Medical Emergencies

1. Medical Emergencies Chapter 16

2. The Dental Assistants Role • Be observant of your patient! • Do they have trouble walking, moving or talking? • Do their eyes respond to light? • Is their speech slurred? • Are they anxious about their treatment? All dental personnel should be well-trained for an emergency and CPR certified

3. Dental Emergency Kit • Each office should have an up-to-date emergency kit that includes: • Sterile syringes, tourniquets, barrier devices for CPR and other oral airway devices • Oxygen equipment (green tank) • Stimulants—ammonia inhalants • Vasodilators such as translingual nitroglycerin, which increases oxygenated blood supply to the heart

4. Dental Emergency Kit • Antihistamines such as epinephrine, adrenaline, benadryl. An epi-pen can be used for quick and easy delivery. • Analgesics—pain relievers • Depressants—such as diazepam, used for seizure treatment. • PPE—personal protective equipment.

5. Dental Emergency Kit

6. Syncope • AKA fainting, The most common emergency in a dental office • Caused by physical or emotional stress and decreased blood flow to the brain. • Symptoms may include: dizziness, nausea, weakness, pale skin, clammy, shallow breathing

7. Treatment for Syncope • If conscious, have the patient sit with their head between their knees • If unconscious, place in the Trendelenburg position (supine with feet slightly elevated) • Administer oxygen and vital signs. Most patients will resume spontaneous breathing within 10 seconds. • If they don’t, crack open the vial of ammonia and wave under their nose (not too close or it can irritate the nasal membranes.

8. Postural Hypotension • Low blood pressure that occurs upon standing up • May occur after long appointments when the patient has been supine for an extended length of time • Raise the patient chair slowly and have them remain seated for 1 minute prior to dismissal

9. Asthma • Narrowing of the bronchioles in the lungs • Recurrent attacks of breathlessness accompanied by wheezing during exhalation. May have a dry cough. • When an asthma patient exhales, the lungs collapse to expel air, which narrows the bronchioles even more • 1 in 10 US children have asthma and it is on the rise.

10. Asthma, cont • Causes: • Heredity • Allergies • Most often occurs in the morning Treatment: antihistamines administered via an inhaler

11. Allergic Reactions • An acute reaction which may be in a general area or cover the entire body • Causes in the dental office may include drugs, latex or dental materials • Symptoms include edema (swelling), erythema (redness) or urticaria (hives) • Treatment includes removing the irritant or administering an antihistamine

12. Anaphylactic Reaction • A severe allergic reaction that is life threatening. • Symptoms include decrease in blood pressure, constriction of airway, swelling of tongue and throat, stomach pain • Treatment is by epinephrine injection • Call 911 if symptoms do not improve quickly

13. Hyperventilation • Abnormally fast or deep breathing which results in the loss of carbon dioxide from the blood (caused by patient panic!) • Symptoms include low blood pressure, numbness or tingling in the extremities, possible fainting • Treatment includes stopping dental treatment, set patient upright, have them breathe in and hold for several seconds before exhaling or have them breathe into their cupped hands or a paper bag

14. Epilepsy/Seizures • Neurological disorder characterized by sudden, recurring attacks of motor, sensory or psychic malfunction with or without loss of consciousness • Two main types: • Petit Mal • Grand Mal

15. Petit Mal • Patient experiences a momentary loss of consciousness. May have a blank stare or blinking of the eye that lasts 5-10 seconds • Others may not be aware of it, as the person looks like they’re daydreaming • Occurs more frequently in children and decreases with age • May be a warning of a grand mal to follow

16. Grand Mal • Most common • Usually lasts from 2-5 minutes • The body jerks, twitches and stiffens • Breathing is irregular and person may be unconscious • Bladder and bowel control may be lost • After seizing, the patient may be disoriented and not be aware of what happened

17. Grand Mal, cont. • Stop dental treatment and remove anything from the mouth (if possible) • Clear all harmful objects out of the way • Allow seizure to run its course • After seizure, place the patient in the recovery position (right side) • If seizure lasts more than 5 minutes, call 911

18. Grand Mal, cont. • Status Epilepticus: when a patient has one seizure after another, call 911 • Dilantin: a common medication used to treat seizures. May cause gingival hyperplasia (overgrowth of gingival tissue)

19. Diabetes • High blood sugar caused by the pancreas not producing enough insulin • Too much sugar in the blood • Symptoms include: thirst, excessive urination, weight loss, fatigue • There are two types of diabetes: Type I and Type II

20. Diabetes, cont. • Type I: • Most severe • Often called juvenile diabetes, but it can occur in all ages. May be caused by heredity. • Patient must have regular insulin injections or coma will result • Type I diabetics experience the most medical complications because they have the disease for long periods of time. • They are susceptible to infections, slow healing, toothaches, gingivitis, periodontitis and xerostomia (dry mouth)

21. Diabetes, cont. • Type II: • Makes up 90% of diabetics • Can be controlled by diet and meds that lower blood sugar levels. Does not require insulin injections • It can result in hyperglycemia (too much sugar in the blood). Patient may experience excessive thirst, increased urination, nausea and vomiting with abdominal pain, etc. • Patient may go into a diabetic coma

22. Diabetes, cont. • Type II, cont: • Stop dental treatment • If patient is conscious, have them administer an insulin shot (many carry insulin pens) • If unconscious, call 911 • Diabetic acidosis: if the patient goes into a coma and is not treated quickly, they will die.

23. Hypoglycemia • Too little sugar in the blood • Rapid onset. Usually caused by skipping meals, stress or overexertion • Patient will become nervous, have trembling and weakness, cold sweats • May become hungry and show personality change • Stop dental treatment and give sugar (orange juice works well) • If unconscious, call 911

24. Cardiovascular Disease • AKA heart disease, a leading cause of death in the US • Avoid epinephrine in anesthetic and gingival retraction cord • The patient may need prophylactic antibiotics prior to treatment, which lowers the risk of bacterial endocarditis (inflammation of the lining of the heart)

25. Cardio, cont. • Causes of heart disease: • Arteriosclerosis: hardening of the arteries • Angina pectoris: “strangling of the chest”, • First sign of heart disease. • Causes pain in the chest, may radiate to the jaw. • high blood pressure and pulse rate. • May become pale and clammy. • Stop treatment and place nitroglycerin pills sublingually. Administer oxygen. Patient can be given 3 doses. If no response, assume the patient is having a myocardial infarction.

26. Cardio, cont. • Myocardial infarction • AKA heart attack • Coronary arteries are blocked or narrowed • Symptoms are similar to angina • Stop dental treatment, position patient with head slightly elevated. • Administer oxygen and nitroglycerin. • Call 911

28. Cerebrovascular Accident • Aka Stroke, a leading cause of disability and death in the US • Caused by the blood supply to the brain being interrupted by a blockage: • Embolism: blood clot • Hemorrhage: rupture of a blood vessel Patient may experience extreme headache, loss of speech, dizziness, paralysis on one side of the body, loss of consciousness

29. Miscellaneous • Dentists are required by law to report suspected child abuse • If a patient has a pacemaker, do not use the ultrasonic scaler or microwave • Remember the tips for blind, hearing impaired and disabled patients.