Upload
drahmadzuhdi
View
220
Download
0
Embed Size (px)
Citation preview
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
1/32
Medical Emergencies AndResuscitation In Dental Practice
Ziad Malkawi D.D.S.,M.Sc., Max.Fac.S.CertFF DRCSI University Of Jordan
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
2/32
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
3/32
MEDICAL EMERGENCIES AND
RESUSCITATION
Be Prepared
- SurgeryD rugsEquipment
- Staff C PR trainingObtaining help
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
4/32
- Patients
Medical historyD rug historyAllergiesInstructionscommunication
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
5/32
MEDICAL EMERGENCIES ANDRESUSCITATION
Emergencies that might occur:- Loss of consciousness
F aintC ardiac arrestHypoglycemiaC erebrovascular accidentdrugs
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
6/32
- Breathing difficultiesAsthmaHeart failureAnaphylaxishysteria
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
7/32
-C
hokingInhaled foreign bodyLaryngeal oedema
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
8/32
- F itting
EpilepsyHypoglycemiaC ardiac arrest
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
9/32
MEDICAL EMERGENCIES AND
RESUSCITATIONManagement- Assessment
ResponsivenessAirwayBreathingC irculation
-F
irst aid treatment- Obtaining help- D efinitive treatment
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
10/32
Appendix ALIST OF DRUGS FOR EMERGENCY USE
1 . D rugs to be available in very dental practice
Minimum
(i) Oxygen
(ii) Adrenaline 1 mg in 1 m x 5 ampoules
(iii) Lignocaine 1% 1 mlx
5 ampoules
(iv) Atropine O .6 mg 1 mlx
5 ampoules
(v) C alcium C hloride 10 % 10 ml x
2 ampoules
(vi) Sodium Bicarbonate 8 .4 %
5 0 ml x
3 ampoules
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
11/32
(vii) Glycery Trinitrate Tabs3 00 mcg or Glyceryl
Trinitrate 400 mcg permetered dose sub-lingual
spray
x
x
10
1
(viii) Aminophylline 25 0 mg 10 ml x
2 ampoules
(ix) Salbutamol inhaler100 mcg per metered
dosex 2 refills
(x) C hlorpheniraminemaleate 10 mg
1 mlx
2 ampoules
(xi) D extrose 5 0% 5 0 ml x
1
(xiv) Hydrocortisone100
mg 2mlx 5 ampoules
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
12/32
(xiv) Infusion solution(a) D extrose 4% saline
0.1 8 %
(b) C olloid solution
5 00 ml x5 00 ml x
2 . D rugs to be available in dental practices providingintravenous sedation .
(i) F lumazenil 5 00 mcg 5ml x 5 ampoules
(ii) Naloxone 0.4 mg
3 . D rugs to be available in dental practices providinggeneral anaesthesia .
(i) Suxamethonium 100 mg 2mlx
5 ampoules
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
13/32
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
14/32
Appendix B
List Of Essential Items Of Equipment ForResuscitation Which Must Be Available In
Every Dental PracticeAIRWAY MAINTENANCE1. Suction apparatus powered and portable (
independently powered) .2 . Simple airway adjunct (e . g . pocket resuscitator mask
with valve) .3 . C ricothyroid puncture needle x 1
Oxygen and Artificial Ventilation1. Portable oxygen with appropriate valves, metering and
delivery system2 . Self-inflating bag, valve and mask with oxygen
enhancement facility .
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
15/32
Appendix B
List Of Essential Items Of Equipment ForResuscitation Which Must Be Available In
Every Dental Practice
Maintenance of Circulation
1. D isposable syringes sizes 2, 5, 10 ml x 5of each
2 . D isposable needles sizes 2 1 & 23g x 10 of each
3 . D isposable IV vannulae sizes 16 & 22g x 5of each
4. Disposable IV Infusion Sets x 25 . Scissors x 1
6. Tourniquet, Sphygmomanometer, Stethoscope x 1 of EA C H
7 . Injection Swabs
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
16/32
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
17/32
Medical Emergencies AndResuscitation
Faint- Features
Reflex response that occurs in the conscious individual .C onsciousness lost if systolic BP falls below 60 mmHg .Effects aggravated by starvation, pain or stuffyenvironment .
- DiagnosisLight headed +/- nauseaPale and unwellC old sweaty handsThready pulse, low BPUnresponsive
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
18/32
Medical Emergencies AndResuscitation
- Management of faint:Lie flat, elevate legsRecovery positionMaintain airway, check
breathing and pulsePostpone treatment .
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
19/32
Medical Emergencies AndResuscitation
H eart Attack- Diagnosis
Previous history
Retrosternal chest pain that might radiatePale and unwellC old and sweaty
- ManagementReassure and sit downGTN under tongueC heck pulse and BPAngina is self-limiting if pain or symptoms persistsuspect MIOxygen by face maskRapid transfer to hospital by ambulance .
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
20/32
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
21/32
Medical Emergencies And
ResuscitationAsthma- Features
bronchospasm may occur in acute asthma, acuteor chronic bronchitis or in anaphylaxis .
- DiagnosisHistory of asthmaBreathing difficulty especially breathing out .Audible wheeze
Sweaty, tachycardia, cyanosis .- Management
ReassureSit upSalbutamol inhaler
Oxygen by face maskArran e transfer to hos ital .
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
22/32
Medical Emergencies And
ResuscitationDiabetic coma (hypoglycaemia)- Features
D iabetics on insulin or oral hypoglycaemicsmay drop their blood sugar if they take theirmedication and do not eat . Presence of oral sepsis may make control of diabetes difficultUse of synthetic human insulin .
- DiagnosisHistoryconfusional aggressionPale and sweatyRapid, thready pulse
Unresponsive
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
23/32
Medical Emergencies And
Resuscitation- Diabetic coma (hypoglycaemia )- Management
Oral glucose if able to swallowIf unresponsive may need to give IV 5 0% dextrose or IM or S C glucagon . If delayed response or unwell arrange transfer
to hospital
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
24/32
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
25/32
Medical Emergencies And
ResuscitationAnaphylactic shock- Features
Allergy to an administered antigen (usually a drug orfood ) causes histamine release from mast cellsresulting in vasodilatation, increased capillarypermeability and bronchospasmUncommon with local anaesthetic agents, morecommon with antibiotics or anaesthetic agents
- Diagnosis
Rash and oedemaTachycardiaHypotensionBronchospasmC ardiopulmonary arrest
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
26/32
Medical Emergencies And
ResuscitationAnaphylactic shock:- Management
If mild symptoms, reassure, sit down,check pulse and BP . IV access if possibleadrenaline 1:1000 0. 5ml S C , IMHydrocortisone 2 00 mg IM/IVIf bronchospasm give oxygen by face mask
If collapse check AB CArrange transfer to hospital
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
27/32
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
28/32
Medical Emergencies And
ResuscitationCerebrovascular accident- Features
An ischaemic episode in the brain caused byvascular spasm, a clot or a bleedSymptoms may last only a short time and acomplete recovery is made . This is a transientischaemic attackIf symptoms are prolonged and neurological
impairment persists it is a completed stroke
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
29/32
Medical Emergencies And
ResuscitationCerebrovascular accident
- DiagnosisVaried symptoms
Slurred speechWeakness of arms or legs, often one-sidedVisual problemsC onfusion, aggressive behaviourUnrousable
- ManagementIf unrousable put in recovery position, maintain airway,check breathing and pulseArrange transfer to hospital
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
30/32
Medical Emergencies And
ResuscitationEpilepsy- Featureson medication and a fit is precipitated by extreme
anxiety, starvation or omission of medicationprior to treatment
- DiagnosisAuraC olonic tonic contractionsLoss of consciousness
- ManagementProtect from injuryMaintain airwayIf rapid recovery, arrange escort and transporthomeIf not known to be epileptic or in statusepilepticus arrange transfer to hospital
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
31/32
Medical Emergencies And
ResuscitationUpper airway obstruction- Causes
Inhaled foreign bodyLaryngeal edema due to infection, trauma or anaphylaxis .
- DiagnosisNo symptomsC oughing and gaggingSpasm of vocal cords giving strider and even respiratoryarrestBronchospasm
- ManagementIf asymptomatic check mouth and faucets carefully;postpone treatment; escort for chest X-ray; may requireendoscopy of gut or bronchoscopy for lungsIf symptoms of upper airway obstruction; encouragecoughing; back blows; heimlichs abdominal thrust;cricothyrodotomy .
8/2/2019 Medical Emergencies and Resuscitations in Dental Practice
32/32
Thank You