preparation prevention recognition management of common medical emergencies in dental practice harihtes@gmail.com

2. Before I start my seminar let me ask you a question
Are we really supposed to treat medical emergencies we might encounter??
Considering we are prespecialized with emphasis on single organ
system…..
Neglecting all so made rules & inferiorities, we are morally obliged to
manage medical emergency situations un till emergency team arrives.

3. Guided by
Dr.Yadav Rao

4. CONTENTS
 INTRODUCTION
 DEFINITIONS
 CLASSIFICATION OF LIFE THREATENING EMERGENCIES
o UNCONSCIOUSNESS
Vasodepressor Syncope
Acute Adrenal Insufficiency
• ALTERED CONSCIOUSNESS
Diabetes Mellitus: Hyper and Hypoglycemia
Thyroid Gland Dysfunction
Cerebro vascular Accident
• RESPIRATORY DISTRESS
Foreign Body Airway Obstruction
Hyperventilation
Asthma
Heart Failure and Acute Pulmonary Edema
SEIZURES

5. • CHEST PAIN
Angina Pectoris
Acute Myocardial Infarction
• DRUG RELATED EMERGENCIES
Hypersensitivity
Drug Overdose Reactions
 PREVENTION
conversational history
vital signs
 BASIC EMERGENCY KIT
 Basic Life Support
 CONCLUSION
 REFERENCES

6. An emergency is a situation in which a risk to
health, life, property or environment is about to
happen. Most emergencies need quick attention to
prevent it from becoming lethal.
A medical emergency is an injury or illness
that is acute and poses an immediate risk to a
person's life or long term health.
DEFINITIONS

7. 
 Life threatening emergencies are not uncommon in dentistry .
 Medical emergencies in dental practice are a minefield into which the
unsuspecting dental practitioner may tread if he is not aware of basic life
support
INTRODUCTION
Example of Dental students A and B
Eyes cannot see what mind doesn’t know

8. • They are potentially life threatening as death occurs rarely.
Factors that increase their likelihood are
1. Increasing number of older persons seeking dental care
2. Growing trend towards longer appointments.
3. increasing use and administration of drugs.
4.present day pts enjoy many medical advances that wernt
available 20yrs back
• The ultimate goal for a dentist managing a medical emergency is
to prevent the death of the victim, a goal achieved through office
preparation, prompt recognition and effective management.
• Every practitioner must be aware to prevent needless death and
morbidity

9. CLASSIFICATION
BASED ON CARDIAC NON-CARDIAC
NON-CARDIAC
EMERGENCY
STRESS
VASODEPRESSOR
SYNCOPE
HYPERVENTILATION
SEIZURES
ACUTE ADRENAL
INSUFFICIENCY
THYROID STORM
ASTHMA
NON-CARDIAC
EMERGENCY
NON-STRESS
ORTHOSTATIC
HYPERTENSION
OVERDOSE
REACTION
HYPOGLYCEMIC
REACTIONS
HYPERGLYCEMIA
ALLERGY
CARDIOVASCULAR
STRESS
ANGINAPECTORIS
ACUTE MI
ACUTE HEART
FAILURE
CEREBRAL
ISCHEMIA &
INFARCTION
CARDIO
VASCULAR
NON-STRESS
ACUTE MI
SUDDEN CARDIAC
ARREST

10. 
 Prevention is lot better than management
 #1. way to prevent medical emergency occurrence is through
PREVENTION
1.A good Conversational
history
2. Checking Vital signs

11.  It include questions we need to ask patients to extract info regarding their health status
 Questions shouldn’t be close ended eg : Any chane in insurance coverage
 Important questions include
 1. Do you drive????====diabetic,epileptic,alcoholic
 2.can you walk flight of stairs with out a block??
 3.for Diabetic pts
• Maturity type 1 or type 2
• Did you take your medications today
• Did you eat?
• Ever been in hospital for problem
Conversational history

12. 4.For Asthmatic pts
type of asthma allergic or environmental or emotional
Do you have inhaler
Ever been in hospital for problem
5.For Epileptic pts ?
What type?
What is your aura?
How often and when was your last attack?
Ever been in hospital for problems?
6.For Angina pectoris pts
What are your signs and symptoms?
How often do you get them?
What do you do?
How often do you use Nitro?
Ever been in hospital for problem

13. DASH approach
DASH the ABC’S
Must ask questions for every patient
Any new Drugs
Any Allergies
Any Surgeries
Any Hospitalization
Advanced questions include
Aspirin regimen or sensitive to it
Any Bleeding History
Chest pain- any history
Shortness of breathe

14. Vital signs
• Automated B.P apparatus-to know pre op
bp
• Pulse oximeter – to know pulse and
oxygen saturation in real time
• Glucometer- to know blood glucose levels
• Thermometer-temperature
Rate Pulse Pressure Product:
RPP = systolic blood pressure x Pulse
If its greater than 12000 its significant –dr.kwin
Faster pulse lesser o2 supply to myocardium
They are vital for a reason any deviation from normal explains situation that
might arise different from normal

15. A great LA administration and testing it can significantly reduce medical
emergencies in dental practice
Because Fear and unexpected pain can trigger
• Syncope
• Hyperventilation
• Epileptic seizure
• Angina attack
• Asthmatic attack

16. 
Prepare
 If you prepare for emergency , emergency ceases to exist.
 Dentist and assistant staff should be prepared to handle
emergency with out surprise.
 Preparation includes
1. Having readily available Basic emergency kit
2. Mock drills to handle emergency situations
3.Regular knowledge updates wrt updated guidelines
4.Color coded algorithm cards for better
coordination during an emergency

17. 
 Following are 10 basic components
 1. oxygen
 2.spirits of Ammonia
 3.Epinephrine---A1B1B2
 4.Benadryyl (diphenhydramine)- Antihist
 5.Nitroglycerine sprays or pills
 6.Albuterol(ventolin/proventil) Bronchodilator
 7.Glucose
 8.Aspirin
 9.Nitrous oxide 4l/l = 10mg of morphine
 10.MIDAZOLAM OR DIAZEPAM—S.E
Basic Emergency kit

19. For our convenience and ease
Common emergencies can be grouped under following color codes
white = syncope
Yellow =Altered consciousness
Hypo and hyperglycemia
Hyperthyroidism
Stroke
Seizures
Adrenal insufficiency

20. GREEN = HYPERSENSITIVIY REACTIONS
ANAPHYLACTIC SHOCK
RED = ALL CARDIOVASCULAR
ANGINA
M.I.
CARDIAC ARREST
CEREBRO VASCULAR ACCIDENT
BLUE= RESPIRATORY
HYPERVENTILATION
ASTHMA

21.  The first step in management of all emergency situations is the
implementation, as needed of BLS
 BASIC LIFE SUPPORT (CPR) : IT CONSISTS OF
APPLICATION , as needed , of the procedures of
positioning(p), Airway maintenance, Breathing (B) and
circulation (c) to victim of any medical emergency, including
cardiac arrest, untill recovery occurs or until victim can be
stabilized and transported to an emergency care facility or
untill advanced life support I available

22. 
 What it is BLS
 PCABD
 POSITIONING THE PATIENT
 AIRWAY
 BREATHING
 CIRCULATION
 DEFINITIVE CARE
Basic life support

23. 
 Victim is positioned in supine position .
 Extra head supports should be removed from head rest of
dental chair.
 For pregnant women in third trimester if they lose
consciousness seated in dental chair,
chair should be lowered to supine position & patient is
turned to right side &tuck a blanket on left side to
maintain that position.
POSITIONING THE
VICTIM

24. 
 Opening airway & restoration of
breathing is an important step in BLS.
 Head tilt –chin lift : one hand placed
on the forehead ,two fingers under
the victims chin ,lifting the chin
&rotating the head upward
&backward.
AIRWAY

25. 
AIRWAY
Jaw thrust :
Rescuer must grasp
the angles 0f
mandible with both
hands &displace the
mandible forward.
These actions clear
the airway

26. 
BREATHING
Look – listen –feel technique
 while maintaining head
tilt ,the rescuer assesses
airway patency by placing
their ear 1 inch from the
victims' nose & mouth
,watching the chest for
spontaneous respiratory
movements.

27. 
BREATHING
 Artificial Breathing: if respiratory arrest occurs the
victim may receive artificial ventilation in one of 3 ways.
1 Exhaled air ventilation contains around 16% of
oxygen which is enough.
2 Atmospheric air ventilation: 21% of o2
3 Oxygen ventilation: 100% usually

28. 
CIRCULATION
 Includes monitoring of heart rate and blood pressure.
 In emergency carotid artery is the most reliable indicator
of cardiovascular function in the adult.
 To locate the carotid pulse the rescuer places two fingers
(not the thumb)on the victims thyroid cartilage &moves
them laterally in to the groove formed by the
sternocleidomastoid muscle .

29. 
LOCATING THE
CAROTID PULSE

30. Cardio Pulmonary resuscitation:
why and When to perform : In emergencies to restore circulation and prevent
cell death and morbidity.
CPR should be done till a spontaneous pulse can be felt.
Patient should be in supine position.
Rescuer position kneeled to side of patient
Locate lower third of sternum and locate area just left of that.
Place heel of one hand on on area located and other hand heel over first hand
and interlock digits.
Elbows should be upright and shouldn’t be bent during pressure application and
hands should be along long axis of sternum
Compressions should be performed with enough pressure so as to depress
sternum from 2 to 2.5 inches in adult at a rate of 100-120 per min
Every 2mins rescuer should interchange to prevent fatigue

31. cpr
30 compressions
followed by 2
ventilations
5 compressions
followed by 1
ventilation
One rescuer
Till you see spontaneous breathing
After 15 to 20 mins if recovery doesn’t occur you can declare
patient as clinically dead….*
when we should stop??
Do not stop cpr for more than 10 seconds except for
defibrillation
After 20mins of CPR if no recovery occurs then patient might be
in refractory asystole that’s when pt can be declared as dead even
if cardiac pattern returns by then the brain has dead.

32. THANK YOU