlled less aware Headache. and conscious with an diabetics!!! Difficulty in intact gag reflex, give concentration / oral glucose (sugar vagueness. (sucrose), milk with Slurring of speech. added sugar, glucose Aggression and tablets or gel). (may be confusion. repeated in 10 -15 mins) Fitting / seizures. In more severe cases - Unconsciousness. where the patient has Blood glucose <3.0mmol impaired consciousness, per litre . is uncooperative or is unable to swallow safely buccal glucose gel and / or IM Glucagon (1mg in adults and children >8 years old or >25 kg, 0.5mg if <8 years old or <25 kg) MILD ALLERGY Previous history of Urticaria, Oral Chlorphenaramine Monitor allergy. Maleate Drug or contact with substances such as latex.Adapted from The Resuscitation Council (UK) Resources COURTESY: DR NEIL PANDE (NEPAL)
  5. 5. COMMON MEDICAL EMERGENCIES AND THEIR MANAGEMENT IN DENTAL PRACTICE CONDITION MEDICAL HISTORY SIGNS / SYMPTOMS ROUTE & DRUG + MANAGEMENT CAUTION MYOCARDIAL Cardiac Conditions Progressive onset Give sublingual Call Ambulance INFARCTION severe, crushing pain in Nitroglycerine. immediately. Allow the the centre and across 300mg Aspirin orally. patient to rest in his most the front of chest. May comfortable position. radiate to the shoulders Oxygen 15 litres/min. and down the arms Assess. (more commonly the If becomes unresponsive left), into the neck and ABCDE. jaw or through to the back. Pale, clammy skin Nausea/vomiting Weak pulse, low bp Shortness of breath. POSTURAL Rising abruptly or of Dizziness Lay the patient flat as When rising, patients HYPOTENSION standing upright for too Going towards syncope. soon as possible and should take their time. long raise the legs to improve ACE inhibitors to control venous BP return. Loosen any tight clothing.Adapted from The Resuscitation Council (UK) Resources COURTESY: DR NEIL PANDE (NEPAL)
  6. 6. COMMON MEDICAL EMERGENCIES AND THEIR MANAGEMENT IN DENTAL PRACTICE CONDITION MEDICAL HISTORY SIGNS / SYMPTOMS ROUTE & DRUG + MANAGEMENT CAUTION STROKE Hypertension Sudden numbness, Hospital Transfer Heart Disease tingling, weakness, or High Cholesterol loss of movement in your Tobacco user face, arm, or leg, Diabetes especially on only one Overweight/obesity side of your body, vision Family History changes, trouble speaking. Sudden confusion or trouble understanding simple statements, problems with walking or balance, severe headache that is different from past headaches. SYNCOPE Repeated Faints Faint / dizzy / light Lay the patient flat as Oxygen (15 litres per headed. soon as possible and minute) Slow pulse rate. raise the legs to improve Low blood pressure. venous Pallor and sweating. return. Nausea and vomiting. Loosen any tight Loss of consciousness. clothing.Adapted from The Resuscitation Council (UK) Resources COURTESY: DR NEIL PANDE (NEPAL)

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