dental office emergencies.ppt

ByByDr Saikat SahaDr Saikat Saha

Dental Office EmergenciesDental Office Emergencies

Be preparedBe prepared

Be alertBe alert

AnticipateAnticipate

By By Dr Saikat SahaDr Saikat Saha

Successful PreventionSuccessful Prevention

Updated medical & health historyUpdated medical & health historyOperator & patient rapportOperator & patient rapportMinimal stress levelMinimal stress levelObservation Observation Vital signs - baselineVital signs - baseline


Patient AssessmentPatient Assessment

Four step treatment approachFour step treatment approach

R - recognition of diseaseR - recognition of disease

A - assessment of the riskA - assessment of the risk

M - management for safetyM - management for safety

E - emergency careE - emergency care


Dental Hygienist’s RoleDental Hygienist’s Role

RDH often the first to RDH often the first to recognize a potential recognize a potential medical emergencymedical emergency

Observe and monitor Observe and monitor throughout care throughout care patient’s changes in patient’s changes in expression, skin tone, expression, skin tone, muscle tonus, muscle tonus, respiration, verbal respiration, verbal expressionsexpressions


Dental Hygienist RoleDental Hygienist Role

Course in First Aid Course in First Aid desirabledesirable

Course in CPR Course in CPR requiredrequired

Classify responses Classify responses and know when and know when emergency situation emergency situation seems imminent seems imminent

Prompt,appropriate Prompt,appropriate reactions to signs of reactions to signs of distress distress

Ability to provide care Ability to provide care until help is secured until help is secured

Provide complete Provide complete description of distress description of distress signs to DDS and signs to DDS and EMT EMT


Being Prepared to ReactBeing Prepared to React

Emergency phone Emergency phone numbersnumbers

Rehearsal of Rehearsal of emergency scenarioemergency scenario

Procedures for Procedures for alerting other staff alerting other staff membersmembers

Write out specific Write out specific protocols for action in protocols for action in the event of medical the event of medical emergencyemergency

Specific assignments Specific assignments made to ensure all made to ensure all designated designated procedures procedures completedcompleted


Generic Functions of Emergency Generic Functions of Emergency Response TasksResponse Tasks

Evaluate vital signsEvaluate vital signs Diagnose nature of Diagnose nature of

emergencyemergency Decide on appropriate Decide on appropriate

treatmenttreatment Instruct others what to Instruct others what to

dodo Phone for helpPhone for help

Prepare for treatment Prepare for treatment administrationadministration

Administer treatmentAdminister treatment Monitor vital signsMonitor vital signs Reassure patientReassure patient Record events that Record events that

occuroccur Ensure privacy/and or Ensure privacy/and or

manage other patientsmanage other patients


Medical EmergenciesMedical Emergencies

Predisposition to emergencyPredisposition to emergency

Patient with HBP, Cardiac insufficiency, asthma, Patient with HBP, Cardiac insufficiency, asthma, angina,diabetesangina,diabetes

High anxiety levelsHigh anxiety levels

Combination of both may trigger physical response Combination of both may trigger physical response that could be classified as emergencythat could be classified as emergency


Medical Emergency PreventionMedical Emergency Prevention

Practitioner must be able toPractitioner must be able to

Recognize patient anxietyRecognize patient anxiety

Modify dental therapyModify dental therapy

Prevent an emergencyPrevent an emergency


Emergency Situation Emergency Situation

Most responses to emergencies can be Most responses to emergencies can be

managed using basic life support (without managed using basic life support (without

use of drugs) until advanced life support use of drugs) until advanced life support

can arrive.can arrive.


Intro: Adrenal CrisisIntro: Adrenal Crisis

Adrenal gland consists of two distinct Adrenal gland consists of two distinct regions . regions . Adrenal cortex produces endogenous steroids. Adrenal cortex produces endogenous steroids. Medulla produces and secretes epinephrine Medulla produces and secretes epinephrine

and norepinephrine.and norepinephrine.Hypofunction of adrenal cortex results in Hypofunction of adrenal cortex results in

decreased cortisol production. Cortisol decreased cortisol production. Cortisol necessary to help body react to stressful necessary to help body react to stressful situations.situations.


Intro: Adrenal CrisisIntro: Adrenal Crisis

Individuals with decreased cortisol Individuals with decreased cortisol production cannot respond to stress and production cannot respond to stress and risk cardiovascular collapse and possible risk cardiovascular collapse and possible death.death.

Patients may be taking supplement. Patients may be taking supplement. (Addison’s disease)(Addison’s disease)

May need to increase level of exogenous May need to increase level of exogenous steroids before undergoing stressful steroids before undergoing stressful proceduresprocedures


Signs & Symptoms: Adrenal CrisisSigns & Symptoms: Adrenal Crisis

Shocklike symptoms(cardiovascular Shocklike symptoms(cardiovascular collapse)collapse)HypotensionHypotensionBradycardiaBradycardiaFeverFeverRespiratory depressionRespiratory depression

HypercalcemiaHypercalcemiaLethargyLethargy


Treatment: Adrenal CrisisTreatment: Adrenal Crisis

Terminate treatmentTerminate treatmentMonitor and record vital signsMonitor and record vital signsPlace patient in Trendelenburg’s positionPlace patient in Trendelenburg’s positionAccess and support airway, breathing, Access and support airway, breathing,

circulation- BLScirculation- BLSActivate emergency protocolActivate emergency protocolProvide supplemental oxygenProvide supplemental oxygenAdminister saline, hydrocortisoneAdminister saline, hydrocortisone


Intro: Airway ObstructionIntro: Airway Obstruction

Unlikely to occur while being treated Unlikely to occur while being treated Upper airway obstruction usually Upper airway obstruction usually

reversiblereversibleMost common is unconsciousness - Most common is unconsciousness -

tongue and epiglottis occluding airwaytongue and epiglottis occluding airwayCan cause loss of consciousness and Can cause loss of consciousness and

cardiac arrestcardiac arrest


Intro: Airway Obstruction Intro: Airway Obstruction

Diagnose partial versus complete is Diagnose partial versus complete is critical and must be done rapidly to critical and must be done rapidly to prevent complications of anoxiaprevent complications of anoxiaPartial: person is making coughing or other Partial: person is making coughing or other

noisesnoisesComplete: no noises are made although Complete: no noises are made although

patient is attempting to cough or talk, patient is attempting to cough or talk, showing signal for chokingshowing signal for choking


Signs & Symptoms:Airway ObstructionSigns & Symptoms:Airway Obstruction

ChokingChoking

GaggingGagging

Violent inspiratory Violent inspiratory effortsefforts

Flushed faceFlushed face

Extreme anxietyExtreme anxiety

CyanosisCyanosis

Cardiovascular Cardiovascular collapsecollapse


Treatment: Airway ObstructionTreatment: Airway Obstruction

Position headPosition headRemove foreign objectRemove foreign object

sweeping motion of fingerssweeping motion of fingersMagil or straight forcepsMagil or straight forcepsSuctionSuction

Perform abdominal thrusts/Heimlich Perform abdominal thrusts/Heimlich manuevermanuever

Repeat as needed, cricothyrotomyRepeat as needed, cricothyrotomy


Intro: Anaphylaxis/AllergyIntro: Anaphylaxis/Allergy

Allergy-hypersensitive state results from Allergy-hypersensitive state results from exposure to allergen.exposure to allergen.

Range in clinical manifestation from Range in clinical manifestation from immediate-life threatening condition seen immediate-life threatening condition seen within seconds or delayed type reaction within seconds or delayed type reaction which may not manifest until hours or days which may not manifest until hours or days after exposure.after exposure.



Immediate or anaphylactic reaction that Immediate or anaphylactic reaction that occur in the dental office pose greatest occur in the dental office pose greatest risk to patient and are of greatest concern risk to patient and are of greatest concern to dental staff.to dental staff.

Usually result from drug administration or Usually result from drug administration or reaction to an allergen in impression reaction to an allergen in impression material or other materials used in oral material or other materials used in oral cavity.cavity.



Generalized most life threatening and Generalized most life threatening and dramatic allergic reaction.dramatic allergic reaction.

Death can occur in minutes if not treated Death can occur in minutes if not treated appropriately.appropriately.

Reactions affect skin,smooth Reactions affect skin,smooth muscle,respiratory and cardiovascular muscle,respiratory and cardiovascular systemsystem



Anaphylactic shock occurs when Anaphylactic shock occurs when consciousness lost as result of consciousness lost as result of hypotension from an anaphylactic hypotension from an anaphylactic reaction.reaction.

Symptoms begin with skin,followed by Symptoms begin with skin,followed by eyes,nose,and gastrointestinal eyes,nose,and gastrointestinal system,then respiratory system, finally system,then respiratory system, finally cardiovascular symptoms developcardiovascular symptoms develop

Prompt therapy can stop reactionPrompt therapy can stop reaction


Signs & Symptoms: Signs & Symptoms: Anaphylaxis/AllergyAnaphylaxis/Allergy

Urticaria-Urticaria-itching,flushing,hivesitching,flushing,hives

RashRash

RhinitisRhinitis

BronchospasmBronchospasm

Laryngeal edemaLaryngeal edema

Weak pulse-syncopeWeak pulse-syncope

Loss of Loss of consciousnessconsciousness

Cardiac arrestCardiac arrest


Treatment: Anaphylaxis/AllergyTreatment: Anaphylaxis/Allergy

Acute Reaction:Acute Reaction:Basic Life SupportBasic Life SupportEpinephrine, injection IMEpinephrine, injection IMOxygenOxygenDiphenhydramine, injection IMDiphenhydramine, injection IMCorticosteroidCorticosteroidCPRCPRAirway management - intubation, Airway management - intubation,

cricothyrotomycricothyrotomy


Signs & Symptoms: Signs & Symptoms: Anaphylactic ShockAnaphylactic Shock

Anaphylactic reaction: immediate allergic Anaphylactic reaction: immediate allergic response response For any allergic reaction to occur patient had For any allergic reaction to occur patient had

to have previous exposure to antigen-called to have previous exposure to antigen-called sensitizing dose sensitizing dose

Subsequent exposure to antigne termed Subsequent exposure to antigne termed challenging dosechallenging dose


Intro: Anesthesia ReactionsIntro: Anesthesia Reactions

Reaction can be varied in extent and Reaction can be varied in extent and severityseverity

Most are result of either local anesthetic Most are result of either local anesthetic agent itself or the vasoconstrictor within agent itself or the vasoconstrictor within formulationformulation

Toxicity can occur especially from rapid Toxicity can occur especially from rapid intravascular injectionintravascular injection

Reaction can occur 30-60 seconds to 1 Reaction can occur 30-60 seconds to 1 hour after injection hour after injection


Intro: Anesthesia ReactionsIntro: Anesthesia Reactions

Local anesthetic Local anesthetic dosing should be dosing should be calculated on: calculated on:

patient’s physical patient’s physical condition condition

body weightbody weight


Signs & Symptoms: Local Signs & Symptoms: Local Anesthesia ReactionsAnesthesia Reactions

Lightheadedness

Slurredspeech

Diasphoresis

Blurred vision Anxiety Nystagmus

Changemental status

Tinnitus Seizures

Confusion Headache Bradycardia

Disorientation Tremors Tachypnea

Drowsiness Nausea/Vomiting


Signs & Symptoms: Signs & Symptoms: Vasoconstrictor ToxicityVasoconstrictor Toxicity

AnxietyAnxiety

Tachycardia/ Tachycardia/ palpitationspalpitations

RestlessnessRestlessness

HeadacheHeadache

TachypneaTachypnea

Chest painChest pain

DysrhythmiasDysrhythmias

Cardiac arrestCardiac arrest


Treatment:Local Anesthesia Treatment:Local Anesthesia ToxicityToxicity

Initially, begin basic cardiac life supportInitially, begin basic cardiac life supportAssess and support Assess and support

airway,breathing,circulationairway,breathing,circulationSupportive treatment may be indicatedSupportive treatment may be indicatedAirway opened, oxygen givenAirway opened, oxygen givenSevere reactions, patient transported to Severe reactions, patient transported to

hospital emergency room as soon as hospital emergency room as soon as possiblepossible


Intro: Angina PectorisIntro: Angina Pectoris

Chest pain caused by temporary myocardial Chest pain caused by temporary myocardial ischemia without damage to heart muscle.ischemia without damage to heart muscle.

Due to narrowed coronary arteries’ inability to Due to narrowed coronary arteries’ inability to supply myocardium with sufficient blood to supply myocardium with sufficient blood to meet heart’s demand for oxygen during times meet heart’s demand for oxygen during times of stress.of stress.

Can be caused by atherosclerosis,coronary Can be caused by atherosclerosis,coronary artery vasospasm, or combination of both.artery vasospasm, or combination of both.


Intro: Angina PectorisIntro: Angina Pectoris

Detailed medical history important to Detailed medical history important to prevent these occurrences.prevent these occurrences.

Try to quantify the extent and pattern of Try to quantify the extent and pattern of the disease before beginning treatment.the disease before beginning treatment.

In other words, know what types of In other words, know what types of activities have caused symptoms in past.activities have caused symptoms in past.


Signs & Symptoms: Signs & Symptoms: Angina PectorisAngina Pectoris

Chest pain brought on by myocardial Chest pain brought on by myocardial stress - left center or center chest stress - left center or center chest

Chest fullnessChest fullnessBurningBurningTightnessTightnessPain radiating to neck,left Pain radiating to neck,left

arm,jaw,back,shoulder and epigastriumarm,jaw,back,shoulder and epigastrium


Signs & Symptoms: Signs & Symptoms: Angina PectorisAngina Pectoris

WeaknessWeaknessDyspneaDyspneaNauseaNauseaDiaphoresisDiaphoresisPain can last up to 20 minutes; prolonged Pain can last up to 20 minutes; prolonged

discomfort should be evaluated at discomfort should be evaluated at emergency medical facilityemergency medical facility


Treatment: Angina PectorisTreatment: Angina Pectoris

Avoid situations needing increased oxygen Avoid situations needing increased oxygen demandsdemands

Stop procedure and allow patient to restStop procedure and allow patient to restMonitor vital signs repeatedlyMonitor vital signs repeatedlyPlace patient in semireclined positionPlace patient in semireclined positionProvide supplemental oxygenProvide supplemental oxygen


Treatment: Angina PectorisTreatment: Angina Pectoris

Administer sublingual Administer sublingual nitroglycerin(0.4mg) nitroglycerin(0.4mg) every five minutes for every five minutes for three dosesthree doses

If not relieved, patient If not relieved, patient may be having may be having myocardial infarction myocardial infarction and transport to and transport to emergency medical emergency medical facility facility


Intro: AsthmaIntro: Asthma

Group of illnesses producing a reversible Group of illnesses producing a reversible hyperreactivity of large and small airwayshyperreactivity of large and small airways

Individuals may react to many stimuliIndividuals may react to many stimuli Incidence is rising in general populationIncidence is rising in general populationTriggering factors include pollen, Triggering factors include pollen,

stress,cold,upper respiratory tract stress,cold,upper respiratory tract infections, exercise, animal fur, infections, exercise, animal fur, nonsteroidal antiinflammatory medicationsnonsteroidal antiinflammatory medications


Signs & Symptoms: AsthmaSigns & Symptoms: Asthma

WheezingWheezingShortness of breathShortness of breathCoughCoughSputum productionSputum productionUse of accessory muscles for breathingUse of accessory muscles for breathingTachycardiaTachycardia


Treatment: AsthmaTreatment: Asthma

Objective is to improve ventilation by reducing Objective is to improve ventilation by reducing or eliminating brochospasmor eliminating brochospasm

Patient removed from irritantsPatient removed from irritants Inhalants used: Albuterol-Ventolin,Proventil or Inhalants used: Albuterol-Ventolin,Proventil or

TerbutalineTerbutaline Monitor vital signsMonitor vital signs Possible oxygen supplementPossible oxygen supplement Assess need for emergency medical Assess need for emergency medical

treatment treatment


Intro: Cardiac DysrhythmiasIntro: Cardiac Dysrhythmias

Commonly known as heart palpitationsCommonly known as heart palpitationsOften result of anxiety over dental Often result of anxiety over dental

proceduresproceduresCan be result of epinephrine given in local Can be result of epinephrine given in local

anesthetic or of underlying cardiac anesthetic or of underlying cardiac conditioncondition

Use simple reassurance to patientUse simple reassurance to patientMore severe may need more interventionMore severe may need more intervention


Signs & Symptoms: Signs & Symptoms: Cardiac DysrhythmiasCardiac Dysrhythmias

Racing heart (tachycardia)Racing heart (tachycardia) Irregular heart beatIrregular heart beatApprehensionApprehensionChest discomfortChest discomfortLight-headednessLight-headednessChest painChest pain


Treatment: Cardiac DysrhythmiasTreatment: Cardiac Dysrhythmias

Monitor vital signsMonitor vital signsPlace patient in reclined positionPlace patient in reclined positionAdminister supplemental oxygenAdminister supplemental oxygenActivate EMS Activate EMS


Intro: Cerebrovascular Accident/StrokeIntro: Cerebrovascular Accident/Stroke

Process that interferes with blood flow to Process that interferes with blood flow to the brainthe brain

Prolonged ischemic event causes Prolonged ischemic event causes infarction of part of brain. Can result in infarction of part of brain. Can result in neurologic deficit.neurologic deficit.

Three major causes of stroke: arterial Three major causes of stroke: arterial thrombosis, embolism, hemorrhage of the thrombosis, embolism, hemorrhage of the vasculaturevasculature


Signs & Symptoms: Cerebrovascular Signs & Symptoms: Cerebrovascular Accident/StrokeAccident/Stroke

HeadacheHeadache ConfusionConfusion VertigoVertigo Nausea/vomitingNausea/vomiting

Alteration in Alteration in consciousness,vision consciousness,vision & speech& speech

Extremity weaknessExtremity weakness

Facial weaknessFacial weakness

HypertensionHypertension

Change in mental Change in mental statusstatus


Treatment: Treatment: Cerebrovascular Accident/StrokeCerebrovascular Accident/Stroke

Assess and monitor vital signsAssess and monitor vital signs Initiate basic cardiac life support as Initiate basic cardiac life support as

neededneededAdminister oxygen if patient goes Administer oxygen if patient goes

unconscious or has trouble breathingunconscious or has trouble breathingPlace patient in supine position with head Place patient in supine position with head

slightly elevatedslightly elevatedActivate EMSActivate EMS


Intro: Congestive Heart FailureIntro: Congestive Heart Failure

Failure of cardiac ventricles to pump blood Failure of cardiac ventricles to pump blood efficiently to the body and lungs.efficiently to the body and lungs.

Result is pulmonary edema and peripheral Result is pulmonary edema and peripheral edema, overfilling venous system.edema, overfilling venous system.

Pulmonary edema can be result of lung Pulmonary edema can be result of lung disease or left ventricular failure.disease or left ventricular failure.


Intro: Congestive Heart FailureIntro: Congestive Heart Failure

Causes of acute onset:Causes of acute onset:

new arrhythmiasnew arrhythmias

new myocardial infarctionnew myocardial infarction

acute volume overloadacute volume overload

stressstress


Signs & Symptoms: Signs & Symptoms: Congestive Heart FailureCongestive Heart Failure

Shortness of breathShortness of breath Exertional dyspneaExertional dyspnea FatigueFatigue Orthopnea(2-3 pillows Orthopnea(2-3 pillows

to sleep) to sleep) CoughCough Rales (crackle) at Rales (crackle) at

lung baselung base

Edema-right side Edema-right side failurefailure

Plural effusion (fluid in Plural effusion (fluid in the lungs)the lungs)

Pink frothy sputumPink frothy sputum Jugular venous Jugular venous

distentiondistention


Treatment: Treatment: Congestive Heart FailureCongestive Heart Failure

Correct underlying causeCorrect underlying causeStress- Infection - Environmental Stress- Infection - Environmental

conditions(heat) conditions(heat)Administer supplemental oxygenAdminister supplemental oxygenActivate emergency responseActivate emergency responseMonitor vital signsMonitor vital signsDiscontinue procedureDiscontinue procedureHave patient rest in semireclined positionHave patient rest in semireclined position


Intro: Drug Related EmergenciesIntro: Drug Related Emergencies

Therapeutic agents can precipitate Therapeutic agents can precipitate physiologic crisisphysiologic crisis

Present as allergic or toxic reactionsPresent as allergic or toxic reactions Drug abuse most commonly found are alcohol Drug abuse most commonly found are alcohol

or cocaine relatedor cocaine related Act on central nervous systemAct on central nervous system Be aware of signs of drug abuse and drug Be aware of signs of drug abuse and drug

interactionsinteractions Explicit directions for patients drug useExplicit directions for patients drug use


Signs & Symptoms: Drug Related Signs & Symptoms: Drug Related EmergenciesEmergencies

Actions on CNS Actions on CNS StimulationStimulation: : Headache, Headache, Nausea,Vomiting, Nausea,Vomiting, Vertigo, Twitching Vertigo, Twitching small muscles, small muscles, Hallucinations, Hallucinations, Increased Increased RR,Elevated body RR,Elevated body temp,Agitated, temp,Agitated, Restless,ExcitationRestless,Excitation

Advanced Advanced StimulationStimulation: : Seizures.Decreased Seizures.Decreased response to response to stimuli,Incontinence, stimuli,Incontinence, Tachycardia,HypertenTachycardia,Hypertension, Weak rapid sion, Weak rapid pulse, Rapid irregular pulse, Rapid irregular breathingbreathing


Signs & Symptoms: Signs & Symptoms: Drug Related EmergenciesDrug Related Emergencies

Depression: Premorbid StateDepression: Premorbid Statecoma coma pupils fixed and dilatedpupils fixed and dilated flaccid paralysisflaccid paralysiscardiac arrestcardiac arrest respiratory arrestrespiratory arrestcyanosiscyanosis lethargy, stuporlethargy, stupor


Treatment: Treatment: Drug Related EmergenciesDrug Related Emergencies

Hypotension with evidence of shock in non Hypotension with evidence of shock in non responsive individuals is indication for responsive individuals is indication for parenteral fluid therapy.parenteral fluid therapy.

Activate emergency procedures protocol.Activate emergency procedures protocol.Basic life supportBasic life supportCPRCPR


Intro: HyperglycemiaIntro: Hyperglycemia

Increased blood sugarIncreased blood sugar

One of two life threatening complications One of two life threatening complications of diabetesof diabetes

Slow to develop but if not treated can Slow to develop but if not treated can result in diabetic coma and deathresult in diabetic coma and death


Signs & Symptoms: HyperglycemiaSigns & Symptoms: Hyperglycemia

Deep,labored Deep,labored respirationsrespirations

Sweet fruity breathSweet fruity breath

Dry. Warm skinDry. Warm skin

Rapid,weak pulseRapid,weak pulse

ThirstThirst

LassitudeLassitude

HeadacheHeadache


Treatment: HyperglycemiaTreatment: Hyperglycemia

Terminate procedureTerminate procedureAdminister glucoseAdminister glucose

Oral- paste or drink(must be conscious)Oral- paste or drink(must be conscious)IVIV

Perform basic life supportPerform basic life supportActivate emergency response protocol Activate emergency response protocol


Intro: HypertensionIntro: Hypertension

Unlikely to be seen but may manifest as Unlikely to be seen but may manifest as underlying cause of another crisisunderlying cause of another crisis

Absolutely essential to control increased Absolutely essential to control increased blood pressure in response to any other blood pressure in response to any other situationsituation

Must decide if patient needs emergent or Must decide if patient needs emergent or referral care-depends on history or any referral care-depends on history or any symptoms presentsymptoms present


Signs & Symptoms: HypertensionSigns & Symptoms: Hypertension

HeadacheHeadache

VomitingVomiting

Change in mental Change in mental statusstatus

Visual disturbanceVisual disturbance

SeizureSeizure

ShockShock

StrokeStroke

Blood Pressure Blood Pressure Readings - WNLReadings - WNL


Treatment: HypertensionTreatment: Hypertension

Discussed elsewhere Discussed elsewhere to control blood to control blood pressurepressure

Must refer for care in Must refer for care in hospital by physicianshospital by physicians

Focus on prevention-Focus on prevention-make sure medication make sure medication taken, anesthetic taken, anesthetic w/out epinephrinew/out epinephrine


Intro: HyperventilationIntro: Hyperventilation

Imbalance in ratio of blood oxygen and Imbalance in ratio of blood oxygen and blood carbon dioxide levelsblood carbon dioxide levels

Produced by either rapid or excessively Produced by either rapid or excessively deep respirationsdeep respirations

Common occurrence in dental office as it Common occurrence in dental office as it is result of anxiety or emotional stressis result of anxiety or emotional stress

Recognition and management of patient Recognition and management of patient anxiety can prevent this problemanxiety can prevent this problem


Signs & Symptoms and Treatment: Signs & Symptoms and Treatment: HyperventilationHyperventilation

Signs & SymptomsSigns & Symptoms:: DizzinessDizziness Light-headednessLight-headedness Numb fingersNumb fingers Heart dysrhythmiasHeart dysrhythmias Abdominal crampsAbdominal cramps Muscle crampsMuscle cramps

Treatment: Treatment: Terminate dental Terminate dental

treatmenttreatment Reassure the patientReassure the patient Try to institute regular Try to institute regular

respirationsrespirations Rebreath exhalations Rebreath exhalations

to reverse alkalosis to reverse alkalosis (breath into (breath into hands/bag)hands/bag)


Intro: HypoglycemiaIntro: Hypoglycemia

Condition of acutely decreased blood Condition of acutely decreased blood sugarsugar

Life threatening- more critical than Life threatening- more critical than hyperglycemia in emergency situationhyperglycemia in emergency situation

Must be treated rapidlyMust be treated rapidlyAdministration of glucose is indicated - will Administration of glucose is indicated - will

not significantly affect patientnot significantly affect patient


Signs & Symptoms and Treatment: Signs & Symptoms and Treatment: HypoglycemiaHypoglycemia

Signs & Symptoms:Signs & Symptoms:

HungerHunger NauseaNausea Cool, moist skinCool, moist skin Shallow respirationsShallow respirations IrritationIrritation ConfusionConfusion Bizarre behaviorBizarre behavior

Treatment:Treatment:

Terminate procedureTerminate procedure Administer glucoseAdminister glucose

Oral-paste or drinkOral-paste or drink IVIV

Perform basic life Perform basic life supportsupport

Activate EMS Activate EMS


Intro, Signs & Symptoms, Intro, Signs & Symptoms, Treatment: Nose BleedTreatment: Nose Bleed

Profuse or uncontrolled bleeding: Apply Profuse or uncontrolled bleeding: Apply compression over bleeding area. Digital compression over bleeding area. Digital pressure on pressure point of supplying pressure on pressure point of supplying vessel. vessel.

Nosebleed: Nosebleed: Request patient to pinch nostrils between thumb Request patient to pinch nostrils between thumb

and index finger for 5 minutesand index finger for 5 minutesApply cold compress to back of neck or over noseApply cold compress to back of neck or over noseUpright positionUpright position


Intro: Intraoral LacerationsIntro: Intraoral Lacerations

Rare but posssibleRare but posssibleHigh speed handpieces, overzealous High speed handpieces, overzealous

subgingival scalingsubgingival scalingSigns & Symptoms: Intraoral Signs & Symptoms: Intraoral

LacerationsLacerations Bleeding-Pulsation,bright red-arterial; Bleeding-Pulsation,bright red-arterial;

Oozing,dark,red-venous Oozing,dark,red-venous Pain at trauma site or over area of swelling Pain at trauma site or over area of swelling Swelling,slowly or rapidly, ecchymosisSwelling,slowly or rapidly, ecchymosis


Treatment: Intraoral LacerationsTreatment: Intraoral Lacerations

Discontinue treatmentDiscontinue treatmentRemove foreign bodies from mouthRemove foreign bodies from mouthPressure applied to site with sterile gauzePressure applied to site with sterile gauzeWound flushed and irrigated with salineWound flushed and irrigated with salineFollow emergency office protocol to inform Follow emergency office protocol to inform

dentist of situationdentist of situationMay be cared for in office or referred to May be cared for in office or referred to

oral surgeonoral surgeon


Intro: Myocardial InfarctionIntro: Myocardial Infarction

Occurs when myocardial oxygen demand Occurs when myocardial oxygen demand exceeds available oxygen supplied by exceeds available oxygen supplied by blood for an extended period.blood for an extended period.

Most myocardial infarctions result of Most myocardial infarctions result of atherosclerotic coronary artery diseaseatherosclerotic coronary artery disease

Plaques develop and occlude coronal Plaques develop and occlude coronal arteries, decrease blood flow to arteries, decrease blood flow to myocardium, cause irreversible damagemyocardium, cause irreversible damage


Signs & Symptoms: Signs & Symptoms: Myocardial InfarctionMyocardial Infarction

Chest painChest pain CrushingCrushing Radiating to Radiating to

neck,jaw,arm,backneck,jaw,arm,back SubsternalSubsternal

Hypertension or Hypertension or hypotensionhypotension

IndigestionIndigestion Diaphoresis(sweatingDiaphoresis(sweating

))

Shortness of breathShortness of breath Tachycardia or Tachycardia or

bradycardiabradycardia DysrhythmiasDysrhythmias Loss of or alteration in Loss of or alteration in

consciousnessconsciousness


Treatment: Myocardial InfarctionTreatment: Myocardial Infarction

Discontinue dental treatmentDiscontinue dental treatmentPlace patient in semireclined positionPlace patient in semireclined positionAdminister supplemental oxygenAdminister supplemental oxygenContinually monitor and record vital signsContinually monitor and record vital signsAdminister sublingual nitroglycerin 0.4mg Administer sublingual nitroglycerin 0.4mg

every 5 minute for 3 dosesevery 5 minute for 3 doses If no improvement,activate EMSIf no improvement,activate EMS


Intro: Ocular InjuriesIntro: Ocular Injuries

Rare but these type of injuries do occurRare but these type of injuries do occurNeed same prompt attention even though Need same prompt attention even though

not life threateningnot life threateningMost ocular injuries affect trauma to Most ocular injuries affect trauma to

cornea or the globe itselfcornea or the globe itselfWant to minimize loss of visual acuityWant to minimize loss of visual acuityRefer patient opthalmologist for definitive Refer patient opthalmologist for definitive

treatmenttreatment


Signs & Symptoms: Signs & Symptoms: Ocular InjuriesOcular Injuries

Chemical Burns:Chemical Burns: serious,alkali burns serious,alkali burns are true emergnciesare true emergncies

Mild to severe painMild to severe pain Blurred visionBlurred vision Excessive tearingExcessive tearing

Treatment:Treatment: Immediate copious Immediate copious irrigation with tap irrigation with tap water Alkali water Alkali and /or acid burns and /or acid burns require 15-20 minutes require 15-20 minutes of irrigation before of irrigation before transportation to transportation to opthalmologist for opthalmologist for immediate consult and immediate consult and evaluationevaluation


Treatment: Ocular InjuriesTreatment: Ocular Injuries

Foreign object in eye: Caution patient not Foreign object in eye: Caution patient not to rub eye to rub eye Blink repeatedly to stimulate tear flow. Blink repeatedly to stimulate tear flow. Locate object by lifting and rolling back Locate object by lifting and rolling back

eyelids. eyelids. Remove with tissue if possible or use eye Remove with tissue if possible or use eye

wash station. wash station. Always have patient wear protective eyewear. Always have patient wear protective eyewear.


Intro: SeizuresIntro: Seizures

Sudden and unexpected central Sudden and unexpected central paroxysmal neuronal depolarization of paroxysmal neuronal depolarization of nerve cells that result in uncontrolled nerve cells that result in uncontrolled muscular movement. muscular movement.

Two types: Two types: Focal- limitedFocal- limitedGeneralized- loss of consciousnessGeneralized- loss of consciousness


Intro: SeizuresIntro: Seizures

Caused by:Caused by:head injurieshead injuries infectionsinfectionsneoplasmsneoplasmscerebrovascular diseasecerebrovascular diseasesystemic conditions idiopathicsystemic conditions idiopathic

Signs & Symptoms: SeizuresSigns & Symptoms: Seizures

Feeling of aura-visual,auditory or olfactory Feeling of aura-visual,auditory or olfactory sensory disturbancesensory disturbance

Minor personality changesMinor personality changesDepressionDepressionAnxietyAnxietyHeadacheHeadacheLoss of consciousness, muscle rigidityLoss of consciousness, muscle rigidityTonic/Clonic movementsTonic/Clonic movements

Treatment: SeizuresTreatment: Seizures

Place patient in reclined or supine positionPlace patient in reclined or supine position Protect patient from injury during seizureProtect patient from injury during seizure Protect head from injury during seizureProtect head from injury during seizure Administer supplemental oxygen prnAdminister supplemental oxygen prn Suction mouth secretions-turn head to side Suction mouth secretions-turn head to side

if vomiting occurs-clear airwayif vomiting occurs-clear airway Monitor vital signsMonitor vital signs Initiate further support if neededInitiate further support if needed

Treatment: SeizuresTreatment: Seizures

Do not allow patients Do not allow patients to drive themselves to drive themselves home. Arrange for home. Arrange for transportation home transportation home by family member or by family member or other service. other service.

Intro: ShockIntro: Shock

Condition in which circulatory system Condition in which circulatory system inadequately perfuses body tissues inadequately perfuses body tissues resulting in cellular hypoxiaresulting in cellular hypoxia

Hypovolemic shock: due to sudden and Hypovolemic shock: due to sudden and acute loss of blood-secondary to traumaacute loss of blood-secondary to trauma

Septic shock: vasodilatory action of Septic shock: vasodilatory action of endotoxins produced by virulent systemic endotoxins produced by virulent systemic bacteremiabacteremia

Intro: ShockIntro: Shock

Cardiogenic shock: failure of heart to Cardiogenic shock: failure of heart to pump a sufficient amount of blood to pump a sufficient amount of blood to maintain perfusion pressuremaintain perfusion pressure

Neurogenic shock: result of spinal cord Neurogenic shock: result of spinal cord trauma causing loss of sympathetic trauma causing loss of sympathetic stimulation. Causes vasodilation.stimulation. Causes vasodilation.

Signs & Symptoms: ShockSigns & Symptoms: Shock

Hypotension/postural hypotensionHypotension/postural hypotensionTachycardiaTachycardiaCool skinCool skinPale skin colorPale skin colorAnxietyAnxietyChange in mental statusChange in mental statusDecrease capillary refillDecrease capillary refill

Treatment: ShockTreatment: Shock

Goal to maintain Goal to maintain perfusion pressure perfusion pressure and maintain and maintain oxygenation to vital oxygenation to vital organs and tissuesorgans and tissues

Monitor vital signsMonitor vital signs Place in Place in

Trendelenburg Trendelenburg positionposition

Keep quiet and warmKeep quiet and warm Activate EMSActivate EMS Provide supplemental Provide supplemental

oxygenoxygen Monitor skin signs Monitor skin signs

and capillary and capillary perfusionperfusion

Signs & Symptoms: Broken and Signs & Symptoms: Broken and Lodged Instrument TipLodged Instrument Tip

Don’t use incorrectly sharpened Don’t use incorrectly sharpened instruments which are extremely thininstruments which are extremely thin

Don’t force instruments out of contact areaDon’t force instruments out of contact areaTo loosen: relax the face of the instrument To loosen: relax the face of the instrument

toward the tooth (close blade),Attempt to toward the tooth (close blade),Attempt to back blade out of areaback blade out of area

Instruct patient not to swallow,check floor Instruct patient not to swallow,check floor of mouth and in gingival tissue, x-ray prnof mouth and in gingival tissue, x-ray prn

Signs & Symptoms: Emotional Signs & Symptoms: Emotional ProblemsProblems

Mental condition can affect physical Mental condition can affect physical condition: Hyperventilation, condition: Hyperventilation, lightheadedness,giddiness,anxiety, lightheadedness,giddiness,anxiety, confusion,dizziness,overbreathing,feelings confusion,dizziness,overbreathing,feelings of suffocation,heart pounds, tingling or of suffocation,heart pounds, tingling or numbness in extremitiesnumbness in extremities

Patient position should be upright;loosen Patient position should be upright;loosen tight collar,reassure patient,breath into bagtight collar,reassure patient,breath into bag

Intro: SyncopeIntro: Syncope

Vasodepressor syncope,fainting occurs Vasodepressor syncope,fainting occurs during stressful situationsduring stressful situations

Usually benign, unless left untreated,fatalUsually benign, unless left untreated,fatalCaused by transitory and sudden loss of Caused by transitory and sudden loss of

consciousness after cerebral ischemiaconsciousness after cerebral ischemiaPlace in supine position,restore blood flowPlace in supine position,restore blood flow

Intro: SyncopeIntro: Syncope

Predisposing factors: Predisposing factors: fright,fright,painpainemotional stress emotional stress anxiety anxiety hunger hunger sudden postural changes sudden postural changes exhaustionexhaustion


Signs & Symptoms: SyncopeSigns & Symptoms: Syncope

Early: Early: Loss of color, pallorLoss of color, pallor PerspirationPerspiration NauseaNausea Increased heart rateIncreased heart rate Feeling of warmthFeeling of warmth

Late:Late: YawningYawning Dilated pupilsDilated pupils Cold extremitiesCold extremities HypotensionHypotension DizzinessDizziness Loss of consciousnessLoss of consciousness

Treatment: SyncopeTreatment: Syncope

Position patient-supine, head lower than Position patient-supine, head lower than feet if possiblefeet if possible

Maintain open airwayMaintain open airwayAdminister oxygenAdminister oxygenAdminister ammonia inhalantAdminister ammonia inhalantMonitor vital signsMonitor vital signs


Procedural OverviewProcedural Overview

Respond in logical, Respond in logical, rehearsed pattern of rehearsed pattern of behaviorbehavior

For each possible For each possible situation clinician situation clinician should be prepared to should be prepared to respond in respond in predetermined predetermined fashionfashion

Move instruments or Move instruments or other potentially other potentially harmful equipmentharmful equipment

Reposition chairReposition chair Go for help calmlyGo for help calmly Let patient sit quietlyLet patient sit quietly Locate Emergency Locate Emergency

first Aid Kitfirst Aid Kit


Procedural OverviewProcedural Overview

Preparing a syringe Preparing a syringe for an intramuscular for an intramuscular injection (IM); injection (IM); intravenous injection intravenous injection (IV) or subcutaneous (IV) or subcutaneous injection.injection.

Performing CPRPerforming CPR

Directing emergency Directing emergency squad to right locationsquad to right location

Prepare dental team Prepare dental team to respond by role to respond by role assignment according assignment according to skill level and to skill level and abilities to react abilities to react appropriatelyappropriately


Importance of Dental Importance of Dental Hygienist’s RoleHygienist’s Role

Prompt, appropriate Prompt, appropriate reaction may reaction may

avert an emergency avert an emergency

save a lifesave a life

References:References:

Braun, Robert J. and Cutilli, Braun, Robert J. and Cutilli, Manuel of Manuel of Emergency Medical Treatment for theEmergency Medical Treatment for the Dental TeamDental Team.1999.Media:Williams & .1999.Media:Williams & Wilkins.Wilkins.

Wilkins,Esther, Wilkins,Esther, Clinical Practice of theClinical Practice of the Dental HygienistDental Hygienist,1994. Malvern:Williams ,1994. Malvern:Williams and Wilkins. and Wilkins.

Woodall,Irene. Woodall,Irene. Comprehensive DentalComprehensive Dental Hygiene CareHygiene Care.1993.St.Louis:Mosby..1993.St.Louis:Mosby.

dental office emergencies.ppt

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adrenal crisisindividuals

vital signsplace patient

adrenal crisisadrenal

decreased cortisol production

signs of distress ability

care patients

cortisol necessary

basic life support