1. Medical Urgencies and Emergencies Donald Falace, DMD Oral Diagnosis and Oral Medicine UK College of Dentistry

2. Goals Develop a sense of vigilance and anticipation Enable you to respond to an urgent medical need in a reasonably confident and efficient fashion

3. Urgencies vs. Emergencies Urgency: a problem that requires prompt response; it is not immediately life threatening but could become so if not resolved promptly  Syncope  Hypoglycemia  Seizure  Asthmatic attack  Hyperventilation  Angina  Mild allergic reaction  Stroke Emergency: a problem that is immediately life threatening and requires immediate action  Cardiac arrest  Anaphylaxis  Obstructed airway

4. Be observant! Look at and listen to your patient Watch for changes in:  Speech (slurring, halting, excessively talkative, silent)  Behavior (becomes quiet, restless, agitated, anxious, fearful, uncomfortable, nauseated, has difficulty breathing, non- communicative)  Appearance (pale, ashen, flushed, sweating, trembling)

5. Anticipation, Prevention and Planning Anticipation: What type of urgency/emergency can you anticipate with this patient? Prevention: What can you do to decrease the risk of occurrence? Planning: What would you do if the problem does occur?

6. Reality Check It is estimated that about 90% of urgencies - emergencies can be prevented. This means that 10% will occur in spite of our best efforts

7. UKCD Urgency/Emergency Response Protocol in Clinic Attend to the patient  If conscious, allow patient to assume a comfortable position, monitor vital signs, give oxygen as needed, try to determine what the problem is  If unconscious, PABCD Stay with the patient Call for help from your supervising faculty member (or any faculty member) If not immediately life-threatening and additional help is needed, call Oral Surgery 3-5279 If cardiac arrest or anaphylaxis, call 3-5200 and report “code 500” and give location and nature of the problem

8. Location of Emergency Equipment

9. Medical Emergencies Equipment in the Clinic Oxygen tank, ambu bag, tubing and mask Automated blood pressure cuff and pulse oximeter Drug box Defibrillator

10. Drug Box Albuterol inhaler Ammonia ampules Aspirin Diphenhydramine (oral; injectable) Epinephrine (EpiPen; ampules) Glucose Nitroglycerine (spray; tablets) Ephedrine (hypotension) Solucortef (adrenal crisis) Narcan (narcotic overdose) Atropine (bradycardia)

11. Defibrillator Located in COD on 2 nd, 3 rd and 5 th floors

12. Phone Oral Surgery  3-5749 Cardiac Arrest or Anaphylaxis  3-5200 and report “code 500” Outside of Medical Center - 911

13. Emergency Medicine in Dentistry Stanley Malamed, DDS Disk 1: Preparation for emergencies Emergency drug kit Basic management protocol Disk 2: Altered consciousness Respiratory distress Allergic response Cardiovascular problems