dental
TRANSCRIPT
DENTAL EMERGENCIESDENTAL EMERGENCIES
Assoc. Prof. (Dr) Rashidi AhmadAssoc. Prof. (Dr) Rashidi AhmadDept. of Emergency MedicineDept. of Emergency Medicine
ObjectivesObjectives
Common dental emergencies Common dental emergencies –– What? When? What? When?
How? Where? Who?.How? Where? Who?.
Basic approach to dental emergenciesBasic approach to dental emergencies
Factors increasing risk during dental Factors increasing risk during dental treatmenttreatment
Increased number of older patientsIncreased number of older patients
Medical advances Medical advances –– drug therapy, surgical drug therapy, surgical techniquestechniques
Longer appointmentsLonger appointments
Increased drug use Increased drug use –– LA, sedatives, LA, sedatives, analgesics, antibioticsanalgesics, antibiotics
DeathDeathMost emergency situations: potentially life threatening BUT deatMost emergency situations: potentially life threatening BUT death h is rare.is rare.
8 deaths a/w GA in a 208 deaths a/w GA in a 20--year period year period
(1 death in every 673,000 GA administration)(1 death in every 673,000 GA administration)
Lytle JJ, Stamper EP: The 1988 anesthesia survey of the SouthernLytle JJ, Stamper EP: The 1988 anesthesia survey of the Southern
California Society of Oral Surgeons, J Oral California Society of Oral Surgeons, J Oral SurgSurg 32:739. 197432:739. 1974
““10% of all non10% of all non--accidental deaths are classified as sudden, accidental deaths are classified as sudden, unexpected death & unpreventable.unexpected death & unpreventable.””
McCarthy EM. J Am Dent Assoc. 1971 83:1091McCarthy EM. J Am Dent Assoc. 1971 83:1091
STILL OK????STILL OK????
““When you prepare for an When you prepare for an emergency, the emergency ceases emergency, the emergency ceases
to existto exist””
““To be forewarned is to be forearmedTo be forewarned is to be forearmed””
““Prevention is better than curePrevention is better than cure””
Important RulesImportant Rules
Find and correct life threatsFind and correct life threats
If lifeIf life--threat is present, CORRECT IT!threat is present, CORRECT IT!
If it canIf it can’’t be correctedt be corrected
Support oxygenation, ventilation, perfusionSupport oxygenation, ventilation, perfusion
GET HELP & TRANSPORT!!GET HELP & TRANSPORT!!
Life threatening eventsLife threatening events
Airway obstructionAirway obstruction
VentilationVentilation--perfusion mismatchperfusion mismatch
Circulatory compromisedCirculatory compromised
Dysfunction of CNSDysfunction of CNS
APPROACHAPPROACH
S: S: Stop Procedure & ObserveStop Procedure & Observe
R: R: ResponseResponse
P: P: PositionPosition
A: A: AirwayAirway
B: B: BreathingBreathing
C: C: Circulation/Cardiac Monitor/Circulation/Cardiac Monitor/CardioversionCardioversion
D: D: Dysfunction Of CNS & Definitive ManagementDysfunction Of CNS & Definitive Management
Stop procedureStop procedure
Avoid injuriesAvoid injuries
Proper assessment and Proper assessment and managementmanagement
Proper positionProper position
ResponseResponse
Ability to speakAbility to speak
Appropriate orientationAppropriate orientation
If unconscious If unconscious --Loud voice & gentle Loud voice & gentle tap/shaketap/shake
Call for HELP!!Call for HELP!!
AirwayAirway
Anticipate airway problems withAnticipate airway problems with
Decreased level of consciousnessDecreased level of consciousness
Oral bleedingOral bleeding
Foreign bodyForeign body
Return head to neutral positionReturn head to neutral position
Head tilt, chin lift, jaw thrustHead tilt, chin lift, jaw thrust
BreathingBreathing
Is oxygen getting to the Is oxygen getting to the blood?blood?
-- Is air moving?Is air moving?
-- Is it moving adequately?Is it moving adequately?
-- Is it moving at an adequate Is it moving at an adequate rate?rate?
BreathingBreathing
Oxygenate immediately if:Oxygenate immediately if:
Decreased level of consciousnessDecreased level of consciousness
ShockShock
Severe hemorrhageSevere hemorrhage
Chest painChest pain
DyspneaDyspnea
Respiratory distressRespiratory distress
If you think about giving oxygen, If you think about giving oxygen, GIVE IT!!GIVE IT!!
Resuscitation trolleyResuscitation trolley
Assisted ventilationAssisted ventilation
Respirations <12Respirations <12
Respirations >24Respirations >24
Tidal volume decreasedTidal volume decreased
Respiratory effort increasedRespiratory effort increased
CirculationCirculation
Is the heart beating?Is the heart beating?
Is there serious external bleeding?Is there serious external bleeding?
Does patient have radial pulse?Does patient have radial pulse?
Absent radial = systolic BP < 80Absent radial = systolic BP < 80
Does patient have carotid pulse?Does patient have carotid pulse?
Absent carotid = systolic BP < 60Absent carotid = systolic BP < 60
CirculationCirculation
Serious oral bleeding?Serious oral bleeding?
Clear the airway/suctionClear the airway/suction
Treat the cause/stop the bleeding Treat the cause/stop the bleeding –– bone wax, stitchesbone wax, stitches
? Intubation? Intubation
GXM GXM –– blood transfusionblood transfusion
Surgical interventionSurgical intervention
Is patient Is patient perfusingperfusing??
Cool, pale, moist skin = shock UPOCool, pale, moist skin = shock UPO
Capillary refill > 2 sec = shock UPOCapillary refill > 2 sec = shock UPO
Restlessness, anxiety, combativeness = shock Restlessness, anxiety, combativeness = shock
Cardiac monitoring/defibrillatorCardiac monitoring/defibrillator
Heart rateHeart rate
DysrythmiasDysrythmias
Ischemic changesIschemic changes
DefibrillationDefibrillation
Disability (CNS dysfunction)Disability (CNS dysfunction)
Decreased LOC =Decreased LOC =
HypoxiaHypoxia
HypoglycemiaHypoglycemia
ShockShock
Acute strokeAcute stroke
Think about drugs, alcohol, or Think about drugs, alcohol, or personality personality
Definitive managementDefinitive management
Confirm the problemConfirm the problemTreat the causeTreat the causeTreat the complicationTreat the complicationDispositionDisposition
ConclusionConclusion
Be prepared Be prepared –– staffs, equipments, trainingstaffs, equipments, training
Proper assessment Proper assessment –– past medical history, past medical history, history of allergy, & PEhistory of allergy, & PE
Intervene possible complicationIntervene possible complication
Emergency approachEmergency approach
APPROACHAPPROACH
S: Stop Procedure & ObserveS: Stop Procedure & Observe
R: ResponseR: Response
P: PositionP: Position
A: AirwayA: Airway
B: BreathingB: Breathing
C: Circulation/Cardiac Monitor/C: Circulation/Cardiac Monitor/CardioversionCardioversion
D: Dysfunction Of CNS & Definitive D: Dysfunction Of CNS & Definitive
ManagementManagement
Important messageImportant message
Survival depends on assessment skillsSurvival depends on assessment skills
Good assessment results fromGood assessment results from
An organized approachAn organized approach
Clearly defined prioritiesClearly defined priorities
Understanding available resourcesUnderstanding available resources
