MEDICAL EMERGENCIES IN THE DENTAL OFFICE
Cardiopulmonary Resuscitation course
CPR COURSE CONTENTS
 INTRODUCTION AND PREVENTION OF MEDICAL
EMERGENCIES
 PREPARATION AND LEGAL CONSIDERATIONS
Dr Nall...
CPR course
Assessment pattern:
 Continuous assessment ( Attendance, BLS certificate
and Quiz)
= 25 %
 Mid term exam
= 2...
Requirement for passing the course!
EVERY STUDENT HAVE TO SUBMET A
DOCUMENTRY PROOF FOR ATTENDANCE OF
BASIC LIFE SUPPORT (...

MEDICAL EMERGENCIES CAN OCCUR IN DENTISTRY.

(LIFE THREATENING EMERGENCIES) INFREQUENT BUT
LIKELIHOOD DUE TO:
- Incr...
-
Occur in both old & young
-
Stress in dental office – Pain, Fear & Anxiety, preexisting
conditions
-
Stress reducti...
Death :
 Deaths can occur in the dental office ( Patient, Doctor or Accompany)
 Again due to stress or drug overdose.
 ...
Risk factors:
 Increased Elderly patients = greater risk for accidents
 Good health, may be subclinical disease. Evaluat...
- Medical advances:
- Incidence of diabetes, CVS diseases- with long life expectancy.
-
Advanced effective, drug therapy ...
Classification of emergencies
Systems- oriented classification:
 Infectious diseases: - immune system
Allergy, angioneuro...
Classification of emergencies

Blood

GI and liver

Obstetrics

Nerves system
Unconsciousness
Vaso depressor sy...
Common Emergencies in dental office:
 Unconsciousness: - Vaso Depressor syncope, Hypotension, Acute
Adrenal insufficienc...
Prevention
 A complete system of physical evaluation for all
prospective dental patients can prevent approximately 90%
o...
Goals of Evaluation
Physically & psychologically
tolerate the stress
Psycho-sedation &
contraindications
If treatment
mo...
Physical evaluation  Medical history questionnaire:
Medical referral
Prophylactic regimes for dental procedures
1.
Standard prophylaxis – Amoxiciin- Adults 2g, child 50 mg/kg oral
1hr before...
Dental drug interactions:
Clinical Examination
Vital Signs
 Blood pressure
 Heart rate (pulse) and rhythm
 Respiratory rate
 Temperature
 Hei...
Guideline for blood pressure in adult
Blood pressure
(mm hg)
ASA
classification
Dental Therapy
Considerations
> 140 and...
ASA physical status classification
 ASA I : Normal healthy pt, without systemic disease.
 ASA II : Pt with mild systemic...
Anxiety reduction
 Recognition of anxiety- history and observation.
Types:
 Moderate
• Usually try to hide their
fears...
Stress reduction protocol
Text book for Reference:
Medical Emergencies in Dental office by
Stanley Malammed – 6th edition
of 24

Prevention of medical emergencies

CPR Forth Year
Published on: Mar 4, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - Prevention of medical emergencies

  • 1. MEDICAL EMERGENCIES IN THE DENTAL OFFICE Cardiopulmonary Resuscitation course
  • 2. CPR COURSE CONTENTS  INTRODUCTION AND PREVENTION OF MEDICAL EMERGENCIES  PREPARATION AND LEGAL CONSIDERATIONS Dr Nallan Chytanya Lecturer in Oral Medicine Department of Biomedical Dental Sciences College of Dental Sciences
  • 3. CPR course Assessment pattern:  Continuous assessment ( Attendance, BLS certificate and Quiz) = 25 %  Mid term exam = 25 %  Final exam = 40 %  OSCE = 10 %
  • 4. Requirement for passing the course! EVERY STUDENT HAVE TO SUBMET A DOCUMENTRY PROOF FOR ATTENDANCE OF BASIC LIFE SUPPORT (BLS CERTFICATE) THIS IS MANDATORY PRIOR ENTRY TO THE FINAL EXAM.
  • 5.  MEDICAL EMERGENCIES CAN OCCUR IN DENTISTRY.  (LIFE THREATENING EMERGENCIES) INFREQUENT BUT LIKELIHOOD DUE TO: - Increasing geriatric patients - Advances in medicine - Long dental appointments - Increased drug usage in dentistry MORBIDITY: - Most common- Syncope > Allergic reaction > Cardiac - Even with most meticulous protocols emergencies still occur
  • 6. - Occur in both old & young - Stress in dental office – Pain, Fear & Anxiety, preexisting conditions - Stress reduction protocols. - Drug related adverse effects add up – Local anesthesia, Drug overdose and Allergy. - Pain---Release of Catecholamine- Triggering of Emergencies. - 65% of cases developed during two types of dental care-- 39% in tooth extraction and pulp extirpation (27%) .
  • 7. Death :  Deaths can occur in the dental office ( Patient, Doctor or Accompany)  Again due to stress or drug overdose.  Failure to recognize the symptoms can lead to deaths. With CPR 75% survived. Most reported deaths- cardiac dys-arrythmias  Unexpected accidental death inspite of preparedness  Successful outcome- act quickly and recognize, manage effectively  Stress – delayed deaths too.
  • 8. Risk factors:  Increased Elderly patients = greater risk for accidents  Good health, may be subclinical disease. Evaluate all major systems. CVS must.  Age involves physiologic and pathologic –alter pt’s ability to adapt to stress.  Changes in renal function, drug usage  Changes in lung elasticity
  • 9. - Medical advances: - Incidence of diabetes, CVS diseases- with long life expectancy. - Advanced effective, drug therapy and surgical techniques. - Challenge from these drug controlled patients. - Longer appointments: - Increased length of treatment. 1-3 hrs.---stressful - Increased drug usage: - For pain, fear and infection. - Drug adverse effects and interactions
  • 10. Classification of emergencies Systems- oriented classification:  Infectious diseases: - immune system Allergy, angioneurotic edema, contact dermatitis, anaphylaxis  Skin and appendages  Eyes, nose and throat  Respiratory system Asthma, hyperventilation  CVS Arteriosclerosis, angina, MI, Heart failure  Blood  GI and liver
  • 11. Classification of emergencies  Blood  GI and liver  Obstetrics  Nerves system Unconsciousness Vaso depressor syncope, hypotension Convulsive disodres Drug overdose CVS - Endocrine disorders: - Diabetes- hyperglycemia . Hypoglycemia, - Thyroid disorders- Hyper and Hypo - Adrenal gland insufficiency
  • 12. Common Emergencies in dental office:  Unconsciousness: - Vaso Depressor syncope, Hypotension, Acute Adrenal insufficiency  Respiratory distress:- Airway obstruction, Hyperventilation, Asthma, Heart failure and Pulmonary edema  Altered consciousness - Diabetes, Thyroid gland disorders  Cerebrovascular accidents & Seizures  Drug related emergencies- Overdose, Allergy  Chest pain- Angina, MI  Cardiac arrest
  • 13. Prevention  A complete system of physical evaluation for all prospective dental patients can prevent approximately 90% of life threatening situations McCarthy  “When you prepare for an emergency, the emergency ceases to exist” Goldberger
  • 14. Goals of Evaluation Physically & psychologically tolerate the stress Psycho-sedation & contraindications If treatment modifications
  • 15. Physical evaluation  Medical history questionnaire:
  • 16. Medical referral
  • 17. Prophylactic regimes for dental procedures 1. Standard prophylaxis – Amoxiciin- Adults 2g, child 50 mg/kg oral 1hr before. 2. Inability for oral med- Ampicillin- 30 min before procedure. 3. Allergy to penicillin- Clindamycin- Adults 600 mg, child 20 mg/kg orally , or Cephalexin -Adults 2g, Child 50mg/kg or AzithromycinAdults 500mg, Child 15 mg /kg oral 1 hr before. 4. Allergy to Penicillin & inability to take oral med- Clindamycin or Cefazolin( 1gm) - Adults 600mg, Child 20 mg/kg IV 30 min before procedure.
  • 18. Dental drug interactions:
  • 19. Clinical Examination Vital Signs  Blood pressure  Heart rate (pulse) and rhythm  Respiratory rate  Temperature  Height  Weight
  • 20. Guideline for blood pressure in adult Blood pressure (mm hg) ASA classification Dental Therapy Considerations > 140 and > 90 ASA I Observe, routine treat. 140-159 or 90-94 ASA II Recheck Bp ( 3 times) , medical consultation, MC implement stress red. Protocol 160-199 or 95-114 ASA III Recheck every 5 minutes, MC, stress reduction protocol <200 and/ or <115 ASA IV Recheck every 5 minutes, MC, stress reduction protocol , only emergency treatment , hospital referral.
  • 21. ASA physical status classification  ASA I : Normal healthy pt, without systemic disease.  ASA II : Pt with mild systemic disease.  ASA III : Pt with sev systemic disease that limits activity but is not incapacitating.  ASA IV : Capacitating systemic disease – threat  ASA V : Pt not expected to survive 24 hrs with/ without operation  ASA E: Emergency operation of any variety
  • 22. Anxiety reduction  Recognition of anxiety- history and observation. Types:  Moderate • Usually try to hide their fears • Cold and sweaty palms • Nervous appearance Severe • • • • • Usually does not hide their fear Appears with severe infection or toothach Increased heart rate and blood pressure Excessive sweating, trembling Dilated pupils
  • 23. Stress reduction protocol
  • 24. Text book for Reference: Medical Emergencies in Dental office by Stanley Malammed – 6th edition

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