MED Emergency_2023

MEDICAL EMERGENCIES in the Dental Office

Factors Contributing to Life-Threatening Emergencies

  • Increased number of older patients seeking treatment.

  • Therapeutic advances in the medical profession leading to complexity in patient care.

  • A growing trend toward longer dental appointments, increasing patient exposure to potential complications.

  • Increased use and administration of drugs in dentistry, raising the risk of adverse reactions.

Minimizing the Development of Life-Threatening Emergencies

  • Conduct a pretreatment physical evaluation for each patient:

    • Medical history: Check for underlying health conditions.

    • Dialogue history: Discuss previous dental experiences.

    • Physical examination: Assess vital signs and any observable issues.

    • Modification of dental care: Tailor approach to reduce medical risks based on evaluation.

  • Implementation of Stress Reduction Procedures (SRPs) can decrease emergencies to 10% or less.

Stress Reduction

  • Create a comfortable, warm, and sincere dental environment.

  • Establish rapport by actively listening to patient fears and concerns.

  • Offer suggestions to alleviate or minimize fears and stress.

Stress Reduction Protocol (SRP)

  • Sedation: Administer sedatives the night before and morning of the appointment.

  • Intraoperative sedation: Ensure patient comfort during procedures.

  • Effective pain control: Manage pain proactively.

  • Schedule morning appointments to enhance patient safety.

  • Time management: Do not exceed the patient's tolerance; monitor conditions (e.g., hot weather).

  • Postoperative care: Provide prescriptions, and conduct follow-up calls after prolonged or traumatic procedures.

OFFICE PREPAREDNESS

  • Develop a well-organized emergency routine for staff.

  • Ensure knowledge of the location and use of emergency equipment.

  • Assign specific duties to team members to prevent confusion during emergencies and minimize response time.

  • Conduct regular practice drills to reinforce preparedness.

PROCEDURES FOR BASIC EMERGENCIES - UNIVERSAL TREATMENT

TEAM MEMBER #1 (First Responder)

  • Perform Basic Life Support (BLS) as needed:

    • Check Circulation, Airway, Breathing (CAB).

    • Call for assistance from the nearest faculty, dentist, or student.

    • Properly position the patient and monitor vital signs (blood pressure, respiration, pulse).

    • Stay with the patient at all times!

TEAM MEMBER #2

  • Contact a faculty member and dentist.

  • Call for medical assistance if necessary (dial ext. 911).

  • Gather emergency equipment:

    • Blood pressure equipment.

    • Emergency kit (including oxygen).

TEAM MEMBER #3

  • Call for medical assistance if TEAM MEMBER #2 is unable to do so.

  • Assist as needed and perform BLS as required.

  • Monitor vital signs and maintain accurate records.

  • If necessary, request an ambulance by calling 911.

AIRWAY MANAGEMENT

  • Be prepared to manage airway obstruction, which can occur due to aspiration of foreign objects.

  • Maintain awareness of common causes such as rubber cups, crowns, burs, instrument tips, and cotton rolls.

  • For Partial Obstruction with Adequate Exchange: Encourage coughing.

  • For Partial Obstruction with Inadequate Air Exchange: Treat as complete airway obstruction.

  • For Complete Obstruction: Administer the Heimlich Maneuver.

BASIC EMERGENCY DRUGS

Critical Injectable Drugs

  • Epinephrine: First-line treatment for anaphylaxis; administered IM or IV.

  • Chlorpheniramine: Second-line drug for allergic reactions, alternative to Diphenhydramine.

Critical Non-injectable Drugs

  • Oxygen: Most vital in cases of respiratory distress; can be delivered via nasal cannula or face mask.

  • Nitroglycerin: For chest pain management, critical for angina and myocardial infarction.

  • Albuterol: Bronchodilator for asthmatic reactions, effective for respiratory distress.

  • Oral Glucose: Administer for hypoglycemic events; use cautiously to prevent aspiration if the patient is unconscious.

COMMON MEDICAL EMERGENCIES

Vasodepressor Syncope

  • Primary Cause: Oxygen deprivation to the brain.

  • Signs: Paleness, dizziness, nausea, increased pulse, loss of consciousness.

  • Management: Position patient comfortably; apply oxygen; document the event.

Hyperglycemia and Diabetes Mellitus

  • Onset due to insufficient insulin leading to increased blood glucose.

  • Signs include fruity breath, dry skin, drowsiness, and blurred vision.

  • If hyperglycemia occurs, call for EMS.

Hypoglycemia

  • Resulting from excessive insulin or inadequate glucose intake.

  • Features sudden onset with symptoms like hunger, confusion, and pale skin.

  • Treatment includes administering glucose if the patient is conscious.

Seizures

  • Different types include simple partial, complex partial, and generalized seizures.

  • Management: Clear the area, protect from injury, and allow to recover safely.

Emergency Situations from Respiratory Diseases

  • Includes COPDs and Asthma, triggered mainly by anxiety or allergens.

  • Position the patient upright, administer bronchodilator if needed, and provide oxygen.

Cardiovascular Emergencies

  • Angina Pectoris: Sudden chest pain management with nitroglycerin and oxygen.

  • Myocardial Infarction: Recognize symptoms (longer duration of pain than angina), administer aspirin, and summon emergency services.

Allergic Reactions

  • Immediate reactions require epinephrine and oxygen; delayed reactions usually involve antihistamines.

Hemorrhage Management

  • Apply pressure to control bleeding; monitor and respond based on the type of bleeding (tooth socket, nosebleed, etc.).

Foreign Body Management

  • Immediate irrigation of the eye for foreign objects; manage dislocated jaws carefully with manual reduction techniques.