presentation talking about management of medical emergency at dental clinic

1. MEDICAL EMERGENCIES IN DENTAL
AND MAXILLOFACIAL SURGERY
DR. ZINA BAKR
MAXILLOFACIAL DEPARMENT

2. Introduction:
The management of emergency should follow the universally accepted ABCDE
approach which incorporate:
A: Airway
B: Breathing
C: Circulation
D: Disability
E: Exposure

3. Medical emergencies that are life threatening and need immediate management are
discussed here:
1. Acute asthmatic attack
2. Airway obstruction.
3. Anaphylaxis
4. Chest pain
5. Cardiac arrest.
6. Adrenal crisis.
7. Hypoglycemia.
8. Tonic-Clonic seizure
9. Syncope.

4. 1- ASTHMA
1.1 :Acute asthmatic attack :
Stress , anxiety and infection can precipitate an asthmatic attack in patient who are prone.
Signs and symptoms:
■ Difficulty in breathing, Cough, Wheezing.
■ Use of accessory muscles of respiration.
■ Tightness of chest.
■ Rapid breathing and tachycardia.
■ Pale and anxious looking face.

5. Management:
 Keep the patient in a sitting position.
 Give 2 puffs of Salbutamol ( 100 microgram/puff)
inhaler
 If no rapid response , give further puffs through a
spacer device.
 Consider O2 supplementation.

6. 1.2: Life threatening acute asthma:
If asthmatic attack do not respond to standard bronchodilator therapy, it
can be fatal if no further proper management done.
Signs and symptoms :
o Silent chest, poor respiratory effort and cyanosis.
o SPO2 < 92%
o Exhaustion.
o Altered consciousness.
o Week or irregular pulse.

7. TREATMENT:
 Oxygen supplementation.
 Hydrocortisone: 100 mg IV or prednisolone 40-50
mg orally.
 Salbutamol 100 microgram/puff,
- give 4 puffs through spacer device,
-followed by 2 puffs every 2 minute according to
response, up to a maximum of 10 puffs.
-Give salbutamol 5mg by neubilizer.
 Adrenaline 1mg/mL of a 1:1000 dilution IM.
 Aminophylline 25mg/ml

8. 2- AIRWAY OBSTRUCTION:
Signs and symptoms :
■ Distressed patient.
■ Abnormal noises like gurgling , crowing, snoring.
■ Forced respiratory efforts.
■ No sound at all in complete airway obstruction.
■ Cyanosis leading to loss of consciousness.

9. MANAGEMENT:
■ Encourage the patient to cough.
■ If an object could be visualized, retrieve it with
appropriate instrument.
■ If obstruction caused by fluids, use high volume
suction. and lay in lateral position.
■ Back slaps: up to five back blows
■ Abdominal thrust: (Heimlich maneuver) up
to five abdominal thrusts
■ If these measures fail, the patient will lose
consciousness.
Lay the patient down on floor and start with CPR

10. ( start with chest compression even if
there is pulse , as this can help relieving the
obstruction)
■ If there is partial obstruction supply O2 .
■ In patient with a completely obstructed,
and could not be relieved with previous
measures where there are no facilities or
skills to use a laryngoscope, emergency
procedures like jet insufflation or
cricothyroidotomy may be needed as life
saving measures.

11. 3- ANAPHYLAXIS:
Sudden onset, severe form of life threatening
allergic reaction.
Signs and symptoms :
 Face red and hot.
 Generalized skin rash with itching.
 Breathing difficulties manifested as stridor,
wheezing or hoarseness.
 Pulse may initially be rapid but can gradually
become weak or impalpable.
 Hypotension can progress into cardiac arrest.

12. MANAGEMENT:
■ Make sure airway is clear.
■ Administer adrenaline
■ Patient in supine position.
■ Supply oxygen at 15L/min
■ Chlorpheniramine maleate IM or IV. (Allermine) 10mg/mL
■ Hydrocortisone sodium succinate 100mg IM or slow IV.
■ Support circulation with Ringer lactate solution or 0.9% normal
saline.
■ Continuous monitoring.
■ Reassess the need for further adrenaline
■ Start CPR in case of cardiac attack.

13. 4-CHEST PAIN:
4-1: Angina:
Transient decrease of oxygen supply to cardiac
muscle precipitate pain.
Sign and symptoms:
■ Pain in the center of the chest heaviness , or
tightness in the chest .
■ Pain in the neck , throat , arms , stomach and
back
■ Pain can be associated with light-headedness ,
nausea, shortness of breath and sweating.

14. MANAGEMENT
■ Stop the procedure and reassure the patient.
■ Clear the mouth from any foreign bodies.
■ Let the patient attain a comfortable position.
■ Administer nitroglycerin subligual spray or tablets.
■ O2 supplementation.
■ Check for any irregularities of pulse.
■ If pain persist it should consider as MI.

15. 4-2: Myocardial infarction:
Signs and symptoms:
o Same as angina but more sever in intensity
and lasts long time.
o Chest pain getting progressively worse.
o Irregular pulse or weak pulse.
o Falling blood pressure.

16. Management:
■ Let the patient in the most comfortable position
■ Administer soluble aspirin 300 mg , chew and swallow
■ Patient should receive at least two doses of sublingual
nitroglycerin spray or tablet.
■ Give antiemetic metoclopramide hydrochloride by IV ,
analgesia and O2 on need.
■ Patient where conscious level deteriorates.
_Watch for signs of cardiac arrest and start CPR.

17. 5- CARDIAC ARREST:
Sudden loss of heart function resulting in hypoxic
damage to body organs.
Signs and symptoms:
■ Unconscious
■ Unresponsive
■ Not breathing normally or absent breathing.

18. Management:
■ Call for help and ask to bring
defibrillator and emergency
drug kit.
 CPR.
 Second person check
ventilation.
 30 Chest compression
and 2 ventilation (bag
valve mask).

19. 6-ACUTE ADRENAL INSUFFICIENCY
Adrenal crisis , Steroid crisis, Addisonian crisis
Sudden and severe hypotension in patients
who cannot mount a normal stress-induced
cortisol response.
Signs and symptoms:
■ Severe hypotension which can manifest as
weakness, confusion , dizziness,
drowsiness, loss of consciousness.
■ Nausea, vomiting.
■ Seizure may occur following deep faint.

20. TREATMENT:
 Lay patient flat.
 Give high flow O2
 Establish IV access.
 Administer hydrocortisone sodium succinate by IV 100 mg.
 Start IV infusion of 0.9% normal saline.

21. 7-HYPOGLYCEMIA:
When blood glucose level drop to a very low level lass than 70
mg/dL ,it cause permanent neurological damage within 4-6 min.
Signs and symptoms :
■ Anxious , confused, irritable or aggressive behavior.
■ Sweating
■ Nausea and vomiting
■ Hungry
■ Visual disturbances
■ convulsion
■ loss of consciousness.

22. Management:
-conscious patient
■ 10-20 g of glucose.
■ Can be repeated in 10-15 minute
■ Once the patient condition improves provide a carbohydrate meal
- Unconscious patient
■ Check the airway.
■ Put patient in recovery position
■ Supply O2 at 15 L/min
■ Glucagon by IM into the anterolateral thigh.
■ Once the patient regain consciousness give oral glucose and carbohydrate.

23. 8-GRAND MAL SEIZURES:
Signs and symptoms:
o Patient behave indifferently, spaced out and
detached.
o Patient will go rigid, loss of consciousness,
loss balance and may cry tonic phase.
o After a few second sudden rhythmic jerking
movements of the body lasting for up to 2
minute
o Mouth goes rigid , frothy saliva can be
noticed.
o Cyanosis around the mouth can be noticed
o Following seizure patient can go into varying
periods of confused state and may fall a
sleep.

24. Management:
 Prevention injury to patient.
 Do not restrain or insert any object between teeth.
 Supply O2 15 L/min.
 Check for hypoglycemia.
 If lasts more than 5 min or repeated seizure activity , which can be fatal,
another management needed:
-Urgent transfer to appropriate medical center
- Administer midazolam IV.

25. 9- Syncope:
Energy demand of the brain are met by oxidation of glucose and
when this affected the patient loss consciousness and falls.
Signs and symptoms:
 Feeling unwell
 Nausea, lightheadedness
 Blurred vision.
 Pallor and sweeting
 Sudden loss of consciousness.
 Seizure.

26. Management:
 Clear airway
 Position flat or legs elevate
 Fresh air and do not let people to crowd around.
 Place cold towel on forehead
 Supply O2.
 Once recovered give the patient a sugary drink.

27. 10- OTHER CAUSES OF LOSS OF
CONSCIOUSNESS:
10-1: Postural hypotention:
Place patient in a supine position and bring him to the upright position
slowly.
10-2: Hyperventilation:
 Lightheaded, dizzy
 chest discomfort and muscle spasm especially in hand and feet.
 Numbness in the arms and perioral region.
 Control the crying/breathing.
 Use a paper bag to rebreathe exhaled air.