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Emergencies in dental practice Instructor – Dr.Jesus George
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Common emergencies in dental practice Syncope Chest pain Cardiac arrest Anaphylactic shock Stroke
2
Cont.
Asthmatic attacks Drug reaction Bleeding Injuries as a result of surgical
procedure
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Syncope
Syncope or fainting or loss of consciousness
Fainting refers to sudden loss of consciousness
Predisposing factors – fear, anxiety, pain
- fatigue - fasting - hot & humid weather
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Cont.
Signs & symptoms – cold & moist skin
- slow pulse initially followed by rapid pulse
- pale skin - dizziness - weakness - nausea - loss of consciousness
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Cont.
Management – monitoring pulse - lowering head to improve
cerebellar circulation - loosening of tight cloths at neck - smelling of salt of aromatic
ammonia - reassurance of patient - if not recovered other causes of
collapse should be considered 6
Other causes of collapse
Anaphylaxis Hypoglycemia in diabetic patient Myocardial infarction Uncertain causes
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Collapse of diabetic patient Hypoglycemia - dampness of skin - rapid pulse - irritability - aggressiveness - decreased blood
sugar - urine sugar is -ve
Hyperglycemia - dry mouth & skin - weak pulse - drowsiness - disorientation - increased blood
sugar - urine sugar is +ve
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Cont.
Management (hypo) If patient can take orally
– 15g oral carbohydrate If the patient is unable
to take orally, i/v 25-50ml 50% dextrose or 1mg glucagon
If i/v line is not there, s/c or i/m 1mg glucagon
Patient is observed for 30-60 min
Management (hyper) immediate medical
assistance Maintenance of
airway & circulation , monitoring vital signs
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Uncertain causes
Management – make the patient lie down flat & monitor pulse
- administer oral glucose - maintenance of airway - administer oxygen - i.v. hydrocortisone sodium
succinate 250 mg
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Chest pain
Mainly caused by angina pectoris, myocardial infarction
Angina pectoris – pain lasts for only a short duration
MI – pain persists for long duration Diagnosis – severe chest pain in
retrosternal region, dyspneoa, vomiting, weak pulse, irregular pulse ( MI), loss of consciousness
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Management
s/l 0.5mg glyceryl trinitrate, if pain is not relieved by 3 min. MI
Nitrous oxide & oxygen 50/50 ratio to relieve pain & anxiety, immediate medical attention
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Cardiac arrest
Sudden appearance of pallor & respiratory arrest
Etiology – MI - Anaphylactic reaction - severe hypotension - hypoxia - anesthetic overdose
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Cont.
Diagnosis – fainting or collapse Late signs – respiratory arrest,
cyanosis, dialatation of pupil, absence of pupillary response to light, absence of BP
Management – immediate cardiopulmonary resuscitation
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Anaphylactic shock
Caused by drugs like penicillin C/Fs – wheezing - abdominal pain - nausea, urticaria - flushing of face, paraesthesia - pallor, rapid & weak pulse - cyanosis, edema of face
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Cont.
Management – make the patient lie down flat with legs raised
- i.m. 1ml in 1000 adrenaline repeated after 15 min. till improvement
- low i.v. infusion 10-20mg chlorpheniramine
- i.v.200mg hydrocortisone sodium succinate
- oxygen administration & medical help
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Cerebrovascular accidents (stroke) Usually occurs in hypertensive
patients Clinical features – depends on site &
extend of brain damage - loss of consciousness - weakness of arm & leg on one side - drooping of one side of face Management – maintenance of airway - hospitalization
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Asthmatic attacks
Causes – anxiety, exposure of allergen, infection
Clinical features – breathlessness, wheezing, use of accessory muscles for respiration
Management – reassurance of patient
- patient should never be allowed to lie down flat
- inhalation of salbutamol nebulizer18
Cont.
- oxygen administration - if no response slow i.v. salbutamol - i.v. 200mg hydrocortisone sodium
succinate - hospitalization
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Bleeding
Occurs mainly after extraction Occurs in hemorrhagic disorders
(hemophilia A, Christmas disease, Vit. K deficiency, anticoagulant therapy, liver disease, congenital cyanotic heart disease, c/c renal failure)
Management – reassurance of patient - oral cavity is cleaned & source of
bleeding is identified
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Cont.
- socket is sutured - local hemostatic measures –
pressure packs - if bleeding persists hospitalization
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Drug reactions
Anaphylaxis Allergy to LA solution Hypotension due to interaction of i.v.
barbiturates with antihypertensive drugs
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Reaction due to LA
Causes – i. v. injection of LA - allergy to LA LA may cause cardiovascular effects
& facial palsy I.V. injection is caused by –
aspiration was not carried out during injection & rapid infusion of LA
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Cont.
- Clinical features – drowsiness - agitation - loss of
consciouness - Management – make the patient lie
down flat - maintain airway - recovery in 30 min.
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Cont.
Allergy to LA – management similar to anaphylaxis
Cardiovascular effects - Manifested as palpitation
- If MI – manage MI Facial palsy – temporary effect - caused by tackling of LA to facial
nerve
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Cont.
- management – wears of gradually -reassurance of patient
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Hypotension
Prevented by proper drug history before procedure
Management – maintenance of airway
- patient is made to lie down flat - artificial ventilation if required - medical help
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Hypertension
Management – medical assistance
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Traumatic injury
Burns Laceration Fractures of jaw
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