Medical Emergencies in dentistry General surgery Medical Emergencies in dentistry Text slide. Dr.Ziad H. Delemi B.D.S., F.I.B.M.S. (M.F.) Mosul university- College of dentistry-oral & maxillofacial surgery department

Respiratory difficulties Medical Emergencies Unconsciousness Respiratory difficulties Chest pain Text slide. Mosul university- College of dentistry-oral & maxillofacial surgery department

Unconsciousness Syncope Shock Cardiac arrest Diabetic coma Adrenal insufficiency Convulsion CVA LA & drug toxicity Text slide. Mosul university- College of dentistry-oral & maxillofacial surgery department

Syncope -Most commonly observed potentially life-threatening emergency -Psychogenic shock or vasovagal attack Trendelenberg position Protect the airway Monitor vital signs Oxygen If not resolved conservatively -low blood pressure IV dextrose & Ringer lactate +adrenaline 0.5mg IM, IV, SC. -Bradycardia 0.4mg Atropine till 1.2mg Text slide. Mosul university- College of dentistry-oral & maxillofacial surgery department

Syncope Psychogenic Fright Anxiety Emotional stress Pain Site of Blood Nonpsychogenic Prolonged sitting or standing Hunger Exhaustion Poor physical condition Hot humid crowded environment Text slide. Mosul university- College of dentistry-oral & maxillofacial surgery department

Cardiac arrest -Airway (secure) -Breathing (mouth to mouth) -Circulation (start CPR) -Drugs (Dextrose + Ringer lactate Adrenaline 1mg every 5minute Sodium Bicarbonate 1mEq/Kg Atropine 0.5mg every 5minute Oxygen 10L/min. Text slide. Mosul university- College of dentistry-oral & maxillofacial surgery department

Head-Tilt/Chin-Lift Text slide. Mosul university- College of dentistry-oral & maxillofacial surgery department

Diabetic coma Text slide. Mosul university- College of dentistry-oral & maxillofacial surgery department

Adrenal insufficiency Adrenal crysis Hydrocortisone 100mg or dexamethasone 4mg Adrenalin 0.5mg Oxygen 10L/min. Text slide. Mosul university- College of dentistry-oral & maxillofacial surgery department

Convulsion hypoglycemia CVA Epilepsy Syncope drugs valium 5-20 mg IV Text slide. Mosul university- College of dentistry-oral & maxillofacial surgery department

CVA occur due thrombus or emboli that closed major artery in the cerebral circulation also called apoplexy or stroke Text slide. Mosul university- College of dentistry-oral & maxillofacial surgery department

LA & drug toxicity Stimulation followed by depression Oxygen Maintain blood pressure & pulse rate Treat convulsion Text slide. Mosul university- College of dentistry-oral & maxillofacial surgery department

Supine- check pulse check respiration Altered bizarre behavior Unconsciousness Supine- check pulse check respiration Open airway Full recovery Syncope (Psychogenic shock) still Altered bizarre behavior No pulse CPR Cardiac arrest There is pulse CVA Text slide. Alcohol overdose Rapid Insulin shock Slow Adrenal insufficiency Mosul university- College of dentistry-oral & maxillofacial surgery department

Respiratory difficulties Respiratory failure (Heart failure) Asthma Foreign body Allergy Hyperventilation (HYS) Text slide. Mosul university- College of dentistry-oral & maxillofacial surgery department

Respiratory failure Chocking Drug overdose (narcotics, sedatives, …) Text slide. Mosul university- College of dentistry-oral & maxillofacial surgery department

Asthma Adrenalin 0.5mg Hydrocortisone 100mg Aminophylline 250-500mg Ventoline inhaler Oxygen Text slide. Mosul university- College of dentistry-oral & maxillofacial surgery department

Foreign body Aspiration or swallowing -tooth -root -endodontic instruments -dental bur Text slide. Mosul university- College of dentistry-oral & maxillofacial surgery department

Allergy Maintain airway, breathing Adrenalin 0.5mg every 5-10 min. Hydrocortisone 100mg Theophylline 250-500mg Oxygen Text slide. Mosul university- College of dentistry-oral & maxillofacial surgery department

Hyperventilation (HYS) Anxiety Most common Metabolic conditions Pain Metabolic acidosis Drug intoxication Hypercapnia CNS disorders Treatment: Terminate procedure Position patient Calm patient Rebreathing bag Sedation Text slide. Mosul university- College of dentistry-oral & maxillofacial surgery department

Chest pain Myocardial infarction Angina pectoris hyperventilation Text slide. Mosul university- College of dentistry-oral & maxillofacial surgery department

Myocardial infarction Recognition Airway Breathing Circulation Oxygen - 4-5 L by NC or face mask Monitor VS Position to comfort Pain relief Morphine sulfate 2-5 mg IM/IV every 5-15 minutes Controls pain and reduces anxiety Prepare to perform CPR or provide Text slide. Mosul university- College of dentistry-oral & maxillofacial surgery department

Angina pectoris Treatment Stop procedure Position patient to comfort Oxygen 2-3 L per NC or face mask Nitroglycerin 0.4 mg SL Repeat every 5 minutes x 3 total doses If no response, assume MI or unstable angina transfer to ER Text slide. Mosul university- College of dentistry-oral & maxillofacial surgery department