This document discusses several medical conditions that can occur during dental procedures in geriatric patients or those with secondary diseases: 1. Anaphylaxis should be treated with epinephrine injections and oxygen therapy. 2. Uncontrolled bleeding can be caused by medications like antiplatelets and anticoagulants, and can be addressed with local adrenaline packing and maintaining blood volume. 3. Hypoglycemia presents with symptoms of sweating and tremors and is treated with intravenous dextrose or oral glucose. The document provides treatment guidelines for several other potential medical emergencies during dental procedures.

1. Dr. RAGHU PRASADA M S
MBBS,MD
ASSISTANT PROFESSOR
DEPT. OF PHARMACOLOGY
SSIMS & RC.

2. Tendencies for longer dental procedures
Increased use of drugs
Secondary diseases in geriatric populations
The conditions are
Anaphylaxis
Uncontrolled Bleeding
Unconciousness-vasovagal attack
Hypoglycemia
Seizures
Arrhythmia
Cardiac arrest

3. 1.Anaphylactic Shock 1:1000 adrenaline
0.5 ml for adults IM
0.3ml for child 6-12 years
May be repeated after 10-20 minutes .
Avoid I/V because fatal ventricular fibrillation may occur.
Contraindications: Hyperthyroidism, HTN
Arrhythmias
2. Oxygen –high flow
3. Cardiopulmonary resusitation
4. IV hydroocortisone 100-200mg
5. Chlorpheniramine IM 20 mg

4. Cotton swab dipped in 1% adrenaline solution packing
Common causes
patients on antiplatelet drugs
patients on antico-agulation therapy
hemophiliacs
Long term glucocorticoid therapy

5. Premonitory stage-diazepam-10-15mg repeated once
after 15 min
Early status-lorazepam-0.1mg/kg repeated once
after 15 min
Give usual AED medications if already on treatment
Established status-fosphenytoin infusion15-20mg/kg
Refractory status-general anaesthesia-propofol 2-
10mg/kg/hr
-midazolam-0.5mg/kg/hr
-Thiopental sodium 3-5mg/kg
Anaesthesia continued for12-24 hrs after last clinical or
electrographic seizure
5

6. 6

7. 1. Pain and anxiety-- -GTN, morphine
2. Opioid analgesics and Antianxiety agents
3. Pethidine, Diazepam, alprazolam
4. General measures-O2 therapy, dopamine,
5. atropine, diltiazem,
6. Maintainance of blood volume-Saline , dextran
7. Correction of acidosis- sod. Bicarbonate infusion
8. Prevention of treatment of arrhythmias
9. -beta blocker
7

8. 7. Pump failure-furosemide, vasodilators, ionotropic
drugs
8. Prevention of thrombus extension, venous
thrombosis- aspirin, heparin, anticoagulants-
dalteparin, Enoxaparin
9. Thrombolysis and reperfusion-fibrinolytic agents-
streptokinase, urokinase
10. Prevention of remodeling and CHF-ACE inhibitors,
ARBs- lisinopril, ramipril
11. Prevention of future attacks-platelet inhibitors-
clopidogrel, β blockers, statins
8

9. Hypovolemic, Septic, Cardiogenic , Anaphylactic
Neurogenic and Obstructive
Hypovolemic Shock
Airway Breathing Circulation
Establish 2 large bore IVs or a central line
Crystalloids
Normal Saline or Lactate Ringers-Up to 3 liters
Packed Red Blood Cells
O negative or cross matched
Control any bleeding
Arrange definitive treatment

10. “Crystalloids”
Normal saline (just NaCl).
Lactated ringers
Plasmalyte-balanced crystalloid solution with
multiple electrolye solution
Normosol-solution of balanced electrolytes in water
for injection.
Last 3 have K+ and other stuff (acetate, Mg++, etc.)

11. Crystalloids enter entire ECF: ISF (3/4 of ECF) and IVF
(1/4 of ECF).
3 or 4:1 for replacement of blood loss with crystalloid
Colloids only enter IVF (in short term– 16 hour half-
time for entrance into ISF)
1:1 replacement of blood loss with colloid

12. 12
Epinephrine , β1, (β2) 2-10 µg/min
Norepinephrine , β1 0 - 2-20 µg/min
Dopamine β1, DR, (α ) 1 - 30
Dobutamine β1, β2 2 - 20
Phenylphrine  20-200µg/min
Vasopressin Angiotensin III 5 - 20
Amrinone PDI 2 -15
Drug Receptor CO SVR Dose Range
0 -
(µg/kg/min)
1
0

14. Careful replacement of fluid deficits.
Correction of acidosis & hyperglycemia via Insulin
administration.
Correction of electrolytes imbalance.
Treatment of underlying cause.
Monitoring for complications of treatment.

15. Hypoglycemia-(bld glucose < 60mg)
due to large dose or missed meals symptoms counter
regulatory sympathetic stimulation- sweating, anxiety,
palpitation and tremors
Those symptoms due to deprivation- dizziness,
headache, visual disturbance, hunger
Treatment
20% dextrose IV 100ml or
50ml 50% dextrose IV

16. Condition precipitated by sudden withdrawal of
steroids after long term administration
ACTH (adrenal corticotropic hormone) regulates
hormone secretion by the cortex of the adrenal glands.
ACTH- stimulates –Glucocorticoids, mineralocorticoid
and androgens. ACTH-stimulated by trauma and stress
It presents as weakness , hypotension, dehydration
Treatment
Hydrocortisone hemisuccinate 100mg every 4-6hrs
Correction of fluid and electrolyte balance

17. Due to hypocalcemia
Presents as muscle cramps, paraesthesias,
laryngospasm and convulsions
Treatment
Slow IV injection of 5-20 ml 10% calcium gluconate

18. Acute attach of bronchial asthma
Oxygen free flow
Nebulization with salbutamol and ipratropium bromide
Nebulization with budesonide
IV injection of deriphylline and dexamethasone

19. 19
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