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Chapter 16: Medical Emergencies in a Dental Office
- 1. Medical Emergencies in a Dental Office CHAPTER 16
- 2. Common Medical Emergencies in a Dental Office Syncope Asthma Orthostatic hypertension Allergic reaction Anaphylactic reaction Hyperventilation Seizures Diabetic emergencies Hypoglycemia Insulin shock Cardiovascular emergencies
- 3. Syncope Fainting Decreased blood flow to brain Lying still for prolonged periods Stress Emotional Physical
- 4. Symptoms of Syncope Dizziness Nausea Weakness Pale and clammy skin Shallow breathing
- 5. Treatment for Syncope in the Conscious Patient Place patient in sitting position Have patient place head between knees
- 6. Treatment for Syncope in the Unconscious Patient Place patient in Trendelenburg position Loosen clothing or jewelry Administer oxygen Administer spirit of ammonia under nose Procedure 16-7
- 8. Asthma Recurrent episodes of breathlessness accompanied by wheezing Narrowing of airways due to stimulus 1 in 10 children have asthma The most common allergens responsible for asthma are: animal fur, house dust, pollens, tobacco smoke, feathers, food and drugs
- 9. Asthma Asthma attacks are more frequent in th emorning and vary from slight breathlessness to respiratory failure. There is no cure for asthma, but tests are available to identify what causes the most severe reactions in an individual so that the individual can avoid it
- 10. Treatment of Asthma Administer inhaler Administer oxygen Calm patient Call 9-1-1 if condition worsens Procedure 16-8
- 11. Orthostatic Hypertension AKA postural hypotension Loss of consciousness or level of consciousness when sitting upright quickly Happens often in a dental office because the pt has been lying in a prone position for a long period of time during tx, then tries to sit up quickly Occurs from lack of blood flow to the brain Patients may say they feel “light-headed”
- 12. Treatment of Orthostatic Hypertension Have the patients rise up with the chair and sit in that position for a few minutes before standing (while you write in your chart). It is also best to ask the patient how he or she feels before attempting to get up out of the chair Patients who are given nitrous oxide or oxygen, patients who have been in the dental chair for long periods, woman who are pregnant, and patients who have had intravenous sedation are more prone to having orthostatic hypotension.
- 13. Allergic Reaction May be caused by drugs, toothpaste, latex, or other dental materials May vary in severity Localized or entire body Happen immediately or hours after May cause dermatitis (skin reactions): Edema: swelling Erythema: redness vesicle formation Urticaria: hives Angioedema: giant urticaria, poorly defined, single swollen areas
- 14. Treatment for Allergic Reaction Remove irritant Administer antihistamine (Benadryl) to reduce the edema
- 15. Anaphylactic Reaction Severe, life-threatening allergic reaction Body creates large amount of histamine once the allergen is into the bloodstream Blood pressure drops, bronchospasm (constriction of the airways in the lungs, the tongue and throat swell, and the pt may experience stomach pain Symptoms come on rapidly Causes: Bee stings Penicillin Anesthetics (preservative)
- 16. Anaphylactic Signs and Symptoms Loss of consciousness Skin rash Drop in blood pressure Nausea and vomiting Shortness of breath Tongue and throat swell
- 17. Treatment of Anaphylaxis Epinephrine Patients that know they are extremely sensitive to an allergen may carry antihistamine drugs and take immunotherapy treatments to desensitize for the allergen
- 18. Hyperventilation Causes: Deep and rapid breathing Loss of carbon dioxide in blood Symptoms: Faintness Numbness A sense that they are unable to take ain a full breath.
- 19. Hyperventilation A loss of carbon dioxide from the blood occurs, causing alkalosis (an increase in blood alkalinity). The patient panics and the breathing speeds up..
- 20. Hyperventilation Treatment: Stop all dental treatment Sit patient upright Calm patient Explain what is happening, and encourage pt to breathe in and hold it several seconds before exhaling This will allow more carbon dioxide to enter the bloodstream Have him or her breathe into paper bag Procedure 16-9
- 21. Epilepsy/Seizure Disorder Unorganized charges in brain cause change in consciousness May appear spontaneously or as a result of a stimulus, such as a flashing light May be insignificant to severe
- 22. Epilepsy/Seizure Disorder 1 in 200 people suffer from epilepsy Many wear bracelets or carry identification cards Epileptics should advise colleagues about what to do in case of a seizure. During a seizure, muscles tighten, and the person has no control over movements. a loose dental appliance may become dislodged or broken, obstructing the airway during a seizure. The dentist will used fixed appliances (where feasible), when treating patient’s with epilepsy
- 23. Some Causes of Epilepsy Head injury Infection Fever Brain tumor Strokes Metabolic imbalance Drug and alcohol withdrawals Extreme stress The causes of the majority of cases are unknown, but heredity is known to play a role.
- 24. General Categories of Seizures Grand Mal Most common 2-5 minutes Person becomes unconscious and the body jerks, twitches and stiffens. Breathing is often irregular Once the seizure subsides, bladder and bowel control may be lost as the muscles relax. The person may be disoriented and exhausted, normally with no memory of the seizure. He or she may want to sleep After the seizure, reassure the patient. If the patient experiences one seizure after another, which is called status epilepticus (continuous seizure), emergency services should be summoned. About 10% of patients experiencing status epilepticus will die due to the body’s inabilioty to deal with this overexertion
- 25. General Categories of Seizures Petit Mal Aka absence seizure Occurs when a person experiences momentary loss of consciousness The patient may exhibit a blank stare or blinking of the eyes that lasts 5-10 seconds Others around the person might not be aware of the seizure because of the lack of abnormal movements. The person may appear to be daydreaming Usually occur in children and normally decrease in frequency with age May occur several times a day and with other forms of seizures. Often, before a grand mal, a petit mal may be experiences first, as a warning.
- 26. General Categories of Seizures Partial Two categories Simple: person remains conscious Jacksonian epilepsy As twitching occurs and spreads slowly from one part of the body to another on one side, the person remains conscious and is able to recall details. Complex: person becomes unconscious Person remembers very little and exhibits involuntary actions, such as lip smacking If the seizure develops into a total body seizure, its considered to be grand mal
- 27. Seizure Prevention Try to eliminate extreme stress and fatigue Anticonvulsant drugs are the first line of tx Side effects of the drugs (Dilantin) cause gingival hyperplasia (overgrowth of gingival tissue, thick and granular that may cover teeth and have to be surgically removed)
- 28. Treatment of an Epileptic Seizure Remove dental materials from patient’s mouth Remove glasses and loosen clothing Remove items from the area that could harm the person Do not restrain patient Let seizure run its course If seizure lasts more than 5 minutes, or continue one after another, summon emergency help and reassure the patient
- 29. Post-seizure Place patient in recovery position Right side with airway open Let patient recover Reassure patient May be embarrassed Patient may: Be disoriented and exhausted Not remember seizure Lose control of bladder or bowel Procedure 16-10
- 30. Diabetes Mellitus The pancreas either does not produce, or produces an insufficient amount of insulin. Insulin is the hormone responsible for absorbing glucose into the cells for energy, and into the liver and fat cells for storage. Therefore, the level of glucose in the blood becomes too high, which causes third and excessive urination. The body cannot store glucose for the vast number of cells in the boyd tha tneed glucose to survive. The body normally experiences weight loss and fatigue. Diabetes mellitus is classified into two categories Type I and Type II
- 31. Hyperglycemia: High Blood Sugar Levels Disturbances in the balance of glucose intake and insulin can result in hyperglycemia Too much sugar (glucose) in blood The onset is slow and th e person experiences early symptoms days prior to the onset, such as increased thirst, increased urination, nausea/vomiting, with abdominal pain, loss of appetite, fatigue, and pain. If these patients (possibly undiagnosed diabetics) are having dental treatment, they could go into diabetic comas. If a patient reacts in this manner, stop dental treatment if a patient is conscious, have him or her administer an insulin shot. If the patient is unconscious, give basic life support and call for emergency help and transfer him or her to a medical faculty as soon as possible.
- 32. Hyperglycemia The most serious consequence of hyperglycemia, a condition in which the patient goes into a com and dies if untreated, is diabetic acidosis. Occurs when patient has too much sugar, and not enough insulin. The body in this condition produces acids, and the body’s pH is lowered. The body’s pH range is 7.35-7.45 If they body’s pH drops below 7.0, diabetic acidosis may occur.
- 33. Signs of Hyperglycemia Increased thirst or dry mouth Excessive urination Acetone breath Blurred vision Rapid pulse Lower blood pressure Loss of consciousness
- 34. Hypoglycemia: Low Blood Sugar Too little glucose or sugar Comes on rapidly and the patient becomes nervous, shows signs of trembling and weakness, and has cold sweats. Pt becomes hungry and shows signs of personality change
- 35. Treatment of Hypoglycemia Conscious Administer sugar source Juice, candy ect Unconscious Terminate dental tx Summon medical assistance Perform basic life support If necessary, give injection of glucagon or other sugar source Administer sugar source under tongue or buccal fold Cake icing/gel
- 36. Hypoglycemia Causes: Overexertion Emotional stress Missing meals Overdose of insulin Excessive exercising
- 37. Hypoglycemia If condition happens frequently, physician may prescribe antidiabetic drugs to stimulate the pancreas to produce more insulin, Normally though, the condition arises only when the person misses a meal, is over exerted, or is in a situation that causes emotional stress. Due to the stress patients experience during dental treatment and long appointment times, most dental offices have orange juice or other sources of sugar available for patients feeling changes in the blood sugar levels.
- 38. Signs and Symptoms of Hypoglycemia (Insulin Shock) Severe hypoglycemia Tremors Sweating Nervousness Followed by delirium Seizure-like jerkings Collapse Treatment requires administration of glucose intravenously Procedure 16-11