Medical emergency in dental office oral surgery 10
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Medical emergency in dental office oral surgery
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Medical emergency in dental office oral surgery 10
- 1. Mosul university- College of dentistry-oral & maxillofacial surgery department Dr.Ziad H. Delemi B.D.S, F.I.B.M.S (M.F.) DENTAL MANAGEMENT OF THE MEDICALLY COMPROMISED PATIENT Medical Emergencies in Dental Practice
- 2. Mosul university- College of dentistry-oral & maxillofacial surgery department Unconsciousness Respiratory difficulties Chest pain Medical Emergencies
- 3. Mosul university- College of dentistry-oral & maxillofacial surgery department 1) Syncope 2) Shock 3) Cardiac arrest 4) Diabetic coma 5) Adrenal insufficiency 6) Convulsion 7) CVA 8) LA & drug toxicity Unconsciousness
- 4. Mosul university- College of dentistry-oral & maxillofacial surgery department -Most commonly observed potentially life-threatening emergency seen in the dental office -Psychogenic shock or vasovagal attack • Trendelenberg position • Protect the airway • Monitor vital signs • Oxygen If not resolved conservatively -low blood pressure= IV dextrose & Ringer lactate +adrenaline 0.5mg IM, IV, SC. -Bradycardia= 0.4mg Atropine till 1.2mg Syncope
- 5. Mosul university- College of dentistry-oral & maxillofacial surgery department Syncope Psychogenic –Fright –Anxiety –Emotional stress –Pain –Site of Blood Nonpsychogenic – Prolonged sitting or standing – Hunger – Exhaustion – Poor physical condition – Hot humid crowded environment
- 6. Mosul university- College of dentistry-oral & maxillofacial surgery department -Airway (secure) -Breathing (mouth to mouth) -Circulation (start CPR) -Drugs (Dextrose + Ringer lactate Adrenaline 1mg every 5minute Sodium Bicarbonate 1mEq/Kg Atropine 0.5mg every 5minute Oxygen 10L/min. Cardiac arrest
- 7. Mosul university- College of dentistry-oral & maxillofacial surgery department Head-Tilt/Chin-Lift
- 8. Mosul university- College of dentistry-oral & maxillofacial surgery department Diabetic coma
- 9. Mosul university- College of dentistry-oral & maxillofacial surgery department Adrenal crysis Hydrocortisone 100mg or dexamethasone 4mg Adrenalin 0.5mg Oxygen 10L/min. Adrenal insufficiency
- 10. Mosul university- College of dentistry-oral & maxillofacial surgery department hypoglycemia CVA Epilepsy Syncope drugs Convulsion valium 5-20 mg IV
- 11. Mosul university- College of dentistry-oral & maxillofacial surgery department CVA A condition occurred due to closure one of cerebral arteries or rupture of it and bleeding intracranialy associated with loss of consciousness and mental alteration need attention and quick response. Give O2 and transfer the case to causality unite .
- 12. Mosul university- College of dentistry-oral & maxillofacial surgery department Stimulation followed by depression Oxygen Maintain blood pressure & pulse rate Treat convulsion LA & drug toxicity
- 13. Mosul university- College of dentistry-oral & maxillofacial surgery department Unconsciousness Supine- check pulse check respiration Open airway still Full recovery Syncope (Psychogenic shock) No pulse CPR Cardiac arrest Altered bizarre behavior CVA Alcohol overdose There is pulse Slow Adrenal insufficiency Rapid Insulin shock
- 14. Mosul university- College of dentistry-oral & maxillofacial surgery department Respiratory difficulties 1. Respiratory failure (Heart failure) 2. Asthma 3. Foreign body 4. Allergy 5. Hyperventilation (HYS)
- 15. Mosul university- College of dentistry-oral & maxillofacial surgery department Chocking Drug overdose (narcotics, sedatives, …) Respiratory failure Tongue Unconscious Obstructed Airway Tongue Unconscious Obstructed Airway
- 16. Mosul university- College of dentistry-oral & maxillofacial surgery department Adrenalin 0.5mg Hydrocortisone 100mg Aminophylline 250-500mg Ventoline inhaler Oxygen Asthma
- 17. Mosul university- College of dentistry-oral & maxillofacial surgery department Aspiration or swallowing -tooth -root -endodontic instruments -dental bur Foreign body
- 18. Mosul university- College of dentistry-oral & maxillofacial surgery department Foreign body
- 19. Mosul university- College of dentistry-oral & maxillofacial surgery department Maintain airway, breathing Adrenalin 0.5mg every 5-10 min. Hydrocortisone 100mg Theophylline 250-500mg Oxygen Allergy
- 20. Mosul university- College of dentistry-oral & maxillofacial surgery department Hyperventilation (HYS) • Anxiety – Most common • Metabolic conditions – Pain – Metabolic acidosis – Drug intoxication – Hypercapnia – CNS disorders Treatment: • Terminate procedure • Position patient • Calm patient • Rebreathing bag • Sedation
- 21. Mosul university- College of dentistry-oral & maxillofacial surgery department Chest pain I. Myocardial infarction II. Angina pectoris III. hyperventilation
- 22. Mosul university- College of dentistry-oral & maxillofacial surgery department Myocardial infarction • Recognition – Airway – Breathing – Circulation • Oxygen - 4-5 L by NC or face mask • Monitor VS • Position to comfort • Pain relief – Morphine sulfate 2-5 mg IM/IV every 5-15 minutes • Controls pain and reduces anxiety • Prepare to perform CPR or provide
- 23. Mosul university- College of dentistry-oral & maxillofacial surgery department Angina pectoris • Treatment – Stop procedure – Position patient to comfort – Oxygen 2-3 L per NC or face mask – Nitroglycerin 0.4 mg SL • Repeat every 5 minutes x 3 total doses • If no response, assume MI or unstable angina • transfer to ER