Emergency Drugs Study Guide

EMERGENCY DRUGS - CHAPTER 21

LEARNING OBJECTIVES

  • General Measures for Training: A dental professional should familiarize themselves with emergency procedures.

    • Necessary Preparations: Outline preparations for emergency treatments.

    • Minimizing Occurrence: Strategies to help mitigate emergency situations in the dental office.

    • Emergency Response Steps: Steps to follow when emergencies occur.

    • Categories of Emergencies: Identify and describe various categories of emergencies with examples.

    • Critical Drugs in Emergency Kit: List essential drugs and optional second- or third-level drugs.

    • Emergency Equipment: Identify necessary equipment to include in an emergency kit.

INTRODUCTION

  • Demographics: The rising average age of dental patients is due to factors such as population demographics, the use of fluorides, and management of periodontal disease leading to more complex drug regimens.

  • Risk Factors: Older adults often take multiple medications which raises the likelihood of emergencies occurring in the dental office.

  • Preparation Importance: Being well-prepared significantly improves patient outcomes during emergencies.

GENERAL MEASURES FOR EMERGENCY PREPARATION

  • Training:

    • All personnel in the dental office should undergo emergency procedure training and retraining every six months.

  • CPR and Advanced Cardiac Life Support (ACLS):

    • Personnel should be trained in CPR and ACLS.

  • Emergency Contact Information:

    • Display contact numbers for emergency rooms, physicians, and ambulance services prominently in the office.

  • Emergency Kit Maintenance:

    • Check drugs and devices in the emergency kit every three months.

  • Preventive Measures:

    • Emphasize that preventing medical emergencies is easier than treating them.

METHODS OF MINIMIZING EMERGENCIES IN THE DENTAL OFFICE

  • Patient Observation:

    • Monitor patient’s stature, build, gait, skin color, facial expression, and respiratory pattern.

  • Anxiety Assessment:

    • Record patient anxiety and use active listening to gauge unspoken fears.

  • Vital Signs Monitoring:

    • Measure blood pressure and pulse rate; conduct necessary lab tests.

  • Comprehensive Patient History:

    • Document medication history, prior dental and anesthetic experiences, physical activity restrictions, diseases, and current condition.

  • Consultations:

    • Seek medical consultations as warranted.

  • Premedication:

    • Prescribe premedication when appropriate, avoiding potentially harmful drug interactions.

EMERGENCY RESPONSE GUIDE FOR DENTAL OFFICE

Steps for Handling a Medical Emergency

  • Recognize Abnormalities: Recognize the abnormal occurrence during treatment.

  • Diagnosis: Make an initial proper diagnosis of the situation.

  • Emergency Contact: Call 911 (or appropriate emergency number).

  • Alert Staff: Notify other staff members and establish a runner if needed.

  • Timing: Note the time of the emergency for reference.

  • Patient Positioning: Ensure the patient is positioned correctly for treatment.

  • Airway Maintenance: Maintain a clear airway for the patient.

  • Administer Oxygen: Provide oxygen if required.

  • Monitor Vital Signs: Keep a vigilant check on the patient's vital signs.

  • Symptomatic Treatment: Provide treatment based on symptoms observed.

  • CPR: Administer CPR if the patient has no pulse.

PREPARATION FOR TREATMENT

  • Signs & Symptoms Assessment:

    • Accurate diagnosis based on the patient's signs and symptoms must precede any emergency treatment.

  • AHA Assessment Protocol:

    • C: Circulation - Ensure proper chest compressions are applied.

    • A: Assessment - Assess the patient's airway safety.

    • B: Breathing - Evaluate the breathing of the patient.

  • Drug Administration:

    • Generally, supportive drugs are not necessary in emergency situations. If uncertain about drug use, refrain from administration.

CATEGORIES OF EMERGENCIES

  1. Lost/Altered Consciousness:

    • Syncope: Most frequent dental office emergency linked to anxiety and fear. Signs include ashen-gray skin and diaphoresis. Recommended treatment includes positioning the patient in the Trendelenburg position, administering oxygen, and using ammonia spirits.

    • Hypoglycemia: Caused by excessive insulin doses in diabetics, exhibiting rapid pulse and confusion. Treatment varies based on consciousness level (sugary drink vs. IV dextrose)

    • Diabetic Coma: Resulting from hyperglycemia, with symptoms including frequent urination, acetone breath, and rapid pulse. Treatment necessitates calling emergency services and may include insulin after lab results.

    • Seizures: Associated mainly with epilepsy; necessitates protecting the patient from harm and optionally administering Valium (diazepam) IV.

  2. Respiratory Emergencies:

    • Hyperventilation: Brought on by anxiety. Symptoms include tachypnea and tingling extremities. Treatment involves position adjustment, reassurance, and breathing controls.

    • Asthma Attacks: Identity confirmed by wheezing. Use patient's inhaler first, monitoring closely while applying oxygen as needed.

    • Anaphylactic Shock: Triggered by allergies. Administer epinephrine intramuscularly; follow up with other emergency medications as needed.

    • Acute Airway Obstruction: Commonly resulting from foreign body aspiration; immediate actions include the Heimlich maneuver for conscious patients and CPR/clearance for unconscious ones.

  3. Cardiovascular Emergencies:

    • Angina Pectoris: Can mimic heart attack symptoms; treatment involves nitroglycerin administration under careful monitoring.

    • Acute Myocardial Infarction: Persistent chest pain with multiple systemic symptoms; immediate emergency services must be called, administer oxygen and aspirin if indicated.

    • Cardiac Arrest: Recognized by absence of pulse and need for immediate CPR; use AED promptly for best outcomes.

    • Other Cardiovascular Emergencies: Includes arrhythmias and strokes—each requiring tailored emergency response protocol.

  4. Other Emergency Situations:

    • Extrapyramidal Reactions: Caused by certain medications; benzodiazepines are first-line treatments.

    • Acute Adrenocortical Insufficiency: Symptoms linked to steroid use, necessitating hydrocortisone administration during emergencies.

    • Malignant Hyperthermia: Triggered by specific anesthetics. Treatment involves cooling measures and administration of Dantrium (dantrolene).

  5. Drug-Related Emergencies:

    • Opioid Overdosage: Potentially arising from both prescribed and illicit substances, presenting primarily with respiratory depression; Narcan (naloxone) is the antidote.

    • Local Anesthetic Reactions: Manage overdose symptoms through careful monitoring; symptomatic treatments may be warranted.

    • Epinephrine Reactions: Post-cord placement can induce symptoms like tachycardia; primary response includes reassurance and removing causative agents.

EMERGENCY KIT FOR THE DENTAL OFFICE

  • The selection of drugs in the emergency kit should reflect individual practitioner experience and preferences while ensuring prominent storage and security of the kit.

LEVEL 1 (CRITICAL) DRUGS IN EMERGENCY KIT

  • Albuterol: Used in respiratory emergencies.

  • Aspirin: Useful for cardiac events.

  • Benadryl (diphenhydramine): An antihistamine for allergic reactions.

  • Epinephrine: Used for anaphylaxis.

  • Glucose: Aids in hypoglycemia treatment.

  • Narcan (naloxone): An opioid antagonist.

  • Nitroglycerin: Addresses angina and myocardial infarctions.

  • Oxygen: Essential for various emergencies.

LEVEL 2 (SECONDARY) DRUGS IN EMERGENCY KIT

  • Aromatic Ammonia Spirits: Helps with syncope.

  • Atropine: For bradycardia treatments.

  • β-Blockers: Such as Trandate (labetalol).

  • Benzodiazepines: E.g., Valium (diazepam) for anxiety or seizures.

  • Dextrose: For hypoglycemia management.

  • Glucagon: Used in specific hypoglycemia cases.

  • Hydrocortisone: For adrenal insufficiency.

  • Antiarrhythmics: Such as lidocaine.

  • Romazicon (flumazenil): A benzodiazepine antagonist.

EMERGENCY EQUIPMENT

  • Level 1 (Critical Devices):

    • Syringes/needles

    • Tourniquets

    • Oxygen administration system

    • Automated external defibrillator (AED)

    • Bivalve mask for CPR

  • Level 2 (Secondary Devices):

    • Cricothyrotomy device

    • Endotracheal tube

    • Laryngoscope

    • IV infusion administration system