د حاتم البيطار د حاتم البيطار د حاتم البيطار د حاتم البيطار د حاتم البيطار د حاتم البيطار

1. 01005684344
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2. Management of Medical Emergencies
• Medical emergencies can and do happen
– Advances in medicine
– Longer lifespan
– Multiple medications
– Medically compromised
– Longer appointments
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3. Incidence
• A survey done in the 90’s showed that, over a
10 year period, 90% of dentists have
encountered at least one medical
emergencies.
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4. Types
TYPE OF EMERGENCY NUMBER PERCENT
Altered Consciousness 17,782 59
Cardiovascular 4,280 14
Allergy 2,887 9.5
Respiratory 2,718 9
Seizures 1,595 5
Diabetes-Related 999 3
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5. Management of Medical Emergencies
• Basic Life Support
• Advanced Life Support
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6. Management of Medical Emergencies
Emergency situations
• Managed properly most emergencies are resolved satisfactorily
• Mismanaged even benign emergencies can turn disastrous
• Recognize
• Position
• Stabilize
• Diagnose
• Treat
• Refer
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7. Management Of Medical Emergencies
1. Recognition
2. Prevention
3. Preparation
4. Basic life support (BLS)
5. Cardiopulmonary resuscitation (CPR)
6. Specific medical emergencies
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8. Prevention
• IS THE BEST
TREATMENT
Know your patient
Never treat a STANGER
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9. Prevention
• 90% of life-threatening situations can be
prevented
• 10% will occur in spite of all preventive efforts
(sudden unexpected death)
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10. Prevention
• Medical History
• Physical Evaluation
• Vital Signs
• Dialogue History
• Determination of Medical Risk
• Stress Reduction
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11. Prevention
MEDICAL HISTORY
• Review
• Update
• Medication
• Medical consultation
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12. Prevention
PHYSICAL EVALUATION
• Length of time since last evaluation
• Vital signs
• Visual inspection of patients
• Referral to physician
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13. Prevention
VITAL SIGNS
• Blood pressure
• Pulse rate
• Respiratory rate
• Temperature
• Height
• Weight
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14. Prevention
DIALOGUE
HISTORY
• Putting it all together
• Check accuracy of
medical history
• Recognize anxiety
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15. Prevention
DETERMINATION OF MEDICAL RISK.
• Ability of patient to safely tolerate dental
treatment.
• Does patient represent increased medical
risk?
• Can patient be managed in the dental office?
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16. Determination Of Medical Risk
American Society of
Anesthesiology
Physical Status Classification
System
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17. ASA I
• A patient without
systemic disease
• A normal healthy
patient
• Can tolerate stress involved
In dental treatment
• No added risk of serious
Complications
• Treatment modification
Usually not necessary
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18. ASA II
A patient with mild systemic
disease
Example:
-Well-controlled diabetic
-Well-controlled asthma
-ASA I with anxiety
• Represent minimal risk
during dental treatment
• Routine dental treatment
With minor modifications
-Short early appointments
-Antibiotic prophylaxis
-Sedation
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19. ASA III
A patient with severe systemic
disease that limits activity but is
not incapacitating
Example:
- a stable angina
- 6 mos. Post - MI
- 6 mos. Post - CVA
- COPD
• Elective Dental Treatment is
not Contraindicated
• Treatment Modification is
Required
- Reduce Stress
- Sedation
- Short Appointments
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20. ASA IV
A patient with incapacitating
systemic disease that is a
constant threat to life
Example:
- Unstable angina
- M I within 6 months
- CVA within 6 months
- BP greater than 200/115
- Uncontrolled diabetic
• Elective dental care should
be postponed
• Emergency dental care only
– Rx only to control
pain and infection
– Other treatment in
hospital
• (I&D, extraction)
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21. ASA V
A morbid patient not
expected to survive
Example:
- End stage renal disease
- End stage hepatic disease
- Terminal cancer
- End stage infectious disease
Elective treatment
definitely
contraindicated
Emergency care only to
relieve pain
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22. Prevention
STRESS REDUCTION
• Premedication
• Sedation
• Pain control (intra and post-op)
• Early appointments
• Short appointments
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23. Preparation
• Team Effort
• BLS for all office personnel
• CPR for all office personnel
• Emergency drills
• Emergency phone numbers (911)
• Emergency equipment
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24. BASIC LIFE SUPPORT
(BLS)
CARDIOPULMONARY
RESUCITATION
(CPR)
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25. SBE Prophylaxis
• In 2012, the guidelines were updated and now premedication is needed for fewer
conditions.
• The conditions for which premedication is necessary includes:
– artificial heart valves
– a history of infective endocarditis
– a cardiac transplant that develops a heart valve problem
– the following congenital (present from birth) heart conditions:
*unrepaired or incompletely repaired cyanotic congenital heart disease, including
those with palliative shunts and conduits
*a completely repaired congenital heart defect with prosthetic material or
device, whether placed by surgery or by catheter intervention, during the first six
months after the procedure
*any repaired congenital heart defect with residual defect at the site or adjacent
to the site of a prosthetic patch or a prosthetic device
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26. SBE Prophylaxis
• Patients who previously needed antibiotic
prophylactic but no longer need them include:
– mitral valve prolapse
– rheumatic heart disease
– bicuspid valve disease
– calcified aortic stenosis
– congenital (present from birth) heart conditions
such as ventricular septal defect, atrial septal
defect and hypertrophic cardiomyopathy
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27. SBE Prophylaxis
• Procedures needing prophylaxis:
– All dental procedures that involve manipulation of
gingival tissue or the periapical region of teeth or
perforation of the oral mucosa.
– procedures that do not require prophylaxis are
radiographs, placement of removable prosthesis,
and placement orthodontic bracket.
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29. Management of Medical Emergencies
Antibiotic Prophylaxis
Prophylactic Regimen for Dental Procedures
AMOXCICILIN
Adults 2 grams
Children 50 mg/kg (not to exceed adult dosage)
Orally 1 hour before procedure
No repeat dose
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30. Management of Medical Emergencies
Antibiotic Prophylaxis
Prophylactic Regimen for Dental Procedures
Allergic to Penecillin
Adult Children
Clindamycin 600 mg 20 mg/kg
Cefalexin or Cfadroxil 2 gr. 50 mg/kg
Azithromycin or Clanthromycin 500 mg 15mg/kg
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ORALLY 1 HOUR BEFORE PROCEDURE

31. Management of Medical Emergencies
Antibiotic Prophylaxis
Prophylactic Regimen for Dental Procedures
Unable to take Oral Medication
Ampicillin
Adults: 2 gr IM or IV
Children: 50 mg/kg IM or IV
Within 30 minutes of procedure
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32. Management of Medical Emergencies
Antibiotic Prophylaxis
• Amoxicillin vs. Penecillin
– Both equally effective against Streptococus viridan
– Amoxicillin is better absorbed from the GI tract, and
provides higher and more sustained serum level
– 2 gr. Provides as effective coverage as 3 gr. With less GI
adverse effects.
– 2nd dosage not required due to prolonged serum level
above the inhibitory period for most oral Streptococci.
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33. Management of Medical Emergencies
Antibiotic Prophylaxis
• ERYTHROMYCIN
No longer recommended due to GI side effects.
Practitioners who have used it successfully in the
past, may continue to use it following the
previously published regimen.
2 gr. 2 hours before procedure
1 gr. 6 hours later
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34. Management of Medical Emergencies
Antibiotic Prophylaxis
• Patient already taking antibiotic used for prophylaxis:
1. Select an antibiotic from a different class, rather
than increasing the dosage
2. Delay treatment if possible 9 to 14 days after
completion of antibiotic to allow usual flora to
reestablish
Example: Amoxicillin, go to Clindamycin.
No Cephalosporin due to cross resistance
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35. Management of Medical Emergencies
Antibiotic Prophylaxis
Prophylaxis for dental patients with
TOTAL JOINT REPLACEMENT
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36. Management of Medical Emergencies
Antibiotic Prophylaxis
• The most crucial period is up to 2 years
following a joint replacement
• Prophylaxis not recommended for dental
patients with: Pins, Plates, and Screws.
• Prophylaxis is not routinely indicated for most
dental patients with total joint replacement
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37. Management of Medical Emergencies
Antibiotic Prophylaxis
Patients at potential increased risk of total joint
infection
• Immunocompromized/Suppressed patients
• Other Patients:
– Insulin Dependent diabetics
– 1st 2 years following joint replacement
– Previous prosthetic joint infection
– Malnourishement
– Hemophilia
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38. Management of Medical Emergencies
Antibiotic Prophylaxis
• Procedures and regimens are the same as
discussed earlier for SBE prophylaxis.
• A cephlosporin is preferable to Amoxicillin due
to its affinity to cynovial fluids
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