Dental

DENTAL EMERGENCIESDENTAL EMERGENCIES

Assoc. Prof. (Dr) Rashidi AhmadAssoc. Prof. (Dr) Rashidi AhmadDept. of Emergency MedicineDept. of Emergency Medicine

ObjectivesObjectives

Common dental emergencies Common dental emergencies –– What? When? What? When?

How? Where? Who?.How? Where? Who?.

Basic approach to dental emergenciesBasic approach to dental emergencies

Factors increasing risk during dental Factors increasing risk during dental treatmenttreatment

Increased number of older patientsIncreased number of older patients

Medical advances Medical advances –– drug therapy, surgical drug therapy, surgical techniquestechniques

Longer appointmentsLonger appointments

Increased drug use Increased drug use –– LA, sedatives, LA, sedatives, analgesics, antibioticsanalgesics, antibiotics

DeathDeathMost emergency situations: potentially life threatening BUT deatMost emergency situations: potentially life threatening BUT death h is rare.is rare.

8 deaths a/w GA in a 208 deaths a/w GA in a 20--year period year period

(1 death in every 673,000 GA administration)(1 death in every 673,000 GA administration)

Lytle JJ, Stamper EP: The 1988 anesthesia survey of the SouthernLytle JJ, Stamper EP: The 1988 anesthesia survey of the Southern

California Society of Oral Surgeons, J Oral California Society of Oral Surgeons, J Oral SurgSurg 32:739. 197432:739. 1974

““10% of all non10% of all non--accidental deaths are classified as sudden, accidental deaths are classified as sudden, unexpected death & unpreventable.unexpected death & unpreventable.””

McCarthy EM. J Am Dent Assoc. 1971 83:1091McCarthy EM. J Am Dent Assoc. 1971 83:1091

STILL OK????STILL OK????

““When you prepare for an When you prepare for an emergency, the emergency ceases emergency, the emergency ceases

to existto exist””

““To be forewarned is to be forearmedTo be forewarned is to be forearmed””

““Prevention is better than curePrevention is better than cure””

Important RulesImportant Rules

Find and correct life threatsFind and correct life threats

If lifeIf life--threat is present, CORRECT IT!threat is present, CORRECT IT!

If it canIf it can’’t be correctedt be corrected

Support oxygenation, ventilation, perfusionSupport oxygenation, ventilation, perfusion

GET HELP & TRANSPORT!!GET HELP & TRANSPORT!!

Life threatening eventsLife threatening events

Airway obstructionAirway obstruction

VentilationVentilation--perfusion mismatchperfusion mismatch

Circulatory compromisedCirculatory compromised

Dysfunction of CNSDysfunction of CNS

APPROACHAPPROACH

S: S: Stop Procedure & ObserveStop Procedure & Observe

R: R: ResponseResponse

P: P: PositionPosition

A: A: AirwayAirway

B: B: BreathingBreathing

C: C: Circulation/Cardiac Monitor/Circulation/Cardiac Monitor/CardioversionCardioversion

D: D: Dysfunction Of CNS & Definitive ManagementDysfunction Of CNS & Definitive Management

Stop procedureStop procedure

Avoid injuriesAvoid injuries

Proper assessment and Proper assessment and managementmanagement

Proper positionProper position

ResponseResponse

Ability to speakAbility to speak

Appropriate orientationAppropriate orientation

If unconscious If unconscious --Loud voice & gentle Loud voice & gentle tap/shaketap/shake

Call for HELP!!Call for HELP!!

AirwayAirway

Anticipate airway problems withAnticipate airway problems with

Decreased level of consciousnessDecreased level of consciousness

Oral bleedingOral bleeding

Foreign bodyForeign body

Return head to neutral positionReturn head to neutral position

Head tilt, chin lift, jaw thrustHead tilt, chin lift, jaw thrust

Triple ManeuverTriple Maneuver

BreathingBreathing

Is oxygen getting to the Is oxygen getting to the blood?blood?

-- Is air moving?Is air moving?

-- Is it moving adequately?Is it moving adequately?

-- Is it moving at an adequate Is it moving at an adequate rate?rate?

BreathingBreathing

Oxygenate immediately if:Oxygenate immediately if:

Decreased level of consciousnessDecreased level of consciousness

ShockShock

Severe hemorrhageSevere hemorrhage

Chest painChest pain

DyspneaDyspnea

Respiratory distressRespiratory distress

If you think about giving oxygen, If you think about giving oxygen, GIVE IT!!GIVE IT!!

Resuscitation trolleyResuscitation trolley

Assisted ventilationAssisted ventilation

Respirations <12Respirations <12

Respirations >24Respirations >24

Tidal volume decreasedTidal volume decreased

Respiratory effort increasedRespiratory effort increased

CirculationCirculation

Is the heart beating?Is the heart beating?

Is there serious external bleeding?Is there serious external bleeding?

Does patient have radial pulse?Does patient have radial pulse?

Absent radial = systolic BP < 80Absent radial = systolic BP < 80

Does patient have carotid pulse?Does patient have carotid pulse?

Absent carotid = systolic BP < 60Absent carotid = systolic BP < 60

CirculationCirculation

Serious oral bleeding?Serious oral bleeding?

Clear the airway/suctionClear the airway/suction

Treat the cause/stop the bleeding Treat the cause/stop the bleeding –– bone wax, stitchesbone wax, stitches

? Intubation? Intubation

GXM GXM –– blood transfusionblood transfusion

Surgical interventionSurgical intervention

Is patient Is patient perfusingperfusing??

Cool, pale, moist skin = shock UPOCool, pale, moist skin = shock UPO

Capillary refill > 2 sec = shock UPOCapillary refill > 2 sec = shock UPO

Restlessness, anxiety, combativeness = shock Restlessness, anxiety, combativeness = shock

Cardiac monitoring/defibrillatorCardiac monitoring/defibrillator

Heart rateHeart rate

DysrythmiasDysrythmias

Ischemic changesIschemic changes

DefibrillationDefibrillation

Disability (CNS dysfunction)Disability (CNS dysfunction)

Decreased LOC =Decreased LOC =

HypoxiaHypoxia

HypoglycemiaHypoglycemia

ShockShock

Acute strokeAcute stroke

Think about drugs, alcohol, or Think about drugs, alcohol, or personality personality

Definitive managementDefinitive management

Confirm the problemConfirm the problemTreat the causeTreat the causeTreat the complicationTreat the complicationDispositionDisposition

ConclusionConclusion

Be prepared Be prepared –– staffs, equipments, trainingstaffs, equipments, training

Proper assessment Proper assessment –– past medical history, past medical history, history of allergy, & PEhistory of allergy, & PE

Intervene possible complicationIntervene possible complication

Emergency approachEmergency approach

APPROACHAPPROACH

S: Stop Procedure & ObserveS: Stop Procedure & Observe

R: ResponseR: Response

P: PositionP: Position

A: AirwayA: Airway

B: BreathingB: Breathing

C: Circulation/Cardiac Monitor/C: Circulation/Cardiac Monitor/CardioversionCardioversion

D: Dysfunction Of CNS & Definitive D: Dysfunction Of CNS & Definitive

ManagementManagement

Important messageImportant message

Survival depends on assessment skillsSurvival depends on assessment skills

Good assessment results fromGood assessment results from

An organized approachAn organized approach

Clearly defined prioritiesClearly defined priorities

Understanding available resourcesUnderstanding available resources