Docstoc

Medical Emergencies And Resuscitation In Dental Practice

Document Sample
Medical Emergencies And Resuscitation In Dental Practice Powered By Docstoc
					Medical Emergencies And
Resuscitation In Dental Practice



   Ziad Malkawi
   DDS, MSc, Max.Fac.S.Cert, FFDRCSI
   Faculty Of Dentistry
   University Of Jordan
MEDICAL EMERGENCIES AND
RESUSCITATION


Be Prepared
- Surgery
 Drugs
 Equipment
- Staff
 CPR training
 Obtaining help
- Patients


   Medical history
   Drug history
   Allergies
   Instructions
   communication
     MEDICAL EMERGENCIES AND
     RESUSCITATION

Emergencies that might occur:
- Loss of consciousness
   Faint
   Cardiac arrest
   Hypoglycemia
   Cerebrovascular accident
   drugs
- Breathing difficulties
 Asthma
 Heart failure
 Anaphylaxis
 hysteria
- Choking
 Inhaled foreign body
 Laryngeal oedema
 -   Fitting


 Epilepsy
 Hypoglycemia
 Cardiac arrest
     MEDICAL EMERGENCIES AND
     RESUSCITATION

Management
- Assessment
   Responsiveness
   Airway
   Breathing
   Circulation
- First aid treatment
- Obtaining help
- Definitive treatment
                                  Appendix A
              LIST OF DRUGS FOR EMERGENCY USE
                                                               Minimum

         1.   Drugs to be available in very dental practice
 (i)                     Oxygen
 (ii)            Adrenaline 1 mg in 1m           x            5 ampoules
(iii)                Lignocaine 1%              1ml           5 ampoules
                                                 x
(iv)                 Atropine O.6mg            1ml x          5 ampoules
 (v)             Calcium Chloride 10 %         10ml           2 ampoules
                                                 x
(vi)            Sodium Bicarbonate 8.4 %       50ml           3 ampoules
                                                 x
(vii)      Glycery Trinitrate Tabs 300mcg        x                10
          or Glyceryl Trinitrate 400mcg per
           metered dose sub-lingual spray        x                1
(viii)            Aminophylline 250mg          10ml           2 ampoules
                                                 x

(ix)          Salbutamol inhaler 100mcg per
                      metered dose               x             2 refills
 (x)      Chlorpheniramine maleate 10mg        1ml x          2 ampoules
(xi)                 Dextrose 50%              50ml               1
                                                 x
(xiv)                  Infusion solution
                       (a) Dextrose 4% saline                      500ml
                             0.18%                                 x
                       (b) Colloid solution                        500ml
                                                                   x

2.     Drugs to be available in dental practices providing intravenous sedation.

(i)                    Flumazenil 500mcg                             5ml x        5 ampoules

(ii)                   Naloxone 0.4mg


3.     Drugs to be available in dental practices providing general anaesthesia.

(i)                    Suxamethonium 100mg                         2ml x          5 ampoules
                                                                               Appendix B
     List Of Essentlal Items Of Equipment For Esuscitation Which
              Must Be Available In Every Dental Practice



AIRWAY MAINTENANCE
1.  Suction apparatus – powered and portable ( independently powered).
2.     Simple airway adjunct (e.g. pocket resuscitator mask with valve).
3.     Cricothyroid puncture needle                   x         1

Oxygen and Artificial Ventilation
1.    Portable oxygen with appropriate valves, metering and delivery system
2.    Self-inflating bag, valve and mask with oxygen enhancement facility.

Maintenance of Circulation

1.     Disposable syringes – sizes 2, 5, 10ml        x          5    of each
2.     Disposable needles – sizes 21 & 23g           x          10   of each
3.     Disposable IV vannulae – sizes 16 & 22g       x          5    of each
4.     Disposable IV Infusion Sets                   x          2
5.     Scissors                                      x          1
6.     Tourniquet, Sphygmomanometer, Stethoscope     x          1    of EACH
7.     Injection Swabs
     Medical Emergencies And
     Resuscitation

Faint
- Features
 Reflex response that occurs in the conscious individual.
 Consciousness lost if systolic BP falls below 60mmHg.
 Effects aggravated by starvation, pain or stuffy
  environment.
- Diagnosis
   Light headed +/- nausea
   Pale and unwell
   Cold sweaty hands
   Thready pulse, low BP
   Unresponsive
Medical Emergencies And
Resuscitation



   - Management of faint:
    Lie flat, elevate legs
    Recovery position
    Maintain airway, check
     breathing and pulse
    Postpone treatment.
Medical Emergencies And
Resuscitation

 Heart Attack
-   Diagnosis
   Previous history
   Retrosternal chest pain that might radiate
   Pale and unwell
   Cold and sweaty
-   Management
 Reassure and sit down
 GTN under tongue
 Check pulse and BP
 Angina is self-limiting if pain or symptoms persist
  suspect MI
 Oxygen by face mask
 Rapid transfer to hospital by ambulance.
Medical Emergencies And
Resuscitation

   Asthma
   -   Features
    bronchospasm may occur in acute asthma, acute
     or chronic bronchitis or in anaphylaxis.
   -   Diagnosis
      History of asthma
      Breathing difficulty especially breathing out.
      Audible wheeze
      Sweaty, tachycardia, cyanosis.
   - Management
    Reassure
      Sit up
      Salbutamol inhaler
      Oxygen by face mask
      Arrange transfer to hospital.
Medical Emergencies And
Resuscitation
Diabetic coma (hypoglycaemia)
- Features
 Diabetics on insulin or oral hypoglycaemics
  may drop their blood sugar if they take their
  medication and do not eat.
 Presence of oral sepsis may make control of
  diabetes difficult
 Use of synthetic human insulin.
- Diagnosis
 History
 confusional aggression
 Pale and sweaty
 Rapid, thready pulse
 Unresponsive
Medical Emergencies And
Resuscitation
- Diabetic coma (hypoglycaemia)
- Management
 Oral glucose if able to swallow
 If unresponsive may need to give IV 50%
  dextrose or IM or SC glucagon.
 If delayed response or unwell arrange transfer
  to hospital
        Medical Emergencies And
        Resuscitation
Anaphylactic shock
- Features
 Allergy to an administered antigen (usually a
  drug or food ) causes histamine release from
  mast cells resulting in vasodilatation, increased
  capillary permeability and bronchospasm
 Uncommon with local anaesthetic agents, more
  common with antibiotics or anaesthetic agents
- Diagnosis
   Rash and oedema
   Tachycardia
   Hypotension
   Bronchospasm
   Cardiopulmonary arrest
Medical Emergencies And
Resuscitation
Anaphylactic shock:
- Management
 If mild symptoms, reassure, sit down,
  check pulse and BP. IV access if possible
 adrenaline 1:1000 0.5ml SC, IM
 Hydrocortisone 200mg IM/IV
 If bronchospasm give oxygen by face mask
 If collapse check ABC
 Arrange transfer to hospital
Medical Emergencies And
Resuscitation
Cerebrovascular accident
- Features
 An ischaemic episode in the brain caused by
  vascular spasm, a clot or a bleed
 Symptoms may last only a short time and a
  complete recovery is made. This is a transient
  ischaemic attack
 If symptoms are prolonged and neurological
  impairment persists it is a completed stroke
Medical Emergencies And
Resuscitation
 Cerebrovascular accident
- Diagnosis
 Varied symptoms
 Slurred speech
 Weakness of arms or legs, often one-sided
 Visual problems
 Confusion, aggressive behaviour
 Unrousable
- Management
 If unrousable put in recovery position, maintain airway,
  check breathing and pulse
 Arrange transfer to hospital
Medical Emergencies And
Resuscitation
Epilepsy
- Features
 on medication and a fit is precipitated by extreme
    anxiety, starvation or omission of medication
    prior to treatment
- Diagnosis
 Aura
 Colonic tonic contractions
 Loss of consciousness
- Management
 Protect from injury
 Maintain airway
 If rapid recovery, arrange escort and transport
    home
 If not known to be epileptic or in status
    epilepticus arrange transfer to hospital
Medical Emergencies And
Resuscitation
Upper airway obstruction
-   Causes
•   Inhaled foreign body
•   Laryngeal edema due to infection, trauma or anaphylaxis.
-   Diagnosis
   No symptoms
   Coughing and gagging
   Spasm of vocal cords giving strider and even respiratory arrest
   Bronchospasm
-   Management
   If asymptomatic check mouth and faucets carefully; postpone
    treatment; escort for chest X-ray; may require endoscopy of gut
    or bronchoscopy for lungs
   If symptoms of upper airway obstruction; encourage coughing;
    back blows; heimlich’s abdominal thrust; cricothyrodotomy.