Medical Emergencies

The Dental Assistants Role Be observant of your patient! 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

Dental Emergency Kit Each office should have an up-to-date emergency kit that includes: 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

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

Dental Emergency Kit

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

Treatment for Syncope If conscious, have the patient sit, recline them if able. If conscious, have the patient sit, recline them if able. If unconscious, place in the Trendelenburg position (supine with feet slightly elevated) 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. 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. 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.

Postural Hypotension Low blood pressure that occurs upon standing up 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 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 Raise the patient chair slowly and have them remain seated for 1 minute prior to dismissal

Asthma Narrowing of the bronchioles in the lungs Narrowing of the bronchioles in the lungs Recurrent attacks of breathlessness accompanied by wheezing during exhalation. May have a dry cough. 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 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. 1 in 10 US children have asthma and it is on the rise.

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

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

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

Hyperventilation Abnormally fast or deep breathing which results in the loss of carbon dioxide from the blood (caused by patient panic!) 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 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 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

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

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

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

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

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

Diabetes High blood sugar caused by the pancreas not producing enough insulin High blood sugar caused by the pancreas not producing enough insulin Too much sugar in the blood Too much sugar in the blood Symptoms include: thirst, excessive urination, weight loss, fatigue Symptoms include: thirst, excessive urination, weight loss, fatigue Two types of diabetes: I and II Two types of diabetes: I and II

Diabetes, cont. Type I: Type I: –AKA: juvenile diabetes  can occur in all ages –Most severe –May be caused by heredity. –Patient must have regular insulin injections or coma will result –Experience the most medical complications  Disease present for long time –Susceptible to infections  slow healing, toothaches, gingivitis, periodontitis and xerostomia (dry mouth)

Diabetes, cont. Type II: Type II: –90% of diabetics –Controlled by diet and meds that lower blood sugar levels  Insulin injections not required –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

Diabetes, cont. Type II, 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.

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

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

Cardio, cont. Causes of heart disease: 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.

Cardio, cont. Myocardial infarction 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

Cerebrovascular Accident Aka Stroke, a leading cause of disability and death in the US 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: 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

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