Emergency Management in

Dental Clinic

How to Avoid a Bad Day ???

Presented ByDr Arya V Devi

Reality bites!! You know that you are not having a good day when:

Prevention is always better than cure…

Never treat as a stranger

Comprehensive medical history

Preparation for emergencies

Vital signs

Emergency kit in dental office

•Epinephrine•Oxygen•Chlorpheniramine maleate •Sugar/cake frosting•Ammonia inhalants•Atropine•Diazepam•Hydrocortisone •Inhaler-Albuterol•Nitrospray/nitroglyceride tablets •Aspirin•Paper bag•Laryngoscope •Oral airways

Each staff member should know where it is located

Rules To Remember

To keep the patient alive remember

Emergency Mangement Algorithm

P-A-B-C-D-E

The very step in management of all

medical emergencies are BLS as needed

Position

Supine or Trendelenburg position

Airway

Head tiltChin lift

Breathing

• Check breathing• If not give 2 breaths via pocket mask• Insert oral airway if apneic

Circulation (CPR)

• Check for pulse• If no, move patient to floor & begin chest

compressions– Push hard 2 inch depth (Full recoil)– 100 depths per minute(Decrease interruptions)

C-A-B

Specific Medical Emergencies

Airway emergenci

es

Cardiovascular

emergencies

CNS emergenci

es

Other emergenci

es

Airway Emergencies

Airway obstruc

tionAsthma

Hyperventilati

on

Airway Obstruction

Coughing“Crowing”

sounds

Patient reaches for

neck

Inability to speak

CyanosisLoss of

consciousness

Death

Treatment Ask the pt to cough forcefully

Back blows

Use laryngoscope for direct visualization and remove with Magill forceps

Treatment

Heimlich Maneuver

Prevention

Adequate protection of the oropharynx

• Rubber dam

• Throat screen

Ligatures around small dental objects

Asthma

Wheezing

Chest tightnes

s

Stidor

Cyanosis

Dyspnea

Coughing

ManagementReassure

the patient

Position pt upright with arms forward

Administer 1 puff from pt’s own inhaler

Give oxygen

Give Adrenaline

Hydrocortisone 200 mg

i.v.

Epinephrine 0.3-0.5 mg

SC/IM/IV

Salbutamol 500 mg i.m/s.c.

Monitor VS

Call An Ambulance

Prevention

Avoid precipitating

factors

Confirm that patient took

asthma medications

Avoid narcotics

Stress reduction

Prophylactic bronchodilat

or

Hyperventilation• Patient restlessness• Increased respiratory rate• Increased depth of respiration• Light headedness• Tingling in hands and feet• Carpal-pedal spasm• Increased anxiety• Loss of consciousness

Management Stop procedure Clear all objects

from mouthVerbally calm the

patient

Rebreathe CO2

• Paper bag• Face mask• Hands

Self-limiting problem

Diazepam 5 mg IV or midazolam 2

mg IM/IV

No O2

Prevention

Reduce stressSedation

Cardiovascular Emergencies

Angina Myocardial infarction

Angina

Sweating

Shortness of

breath

Nausea

Unsettling to

patient

Myocardial infarction

ManagementSemi Fowlers

position

Nitroglycerin

0.4 mg

sublingual or

spray, repeat

ed every

5 minutes X 3

oxygen

CPR/ Emergency

dept.

CNS Emergencies

Syncope

Epilepsy

Stroke

SyncopePale Sweatin

g

Room “feels warm”Nausea

Pulse rapid

BP nearly normal

Loss of consciousne

ss

Possible seizure activity

BP extremely low

Pulse extremely

slow and weak

Treatment Stop dental treatment

Remove objects in

mouth

Trendelenburg position

Raise feet

Loosen restrictive clothing

Supplemental oxygen

Cool towel to forehead

Monitor vital signs

Ammonia vaporole

Prevention Short appointments

Morning appointments

Distraction techniques

Patient education and communication

Sedation

Treat in more supine or slight Trendelenburg position

Snack before appointment

Epilepsy Personality

changes

Seizure Loss of

consciousness

Treatment Stop dental treatment, all objects

out of mouth

Remove dangerous items from

around patient

Gently restrain and

protect patient

NO tongue blades,

maintain airway

Oxygen Monitor vital signs

Call emergency

dept

Valium 5-10 mg IV or

midazolam 2-4 mg IV/IM

Prevention

Confirm that patient has taken

antiseizure medications on

day of procedure

Limit stress

Sedation

• Benzodiazepines

• Barbiturates

Stroke• Check these signs

F-A-S-T• Smile: Is 1 side

drooping

Face

• Raise both arms: Is 1 side weak

Arms

• Unable?• Words slurry

Speech

• Time lost means brain lost

Time

Management

BLS, supine position

BUT head slightly

elevated

Reassurance and transfer to hospital

Other Emergencies

Allergic reactions

Hypoglycemia

Allergic reactions

Timing of the reaction

• Immediate• Delayed

Extent of the reaction

• Rash• Swelling• Respiratory

compromise

Treatment

Delayed onset skin reaction• Stop dental

treatment/medications

• Assess respiration• Consider

observation if localized

• If more generalized, diphenhydramine (Benadryl) 25-50 mg TID x 2 days

Immediate skin reaction• Stop dental

treatment• Assess

respiration• Diphenhydramin

e 25-50 mg IM/IV• Diphenhydramin

e 25-50 mg TID x 2 days

Respiratory or cardiovascular compromise• Stop treatment• Oxygen• Basic life support as

indicated• Epinephrine 0.3-0.5

mg SC/IM/IV• Bronchodilator inhaler

if wheezing present• Diphenhydramine 25-

50 mg IM/IV• Hydrocortisone 100

mg IM/IV

Prevention

Careful medical history

Avoid prescribing medications in the same class as those to which known

allergy exists

Prophylactic antihistamines?

Hypoglycemia

Confusion

Abnormal behavior

Diaphoresis

Tachycardia

Anxiety

Loss of consciousness

Seizure

• Juice• Cake frosting

If conscious:

• Epinephrine 0.3-0.5 mg SC/IM/IV• Dextrose• Glucagon 1 mg IM/IV

Treatment

PreventionAssure

appropriate food intake

Request serum

glucose level

Stress reduction

Check blood sugar level

before dental procedure

Keep ‘em sweet

Conclusion

Prevention

Recognation

Management

Satisfactory Outcome

When you prepare for an emergency, the emergency ceases to exist

Always Be Prepared…..