Dr. RAGHU PRASADA M SMBBS,MDASSISTANT PROFESSORDEPT. OF PHARMACOLOGYSSIMS & RC.

Tendencies for longer dental proceduresIncreased use of drugsSecondary diseases in geriatric populationsThe conditions are

AnaphylaxisUncontrolled BleedingUnconciousness-vasovagal attackHypoglycemiaSeizuresArrhythmiaCardiac arrest

1.Anaphylactic Shock 1:1000 adrenaline0.5 ml for adults IM0.3ml for child 6-12 years

May be repeated after 10-20 minutes .Avoid I/V because fatal ventricular fibrillation may occur.Contraindications: Hyperthyroidism, HTN

Arrhythmias2. Oxygen –high flow3. Cardiopulmonary resusitation4. IV hydroocortisone 100-200mg5. Chlorpheniramine IM 20 mg

Cotton swab dipped in 1% adrenaline solution packingCommon causes

patients on antiplatelet drugspatients on antico-agulation therapyhemophiliacsLong term glucocorticoid therapy

Premonitory stage-diazepam-10-15mg repeated onceafter 15 min

Early status-lorazepam-0.1mg/kg repeated onceafter 15 min

Give usual AED medications if already on treatmentEstablished status-fosphenytoin infusion15-20mg/kgRefractory status-general anaesthesia-propofol 2-

10mg/kg/hr-midazolam-0.5mg/kg/hr-Thiopental sodium 3-5mg/kg

Anaesthesia continued for12-24 hrs after last clinical orelectrographic seizure

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1. Pain and anxiety-- -GTN, morphine2. Opioid analgesics and Antianxiety agents3. Pethidine, Diazepam, alprazolam

4. General measures-O2 therapy, dopamine,5. atropine, diltiazem,6. Maintainance of blood volume-Saline , dextran7. Correction of acidosis- sod. Bicarbonate infusion8. Prevention of treatment of arrhythmias9. -beta blocker

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7. Pump failure-furosemide, vasodilators, ionotropicdrugs

8. Prevention of thrombus extension, venousthrombosis- aspirin, heparin, anticoagulants-dalteparin, Enoxaparin

9. Thrombolysis and reperfusion-fibrinolytic agents-streptokinase, urokinase

10. Prevention of remodeling and CHF-ACE inhibitors,ARBs- lisinopril, ramipril

11. Prevention of future attacks-platelet inhibitors-clopidogrel, β blockers, statins

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Hypovolemic, Septic, Cardiogenic , AnaphylacticNeurogenic and Obstructive

Hypovolemic ShockAirway Breathing CirculationEstablish 2 large bore IVs or a central lineCrystalloids

Normal Saline or Lactate Ringers-Up to 3 litersPacked Red Blood CellsO negative or cross matchedControl any bleedingArrange definitive treatment

“Crystalloids”Normal saline (just NaCl).Lactated ringersPlasmalyte-balanced crystalloid solution withmultiple electrolye solutionNormosol-solution of balanced electrolytes in waterfor injection.Last 3 have K+ and other stuff (acetate, Mg++, etc.)

Crystalloids enter entire ECF: ISF (3/4 of ECF) and IVF(1/4 of ECF).3 or 4:1 for replacement of blood loss with crystalloidColloids only enter IVF (in short term– 16 hour half-time for entrance into ISF)1:1 replacement of blood loss with colloid

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Epinephrine , β1, (β2) 2-10 µg/min

Norepinephrine , β1 0 - 2-20 µg/min

Dopamine β1, DR, (α ) 1 - 30

Dobutamine β1, β2 2 - 20

Phenylphrine 20-200µg/min

Vasopressin Angiotensin III 5 - 20

Amrinone PDI 2 -15

Drug Receptor CO SVR Dose Range

0 -

(µg/kg/min)

1

0

Careful replacement of fluid deficits.Correction of acidosis & hyperglycemia via Insulin

administration.Correction of electrolytes imbalance.Treatment of underlying cause.Monitoring for complications of treatment.

Hypoglycemia-(bld glucose < 60mg)due to large dose or missed meals symptoms counterregulatory sympathetic stimulation- sweating, anxiety,palpitation and tremorsThose symptoms due to deprivation- dizziness,headache, visual disturbance, hungerTreatment20% dextrose IV 100ml or50ml 50% dextrose IV

Condition precipitated by sudden withdrawal ofsteroids after long term administrationACTH (adrenal corticotropic hormone) regulateshormone secretion by the cortex of the adrenal glands.ACTH- stimulates –Glucocorticoids, mineralocorticoidand androgens. ACTH-stimulated by trauma and stressIt presents as weakness , hypotension, dehydrationTreatmentHydrocortisone hemisuccinate 100mg every 4-6hrsCorrection of fluid and electrolyte balance

Due to hypocalcemiaPresents as muscle cramps, paraesthesias,laryngospasm and convulsions

TreatmentSlow IV injection of 5-20 ml 10% calcium gluconate

Acute attach of bronchial asthmaOxygen free flowNebulization with salbutamol and ipratropium bromideNebulization with budesonideIV injection of deriphylline and dexamethasone

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