1) The document discusses various medical emergencies that may occur in a dental practice, including syncope, seizures, respiratory issues like asthma, cardiovascular issues like angina and myocardial infarction, allergic reactions, and drug-related issues.
2) It emphasizes the importance of prevention through thorough medical history collection, stress reduction techniques, and having emergency equipment available.
3) In the event of an emergency, the document outlines management steps like activating emergency response, providing oxygen, administering appropriate medications, and performing CPR if needed while waiting for additional medical help to arrive.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
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syncope in children , vasovagal syncope , fainting in children , causes of syncope in children , how to manage syncope in children , cardiac syncope , differnetial diagnosis of syncope , approach to syncope
Basic data about heat stroke uncluding: Definition, forms, exertional and non exertional, epidemiology, risk factors, characteristics, ettiology, pathophysiology, clinical presentation in all body systems, management, cooling tools, assisting procedures, complications, prevention, and patient education
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Precise guide for DGNM, B.Sc Nursing & M.Sc Nursing Students .. regarding shock, types of shock, stages of shock and its management. Highly recommended for II B.Sc Nursing Students.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
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syncope in children , vasovagal syncope , fainting in children , causes of syncope in children , how to manage syncope in children , cardiac syncope , differnetial diagnosis of syncope , approach to syncope
Basic data about heat stroke uncluding: Definition, forms, exertional and non exertional, epidemiology, risk factors, characteristics, ettiology, pathophysiology, clinical presentation in all body systems, management, cooling tools, assisting procedures, complications, prevention, and patient education
Syncope (nx power lite) /certified fixed orthodontic courses by Indian dental...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Precise guide for DGNM, B.Sc Nursing & M.Sc Nursing Students .. regarding shock, types of shock, stages of shock and its management. Highly recommended for II B.Sc Nursing Students.
Meningitis involves meninges
Viral meningitis
Bacterial meningitis
Fungal meningitis
Parasitic meningitis
Meningitis is an acute inflammation of the meningeal tissues surrounding the brain and the spinal cord (meninges).
Skipping vaccinations
Age-Viral meningitis occur in children younger than age 5. Bacterial meningitis is common in those under age 20.
Living in a community setting
Pregnancy.
Compromised immune system. AIDS, alcoholism, diabetes, use of immunosuppressant drugs etc.
Primary- Neisseria meningitidis
Secondary- E. coli
Haemophilus influenzae
Streptococcus pneumoniae
Meningitis involves meninges
Viral meningitis
Bacterial meningitis
Fungal meningitis
Parasitic meningitis
Meningitis is an acute inflammation of the meningeal tissues surrounding the brain and the spinal cord (meninges).
Skipping vaccinations
Age-Viral meningitis occur in children younger than age 5. Bacterial meningitis is common in those under age 20.
Living in a community setting
Pregnancy.
Compromised immune system. AIDS, alcoholism, diabetes, use of immunosuppressant drugs etc.
Primary- Neisseria meningitidis
Secondary- E. coli
Haemophilus influenzae
Streptococcus pneumoniae
Encephalitis is a rare yet serious disease that can be life-threatening.
Encephalitis is an inflammation of the brain tissue.
The most common cause is viral infections.
In rare cases it can be caused by bacteria or even fungi.
Encephalitis is an inflammation of the brain tissue.
Primary encephalitis- It occurs when a virus directly infects the brain and spinal cord.
Secondary encephalitis- It occurs when an infection starts elsewhere in the body and then travels to your brain.
Older adults
Children under the age of 1 year
People with weak immune systems
Primary (infectious) encephalitis
Common viruses, including HSV (herpes simplex virus) and EBV (Epstein-Barr virus)
Childhood viruses, including measles and mumps
Arboviruses (spread by mosquitoes, ticks, and other insects), including Japanese encephalitis, West Nile encephalitis, and tick-borne encephalitis
Secondary encephalitis: could be caused by a complication of a viral infection.
Medical Emergencies in Dental Practice - by SAKSHI JOSHI.pptxSakshi711304
Management of Medical Emergencies like Seizures, Hyperventilation, Stroke, Asthmatic attack, Syncope etc are discussed about taking into consideration the patients who are at risk of these diseases. Detection of risk patients prior to treatment is key. After reading this presentation you will know how to manage such emergencies in your Dental office.
Prepare for the worst.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. MEDICAL EMERGENCIES
IN DENTAL PRACTICE
Dr. Naresh Sen
MD(Medicine), DM (Cardio),
PhD(Cardio), FACC , FESC,
FRCP, FACP, FRSM, FCCP,FAHA
CONSULTANT CARDIOLOGIST 2
6. Comprehensive medical history
Vigilant observation & prompt recognition of
symptoms of an emergency
Basic life support
Affiliation to definitive medical care
6
10. CLASS I: Healthy patient with no systemic
disease.
CLASS II: Patient with mild systemic disease
with no limits on activity.
CLASS III: Patient with severe systemic
disease that limits activity.
CLASS IV: Patient with incapacitating
systemic disease that is life threatening.
CLASS V: Terminal moribund patient.
10
13. “Sudden transient loss of consciousness in which
one shows no responsiveness to non-deliberate
environmental stimuli”
Predisposing factors:
STRESS
IMPAIRED PHYSICAL CONDITION
HYPOGLYCEMIA
Webster-Merriam’s Medical Dictionary. 12th ed.
Baltimore:Williams;2011.“syncope”;p.348
13
14. Via prevention of predisposing factors:
Use of psychosedative drugs
ingestion-alprazolam(4mg), diazepam(5mg)
i.m/i.v administration-butorphenol(1mg), midazolam(5mg)
inhalation-N2O+O2 (15%+85%)
Persuasion/Hypnosis
14
MANAGEMENT OF MEDICAL EMERGENCIES IN
DENTAL PRACTICE - 60
16. 16
Pt attains upright
position
SBP falls =<60mm of Hg
due to ANS response
failure
Cerebral blood
flow<critical level
Loss of consciousness
Supination=revival
PATHOLOGY
Drugs
Prolonged
recumbency /
convalescence
Late stage
pregnancy
Varicosities
Addison’s Disease
Severe exhaustion
Shy-Drager
Syndrome
ETIOLOGY
17. 17
Cause1
• Sudden supplement withdrawal
in Addison’s disease pts.
Cause2
• Stress, either physiological or
psychological.
Cause3
• Bilateral adrenalectomy pts.
Cause4
• Trauma/thrombosis/tumour of
adrenals
Syncope caused due to lack of an adrenaline response in
medullary deficient patients resulting from:-
21. EPILEPSY- “A chronic brain disorder of various etiologies
characterized by recurrent seizures due to excessive
neuronal discharge”
SEIZURE/ICTUS- “A paroxysmal disorder of cerebral
function characterized by a short attack involving changes
in the state of consciousness, motor activity, or sensory
phenomena”
TONUS- “Neuromuscular dysfunction characterised by
sustained contraction and tonicity of all striated muscles”
Webster-Merriam’s Medical Dictionary. 12th ed. Baltimore:Williams;2011. “Epilepsy”, “Seizure”, “Tonus”;
p166,327,428
21
22. CLONUS- “An abnormality in neuromuscular activity
characterized by rapidly alternating muscular
contraction and relaxation”
POST-ICTAL PHASE- “A phase of centralised
neuronal depression following a clonic seizure in
which the subject demonstrates generalised
muscular relaxation observable as deep slumber”
STATUS EPILEPTICUS- “A prolonged repetitive
seizure with no recovery between attacks leading to
a life-threatening emergency situation”
Webster-Merriam’s Medical Dictionary. 12th ed. Baltimore:Williams;2011.“Clonus”, “Post-Ictal Phase”,
“Status Epilepticus”; p98,279,369
22
23. TYPE I-Absence Seizures/Petit Mal Epilepsy
TYPE II-Myoclonic Seizures
TYPE III-Clonic Seizures
TYPE IV-Tonic Seizures
TYPE V-Tonic-Clonic Seizures/Grand Mal Epilepsy
TYPE-VI-Atonic Seizures
23
78%
11%
3%
4.8%
1%
2.2
%
24. If pt is a known epileptic, make sure he/she has
taken their regular dose of anti-convulsant on the
day of appointment.
Instruct him/her to alert you as the aura of the
impending seizure manifests itself.
Inhalational sedation, based on individualised
severity levels.
Keep life support equipment ready in case of an
emergent status epilepticus.
24
25. Self limiting emergency
Remove dangerous objects from the mouth and
around the pt.eg. sharp instruments, needles,
etc.
Loosen any tight clothing.
Avoid restraining the pt.
In case the ictus fails to subside within a
maximum of 10 minutes, declare status
epilepticus and proceed with BLS + definitive
care. 25
27. May occur due to:
Pathology in the airway
Dental instruments
Tongue
Patient demonstrates symptoms ranging from
coughing, gurgling, gagging to choking & gasping with
panic.
Aspired object may pass into the trachea or the
oesophagus
27
29. Rubber dam
Oral packing
Chair position
Dental assistant
Magill’s intubation forceps
29
30. Re-establishment of airway:
NON INVASIVE PROCEDURES
o Forceful coughing
o Back blows
o Heimlich Maneuver
o Chest thrust
o Finger sweeps
INVASIVE PROCEDURES
o Tracheotomy
o Cricothyrotomy
30
32. Excessive rate and depth of respiration leading to
abnormal loss of carbon dioxide from the blood
primarily predisposed to anxiety.
Characterised by:
Rapid short strained breaths
Cold Sweats
Palpitations
Dizziness
Chest muscle fatigue
Prevention includes practicing stress reduction
protocols and administration of psychosedatives.
32
33. Anxiety
Increased rate and depth of
respiration
Increased O2/CO2 exchange by
lungs
Excessive CO2 blow off>>paCO2
decreases
Hypocapnia=decreased HCO3 ion
conc.
Increased blood
pH>>RESPIRATORY ALKALOSIS
PATHOLOGY
Position pt UPRIGHT comfortably
Reassure pt & stabilise vitals
Remove dental
materials/instruments from pt’s
mouth
Re-establish O2:CO2 ratio by
inhalation of exhaled air(85%:15%)
Check vitals & patient status again
Resume treatment procedure
MANAGEMENT
33
34. A clinical state of hyper reactivity of the
tracheobronchial tree, characterized by recurrent
paroxysms of dyspnea and wheezing
In diagnosed pts, not an emergency.
Results from constriction of smooth muscles of the
tracheobronchial tree resulting from infection,
inflammation or a genetic disposition.
34
36. EXTRINSIC OR ALLERGIC ASTHMA
The allergens may be airborne – house dust, feathers,
animal dander, furniture stuffing, fungal spores, or plant
pollens.
Food and drugs – cow’s milk, egg, fish, chocolate,
shellfish, tomatoes, penicillins, vaccines , asprin, and
sulfites.
Type I hypersensitivity reaction – Ig E antibodies
produced in response to allergen
Approximately, 50% asthmatic children become
symptomatic before reaching adulthood
36
37. Usually develops in adult age > 35 years
Non allergic factors – respiratory infection, physical
exertion, environmental and air pollution, and
occupational stimuli.
Psychological and physiologic stress can also
contribute to asthmatic episodes.
Acute episodes are usually more fulminant and
severe than those of extrinsic asthma. Long-term
prognosis also less optimistic.
37
INTRINSIC OR IDIOSYNCRATIC OR NON-ATOPIC
ASTHMA
38. 38
Recognise symptoms
Stop dental procedure
Position pt upright or bending forwards with arms
straight ahead
Administer bronchodilator
Episode terminates?
YES NO
Continue dental procedure Declare status asthmaticus
Summon EMS
40. Heart recieves blood via coronaries
Coronaries narrow down due to
cholesterol
Reduced nutrition to respective cardiac
muscle
Treatment anxiety leads to palpitations
Greater oxygen requirements for greater
pumping
Acute Coronary
Syndrome(ACS)
ANGINA
PECTORIS
MYOCARDIAL
INFARCTION
40
41. Definition- “A condition marked by severe pain in the
chest, often also spreading to the shoulders, arms, and
neck, owing to an indequate blood supply to the heart.”
Types:
Stable (classic or exertional)
Variant (prinzmetal , vasospastic)
Unstable (crescendo, acute coronary insufficiency)
Prevention includes stress reduction protocol,
reassurance & psychosedation.
Webster-Merriam’s Medical Dictionary. 12th ed. Baltimore:Williams;2011. “Angina Pectoris”; p73
41
42. Recognize problem (chest pain – angina attack)
Discontinue dental treatment
Activate office emergency team
P – Position, patient comfortably usually upright
A → B → C –Assess and perform BLS
D – definitive management
HISTORY OF ANGINA PRESENT NO HISTORY OF ANGINA
Administer vasodilator and O2 Activate EMS
Transmucosal nitroglycerine spray O2 and nitroglycerine
Or sublingual nitroglycerine tablet Monitor and record
0.3 – 0.6 mg for every 5 min (3 doses)
IF PAIN RESOLVES IF PAIN DOES NOT RESOLVE
continue with dental procedure summon medical care
Administer aspirin
Continue to monitor and record vital
signs
42
43. DEFINITION- “A clinical syndrome caused by deficient
coronary arterial blood supply resulting in ischaemia to a
region of the myocardium and causing cellular death and
necrosis.”
Predisposing Factors:
Atherosclerosis and coronary artery disease
Coronary thrombosis, occlusion and spasm
Males
5th and 6th decades of life
Undue stress
Webster-Merriam’s Medical Dictionary. 12th ed. Baltimore:Williams;2011. “Myocardial Infarction”; p197
43
44. Avoid overstressing the patient
Supplemental oxygen via nasal cannula or nasal hood
during the treatment – 3-5 L/min and 5 – 7 L/min
Pain control during therapy – appropriate use of local
anesthesia – smaller dose with maximum effect – slow
administration
Psychosedation – N2O – O2 is preferable
It is strongly recommended that elective dental care is
avoided until at least 6months after MI
Inferior alveolar NB and Posterior superior alveolar NB –
risk of hemorrhage – should be avoided
44
45. Protocol common for both ACS outcomes
NOTE: In a patient experiencing chest pain for the
very first time, summon medical assistance
immediately before any self-support measures.
Thereafter, continue with immediate emergency
protocol as with AP.
45
48. In a dental practice, commonest overdosage>>LA
Predisposing factors for over dosage:
Pt age/body wt
Route of administration
Presence of vasoconstrictor
Type of local anaesthetic
Drug dosage formulation vital
48
D
H
X
50. Administer basic life support
100% oxygen, anticonvulsants
Allow recovery to occur
In case of continuation of symptoms, summon EMS.
50
51. DEFINITION- “A hypersensitive state of skin and
various mucosae acquired through exposure to a
particular allergen, reexposure to which
produces a heightened emergent capacity to
react”
Occuring via expression
of IgE in response to
allergen exposure
51
52. Reassure pt.
Initiate basic life support as needed.
Administer antihistaminics (diphenhydramine 50mg),
epinephrine 0.123-0.3ml of 1:1000 i.m /s.c
Monitor vitals regularly.
Summon EMS
52
55. Injury made with any sharp instrument, not just.
Encountered more commonly by the practitioner.
Stop procedure immediately.
Wash skin with disinfectant.
Treat with running water and encourage bleeding
Dry area and cover with antiseptic dressing
Recording medical history vital in case of an exposed
needle situation.
Seek antidotal vaccination or treatment if necessary.
55
56. Invariably associated with faulty techniques such
as:
bending the needle while administering LA
inserting the needle upto the hub
directing the needle against resistance
May also occur if pt jerks head during
administration.
Most commonly with IANB.
Elasticity of soft tissue produces rebound,
burying the fragment within.
56
57. Inform pt of the occurance, tell him/her to remain
calm, keep mouth open and refrain from any jaw
movements.
Retrieve the fragment, if visible, with a haemostat.
A buried fragment needs to be located ASAP using
radiographs or CT scans & retrieved surgically.
57
59. ALWAYS BE PREPARED
Prompt recognition and efficient management of
medical emergencies by a well-prepared dental team
can increase the likelihood of a safe & satisfactory
outcome.
Basic life support training- A MUST
As always, prevention is better than cure.
59
60. Malamed SF. Medical Emergencies in the Dental
Practice. 4th ed. Baltimore: Elsevier; 2007
Limmer D, O’Keefe M. Emergency Care. 10th ed.
St.Louis: Macmillan Co; 2010
Malik NA. Textbook of Oral & Maxillofacial Surgery.
2nd ed. New Delhi: Jaypee Brothers Pub; 2008
60
61. Haas DA. Management of Medical Emergencies
in the Dental Office: Conditions in Each Country,
the Extent of Treatment by the Dentist. J Anaesth
Prog 2006;53(2):20-24
Geller S, Malamed SF. Knowing Your Patient. J
Am Dent Assoc 2010;104:3S-7S
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