CPR Forth Year

1. CPR Course
Introduction
Prevention of Medical Complications
During Dental
Treatment
Dr. Adel I. Abdelhady
BDS, Msc, (Tanta,EG.), Phd (EG.USA)
Oral and maxillofacial surgery dept.
College of dentistry, King Faisal
university, KSA

2. Student Assessment
Continuous Assessment (quiz 30%
+ Attendance)
Midterm Exam
25%
Final Written Exam.
45%

3. Requirement for passing the course
EVERY STUDENT ERGENTLY HAVE TO
SUBMET A DOCUOMENTRY PROOF
FOR ATTENDANCE OF BASIC LIFE
SUPPORT (BLS) THIS IS MANDATORY
PRIOR ENTRY TO THE FINAL EXAM.

4. Life Threatening Emergencies
(L.T.E.)
LTE can and do occur in the practice of dentistry. This
can happen to the patient to the Dr., office staff, or to a
person accompanying the patient
Factors leading to increasing number of patients
complaining of LTE in dental office:
1-The increasing number older persons
2-The therapeutic advances in the medical profession
3-Growing trend toward longer dental appointments
4-The increasing use of administration drug s in dentistry

5. Morbidity
In spite of most meticulous protocols designed
to prevent the development of life threatening
situations, emergencies still occur.
Sudden unexpected death can happen of young,
well-conditioned athletes.
Overwhelming majority of situations involve a lot
a medical emergencies starting from syncope
(fainting, benign be aware of word benign might
be lead to catastrophe if not properly managed)
to acute MI and cerebrovascular accident ……
Most situations occur either during treatment ,or
in waiting area.

6. The type of dental care being administered more
than 65% of cases developed during two types
of dental care tooth extraction 39% and pulp
extirpation 27% .
The sudden unexpected pain triggered release
the endogenous of catecholamine, which in turn
added to the creation of an emergency, thus
proper and adequate pain control in safe dental
care cannot be overstated

7. Death
Most emergency situations that occur in
dental practice potentially can threaten the
patient’s life. However, only in rare
occasions does a patient actually die in a
dental office.
Patient has heart attack, Dies; Dentist also
Stricken
Three deaths from appliance aspiration
Failure to properly recognize and treat
clinical signs and symptoms can turn
innocuous situation into an office tragedy.

8. Pre-Treatment Evaluations
Adequate pretreatment evaluation combined
with pain and anxiety control can help to prevent
many emergencies and deaths
Unfortunately, the most stringent precautions
cannot prevent the occurrence of death.
The usual cause of death is lethal cardiac
dysrhythmia, most often ventricular fibrillations
preventive measure cannot entirely eliminate
this events

9. Risk Factors
1-Increased Number of Older Patients
Many older patients appear to be in good health in practitioner must
always lookout of subclinical diseases( cardiovascular, renal,
pulmonary, endocrine and CNS) must be monitored in older patients
2-Medical advances
With age, the incidence of disease rises, diabetic and cardiovascular
disease significantly have long life expectance today than they did
20 or 30 years ago
3-Longer Appointments stressful and create more hazard to the
patient
4-Increased drug used LA, Antibiotics can be lethal when interact
with other drugs received by patient the dentist have to be cautious
Goldberger Wrote ‘ WHEN YOU PREPARE FOR AN
EMERGENCY, THE EMERGENCY CEASES TO EXIST’

10. Prevention
 According to McCarthy a complete system
of physical evaluation for all prospective
dental patients can prevent approximately
90% of life threatening situations

11. Evaluation Goals
1-Determine the patient’s ability to physically tolerate the
stress involved in the planned treatment
2-Determine the patient’s ability to psycologically tolerate
the stress involved in the planned treatment
3-Determine whether treatment modifications are
required to enable the patient to better tolerate the stress
of the planned treatment
4-Determine whether the use of psycho-sedation is
warranted, and which sedation technique is most
appropriate and the contraindications if exist to any drug
to be used in the planned treatment

12. Physical Evaluation
Physical evaluation describes the steps
involved in the fulfillment of the goals
Medical history questionnaire

15. Physical Examination
Heart failure
Heart disease or attack
Angina pectoris
High blood pressure
Heart murmur
Rheumatic fever
Congenital heart disease
Asthma
Sinus trouble
Allergies
Prosthetic heart valve
Heart pacemaker
Implant defibrillator
Heart surgery
Prosthetic joint repl.
Anemia
Stroke
Kidney dysfunction
Emphysema
TB

16. Physical Examination
Aids
Diabetes
Radiotherapy
Chemotherapy
Hemophilia
Epilepsy
Fainting or dizzy
Nervousness
Psychiatric treatment
Sickle cell disease
Bruise easily
Do you loss weight
Are you a pregnant

18. Clinical Examination
Vital Signs
Blood pressure
Heart rate (pulse) and rhythm
Respiratory rate
Temperature
Height
Weight

19. PATIENT’S CLASSIFICATION
According to AHA

20. ASA I
Healthy, normal patient
Physiologically able to tolerate the stress
Without psychological problems
No treatment modifications are indicated

21. ASA II
Mild systemic disease
Can perform normal activity without
experiencing distress
Healthy patient with more extreme anxiety
May need modification in treatment

22. ASA III
Severe systemic disease
Limited activity but not incapacitated
Need stress reduction method during dental
treatment
May need to alter treatment

23. ASA IV
Has an incapacitating disease that is life
threatening
Patient is in distress at rest
No elective dental therapy
Emergency treatment should be in hospital
setting

24. ASA V
Moribund patient - not expected to live 24
hours with or without operation

26. Guideline for blood pressure in adult
Blood pressure
(mm hg)
ASA
classification
Dental Therapy
Considerations
> 140 and > 90
ASA I
Observe, routine treat.
140-159 or 90-94
ASA II
Recheck Bp , medical
consultation, MC implement
stress red. protocol
160-199 or 95-114 ASA III
Recheck every 5
minutes,MC, stress
reduction protocol
< 200 and/ or
<115
Recheck every 5 minutes,MC, stress
reduction protocol emergency
treatment
ASA IV

31. Medical emergencies commonly
provoked by anxiety in dental unit
•
•
•
•
•
•
•
•
•
•
Fainting/ syncope
Angina pectoris
Myocardial infarction
Asthmatic bronchospasm
Adrenal insufficiency
(acute)
Severe hypertension
Thyroid storm
Insulin shock
Hyperventilation
Epilepsy

33. Prior to Treatment
 Complete review of medical status

(including vital signs)
 Anxiety / Fear should be assessed and
managed before administering anesthetic

35. Prevention and management of
medical emergencies
 Prevention
 Preparation
Personal continuing education in emergency
recognition and management
Auxiliary staff education in emergency
recognition and management
Establishment and periodic testing of readily
access medical assistance.
Equipping office with supplies necessary for
emergency care.

36. Church of Selva Di Cadore, Colle Santa Lucia

37. Patient Evaluation
Enables one to accurately assess the
potential risk presented by a patient, prior
to the start of treatment

38. Goals of Physical Examination
To determine patient's ability to physically
tolerate the dental treatment
To determine patient's ability to
psychologically tolerate the dental
treatment

39. Goals of Physical Examination
To determine whether treatment
modifications are required
To seek medical consultation if indicated

40. Routine Pre-operative
Monitoring
Blood pressure - BP
Heart rate / rhythm - P
Respiratory rate - R

41. Respiration
 Monitor respiratory rate
 Observe movement of chest wall

42. Recognition of Anxiety
History
Observation

43. Moderate Anxiety
Usually try to hide their fears
Cold and sweaty palms
Nervous appearance

44. Severe Anxiety
Usually does not hide their fear
Appears with severe infection or toothache
Increased heart rate and blood pressure
Excessive sweating, trembling
Dilated pupils

47. Medical History Questionnaire
 1. Are you having pain or discomfort
at this time?
 2. Do you feel nervous about having
dentistry?
 3. Have you ever had a bad experience
in the dental office?

48. Systemic Problems
 Heart failure
 Heart disease or attack
 Angina pectoris
 High blood pressure

49. Systemic Problems
 Dysrhythmia
 Congenital heart lesions
 Rheumatic fever / Scarlet fever
 Pacemaker

50. Systemic Problems
 Renal disease
 Stroke
 Ulcers
 Emphysema

51. Systemic Problems
 Tuberculosis
 Asthma
 COPD
 Hay fever

52. Systemic Problems
 Sinus trouble
 Diabetes
 Thyroid disease
 Chemotherapy or Radiation therapy