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Medical Emergencies in clinical practise
This document provides information on various medical emergencies that may occur in a dental practice setting. It discusses conditions that may arise due to anxiety of the procedure like hyperventilation and vasovagal syncope. It also covers emergencies related to prior medical conditions of the patient such as asthma, cardiac issues, epilepsy, and diabetes. Procedures that could potentially cause emergencies like anaphylaxis from anesthetic drugs or choking from a foreign object are also outlined. Each condition discusses signs, symptoms and recommended management approaches.
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Medical Emergencies in clinical practise
- 1. MEDICAL EMERGENCIES DR. CHHAVIBAJAJ AIILSG
- 2. CONTENTS • HYPERVENTILATION • EPILEPSY •HYPOGLYCEMIA • ANGINA PECTORIS • MYOCARDIALINFARCTION • HAEMORRAHGE • FOREIGN BODY ASPIRATION • ACUTE ADRENALINSUFFICIENCY • ASTHEMA • VASOVAGALSYNCOPE • POSTURAL HYPOTENSION • ANAPHYLACTICREACTION • SHOCK
- 3. MEDICAL EMERGENCIES INDENTAL PRACTICES DUE TO ANXIETY • SYNCOPE • HYPERVENTILATION DUE TO PRIOR MEDICAL CONDITION OF THE PATIENT • STATUS ASTHMATICS • CARDIAC EMERGENCIES (i) ANGINA PECTORIS (ii) ACUTE MI and CARDIAC ARREST • STATUS EPILEPTICUS • DIABETIC COMPLICATIONS (i) HYPOGLYCAEMIA (ii) HYPERGLYCAEMIA • ADRENAL CRISIS • HAEMORRHAGIC DISORDERS
- 4. DUE TO ANAESTHETICDRUGS USED BY ORAL SURGEON • ANAPHYLAXIS • LA toxicity AN ACCIDENT DURING THE PROCEDURE • NEEDLE BREAKAGE • CHOKING and ASPIRATION POSTSURGICAL SEQUELAE HAEMORRHAGE • HEMATOMA • SURGICAL EMPHYSEMA
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- 6. HYPERVENTILATION It is causedby ANXIETY Commonly seen in males The condition is self limiting and eventually the patient will settle It may lead to profound metabolic changes that include a fall in arterial carbon dioxide concentration It leads to Unconsciousness As the arterial carbon dioxide rises, the patient starts breathing and regains consciousness
- 7. MANIFESTATIONS • DIZZINESS • WEAKNESS •DISTURBED CONSCIOUSNESS • NUMBNESS OF FINGERS, TOES AND LIPS • INCREASED RATE AND DEPTH OF BREATHING • ANGINA • XEROSTOMIA • PALPITATIONS • TACHYCARDIA • MYALGIA • TREMOR • EXTREME ANXIETY
- 8. MANAGEMENT • STOP THETREATMENT • Make the patient lie in SEMI ERECT position • Ask patient to RE-BREATH into paper bag • Diazepam 10-15 mg (IV) for adults or Midazolam 3-5mg (IV)
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- 10. Postural Hypotension • Adisorder of autonomic nervous syndromein which syncope occurs when the patient assumes an upright position • PREDISPOSING FACTORS • With age • If we suddenly change the position of the dental chair after a long period to upright position • Drugs like vasodilators CLINICAL FEATURES • Palpitations • Generalized weakness • Fatigue • MANAGEMENT • Patient should be placed in supine position with legs elevated
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- 12. ASTHMA • Disease characterizedby increased responsiveness of trachea and bronchus to various stimuli and is manifested by undispersed narrowing of airway that changes in severity either spontaneously or as a result of therapy CLINICAL FEATURES • Respiratory Distress • Audible wheezing • Coughing • Dyspnea • Tachycardia
- 14. • DENTAL CONSIDERATIONS •ANXIETY REDUCTION PROTOCOL • Barbiturates, opioids, NSAIDS should not be used • MANAGEMENT • Position the patient in erect or semi-erect position • Administrate the normal anti-asthmatic drugs used by the patient followed immediately by hydrocortisone 200mg IV along with oxygen • If there is no response, give salbutamol by slow intravenous injection or 1ml in 1:1000 adrenaline IM
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- 16. ANGINA PECTORIS • SPASMODIC,CRAMP LIKE, CHOCKING, AND SUFFOCATING PAIN IN THE CHEST • The discomfort from the cardiac ischemia is a squeezing sensation which begins in the retrosternal location radiating to the left arm and shoulder TYPES • STABLE ANGINA Occurs only on exertions and relieved by rest • UNSTABLE ANGINA Intermediate between stable angina and myocardial infarction
- 18. Management • Change chairposition to patient’s comfort • Administrate 0.5 mg glyceryl tri-nitrate sublingually • Monitor vitals • If pain relieved in 2-3 mint, postpone dental treatment • If pain persists, hospital care is required
- 19. MYOCARDIAL INFARCTION • Clinicalcondition caused by necrosis of a region of myocardium due to decrease in the coronary artery blood supply • Patient complains of severe pain, usually described as pressing, squeezing, bursting, burning, crushing sensation within the chest not relieved by nitroglycerine and persists for a long time • SIGNS AND SYMPTOMS • Cold sweat • Levine sign • Dyspnea • Orthopnea • Nausea • Vomiting • Light headedness
- 20. • Patients withrecent MI episode within 6 months are usually on anticoagulants and at increased risk of another episode MANAGEMENT • Anxiety reduction protocol Dental treatment • should be carried out with • effective LA, • less anxiety and • oxygen saturation • Pulse and BP monitoring
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- 22. EPILEPSY • Group ofdisorders of brain function causing episodic disturbances of consciousness and motor and sensory function • STATUS EPILEPTICUS refers to a type of seizure that continues for more than 5 mint or a repeated seizure that beings before the individual recovers from the initial episode • CAUSES • Hypoxia secondary to syncope • Hypo glycaemia • LA overdose • Failure of epileptic patient to take anti-epileptic drug • Head injury
- 23. • TRIGGERING FACTORS •Flashing lights • Alcohol ingestions • Stress • Missed meal • Infection • Epileptic genic drugs • Withdrawal of anticonvulsant drugs • CLINICAL MANIFESTATIONS • AURA- involuntary movement of any part of the body before loss of consciousness • It consists of mood changes, irritability, brief hallucination or headache • Characterized by sudden loss of consciousness, continued spasm of respiratory muscles • Bladder and bowel control may be lost
- 24. • DENTAL CONSIDERATIONS- •Treatment should be undertaken only if the patient is under good control • Premedication with antianxiety drugs and stress reduction protocol should be followed • Optimal dosage of LA • MANAGEMENT • Terminate the treatment • If the patient is conscious, monitor vital signs, administrateoxygen, and consult a physician • If the patient is unconscious, transfer the patient to hospital care fascility • For status epilepticus • Administer diazepam 5mg per minute IV ( 10 mg) till seizure stops • Administer oxygen and transfer to hospital
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- 26. HYPOGLYCAEMIA • Common medicalemergency encountered in a diabetic patient resulting from mismatchof insulin dose and serum glucose • Clinical manifestations • Lethargy • Sweating • Tachycardia • Nausea • Anxiety • irritability • Unconsciousness • Hypothermia • Hypotension • Seizure
- 27. • DENTAL CONSIDERATIONS •Stress reduction protocol • Short duration appointments and early in the morning • Routine dental procedures can be performed after taking a meal and anti diabetic drugs • LA of short duration should be used without epinephrine • MANAGEMENT • In case of known diabetics, loss of consciousness is mainly due to hypoglycemia • If conscious, oral sugar or glucose should be given • If unconscious, 20ml of 50% dextrose IV
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- 29. ANAPHYLAXIS • Anaphylaxis isa clinical syndrome of severe hypersensitivity reaction characterized by CVS collapse, respiratory system depression, skin reactions and smooth muscle contractions • Clinical features Cutaneous manifestations • Pruritus • Urticaria • Angioedema Respiratory manifestations • Wheezing • Coughing • Stridor • Laryngeal edema
- 30. CVS Manifestations • Tachycardia •Shock • Light headedness • Hypotension • Cardiac arrest GIT manifestations • Nausea • Vomiting • Abdominalcramps • Diarrhea • Tenesmus MANAGEMENT • terminate the dentaltreatment • Allergic reaction confined to skin, antihistaminicis administered • If respiratory involvementis seen, supine position, clear upper airway, give oxygen, 0.5 ml of 1:1000 ml of epinephrine,chlorpheniramine10mg IV and 20mg IV of hydrocortisone
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- 32. VASOVAGAL SYNCOPE • Definedas transient loss of consciousness due to cerebral ischemia caused by a reduction in blood supply to the brain • It consists of three phases (a) Pre-syncope (b) Syncope (c) Post-syncope CAUSES • Psychological factor • Postural changes • Anoxia • Carotid sinus syndrome
- 33. Patho-physiology Anxiety • Increased releaseof Catechol amines • Decreased peripheralvascularresistance • Pooling of blood and fall in B.P. Compensatory mechanism • Hypotension • Reduced cerebral blood flow • Syncope • increased heart rate • Rapid breathing • Pallor • Perspiration • Decompensation
- 34. CLINICAL FEATURES ANDPATHOPHYSIOLOGY PRESYNCOPE CLINICAL FINDINGS PATHOPHYSIOLOGY FEELING OF WARMTH RELEASE OF CATECHOLAMINES PALLOR AND REDUCED B.P. DEC. PERIPHERAL VASCULAR RESISTANCE H.R. INCREASED COMPENSATORY REFLEX DIZZINESS REDUCED VASCULAR PERFORATION TO BRAIN YAWNING CEREBRAL HYPOXIA COLDNESS OF HAND AND FEET PERIPHERAL VASOCONTRICTION LOSS OF CONSCIOUSNESS FALL IN B.P. SYNCOPE CLINICAL FINDINGS PATHOPHYSIOLOGY BREATHING IRREGULAR CNS DEPRESSION INCONTINENCE MUSCLE RELAXATION AIRWAY OBSTRUCTION TONGUE FALL BACK
- 35. POSTSYNCOPE CLINICAL FINDINGS PATHOPHYSIOLOGY CONSCIOUSNESSREGAINEDINC IN B.P. PALLOR, NAUSEA, WEAKNESS, SWEATING AUTONOMIC DISTURBANCES H.R. AND B.P. NORMALISES RESTORED CEREBRAL PERFUSION
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- 37. FOREIGN BODY ASPIRATION •During oral surgical procedures, aspiration of foreign bodies into the airway is always a serious problem, which might cause severe airway obstruction • Objects swallowed into the GIT tract can produce peritoneal abscess, peritonitis and perforation PREVENTION- use of rubber dam, and oral packing using gauge CLINICAL FEATURES • Coughing • Chocking sensation • Dyspnea • Stridor • Cyanosis
- 38. MANAGEMENT • STOP THEPROCEDURE • ASK THE PATIENT TO COUGH OUT THE OBSTRUCTION • IF THE PATIENT IS UNABLE TO REMOVE, PERFORM HIEMLICH MANOEUVRE • PERFORM ‘FINGER SWEEP’ OR USE MAGILL FORCEP • IF SUCCESSFUL, PERFORM BLS
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