16 Emergency Management

2 Routine Preparedness for Dental Team Members Rehearse medical emergencies Establish roles for each employee Check emergency kit and equipment Post emergency contact numbers Post directions to office

3 General Protocol for Emergencies Stop procedure Reposition patient Activate emergency medical service (EMS) Assess and monitor airway and breathing Take vital signs –Assess circulation Administer oxygen

4 The Dental Assistant’s Role in an Emergency Observation of patient Report concerns to dentist Review medical history Know emergency plan

5 Contents of Emergency Kit Blood pressure kit Oxygen kit Sterile syringes Tracheotomy needle

6 Contents of Emergency Kit Latex gloves and mask Pocket mask Cold compress Blanket

7 Contents of Emergency Kit Paper bag –Used to treat hyperventilation Stress induced –Cupped hands may be used –Increases carbon dioxide in blood

8 Drugs in Emergency Kit Epinephrine (adrenaline) –Used for acute allergic reactions such as anaphylactic shock –Uses preloaded syringe Epi-pen –Classified as a vasoconstrictor –Serves as a cardiac stimulant –Relaxes bronchioles

9 Drugs in Emergency Kit Bronchodilator –Albuterol (inhaler) –Improves air flow –Does not stimulate cardiovascular system

10 Drugs in Emergency Kit Bronchodilator –Patient exhales Breathes in while dispensing drug Repeat –Within 15 minutes Breathing improves –If no improvement Call 9-1-1, give oxygen

11 Drugs in Emergency Kit Antihistamine –Used for allergic reactions Edema, erythema, urticaria, angioedema –Counteracts effect of histamine –Benadryl commonly used

12 Drugs in Emergency Kit Antihistamine –Administered by: Liquid Injection Inhaler

13 Drugs in Emergency Kit Anticonvulsants –Diazepam (valium) –Injection form –Controls seizures –Valium may be given as a premed in tablet form to manage stress

14 Drugs in Emergency Kit Analgesics –Demerol or Talwin –Administered by injection –Used to manage acute pain or anxiety

15 Drugs in Emergency Kit Vasopressors –Vasoxyl or Wyamine –Management of hypotension –Increases blood pressure –Administered by injection

16 Drugs in Emergency Kit Antihypoglycemic –Management of hypoglycemia –Tube of cake icing –Orange juice –Cola syrup –Sugar packets

17 Drugs in Emergency Kit Nitroglycerin –Management of chest pain –Vasodilator –Route of administration Translingual Sublingual Transdermal patch

18 Drugs in Emergency Kit Spirits of ammonia –Ammonia inhalants Glass tube covered with gauze Broken under patient’s nose –Used to treat syncope

19 Cardiopulmonary Resuscitation All dental staff must be certified in CPR Phone first and phone fast Certify every two years

20 The ABCs of CPR Airway Breathing Circulation Defibrillation

21 Foreign Body Airway Obstructions FBAO during treatment –Dental materials fall into throat Common problematic materials –Crowns –Cotton rolls –Gauze

22 Treatment of Obstruction in the Conscious Patient Stop treatment Sit patient upright Encourage patient to cough Perform Heimlich maneuver if necessary

23 Heimlich Maneuver in the Conscious Adult

24 Heimlich Maneuver in the Conscious Adult

25 Treatment of Obstruction in the Unconscious Patient Lay patient on floor –Perform finger sweep –Give two rescue breaths If airway is still obstructed –Reposition patient –Perform chest thrusts

26 Treatment of Unconscious Adult with FBAO

27 Common Emergencies in a Dental Office Syncope Asthma Orthostatic Hypertension Allergic reaction Anaphylactic reaction

28 Common Emergencies in a Dental Office Hyperventilation Seizures Diabetic emergencies Hypoglycemia –Insulin shock Cardiovascular emergencies

29 Syncope Fainting –Decreased blood flow to brain –Lying still for prolonged periods –Stress Emotional or physical

30 Symptoms of Syncope Dizziness Nausea Weakness Pale and clammy skin Shallow breathing

31 Treatment for Syncope in the Conscious Patient Place patient in sitting position Have patient place head between knees

32 Treatment for Syncope in the Unconscious Patient Place patient in Trendelenburg position Loosen clothing or jewelry Administer oxygen Administer spirit of ammonia under nose

33 Trendelenburg Position

34 Asthma Recurrent episodes of breathlessness accompanied by wheezing Narrowing of airways due to stimulus

35 Treatment of Asthma Administer inhaler Administer oxygen Calm patient Call if condition worsens

36 Orthostatic Hypertension Lose of consciousness or a level of consciousness when sitting upright quickly

37 Anaphylactic Reaction Severe, life-threatening allergic reaction Body creates large amount of histamine Tongue and throat swell Causes include: –Bee stings –Penicillin –Anesthetics

38 Anaphylactic Signs and Symptoms Loss of consciousness Skin rash Drop in blood pressure Nausea and vomiting Shortness in breath Tongue and throat swell

39 Treatment of Anaphylaxis Epinephrine

40 Hyperventilation Causes –Deep and rapid breathing –Loss of carbon dioxide in blood Symptoms –Faintness –Numbness

41 Hyperventilation Treatment –Sit patient upright –Have him or her breathe into a paper bag

42 Epilepsy/Seizure Disorder Unorganized charges in the brain causing a change in consciousness May be minimal to severe Grand mal, petit mal, partial seizures

43 Treatment of an Epileptic Seizure Remove dental materials from the patient’s mouth Remove glasses and loosen clothing Do not restrain the patient

44 Postseizure Place patient in recovery position Reassure patient Let patient recover Patient may: –Be disoriented and exhausted –Not remember seizure –Lose control of bladder or bowel

45 Type I Diabetes: Juvenile Diabetes Affects mostly ages 10 to 16 years Associated most often with additional medical problems Usually requires daily insulin injections Comprises 10 percent of diabetes cases Most severe form of disease

46 Type II Diabetes: Adult Onset Usually controlled with diet and/or hypoglycemics Does not require insulin injections Seen most often in: –Obese adults –Adults over age 40

47 Hyperglycemia: High Blood Sugar Levels Patient has eaten but not taken insulin Too much sugar (glucose) in blood Not enough insulin

48 Signs of Hyperglycemia Increased thirst; dry mouth Excessive urination Acetone breath Blurred vision Rapid pulse Lower blood pressure Loss of consciousness

49 Treatment of Hyperglycemia: Diabetic Ketoacidosis or Coma Conscious –Patient administers own insulin if available Unconscious –Provide basic life support –Transport to medical facility

50 Hypoglycemia: Low Blood Sugar Causes –Overexertion –Emotional stress –Missing meals –Overdose of insulin –Excessive exercising

51 Signs and Symptoms of Hypoglycemia (Insulin Shock) Cold sweat Nervousness Trembling Weakness Hunger Personality change Confusion

52 Treatment of Hypoglycemia Conscious –Administer sugar source Unconscious –Give injection of glucagon –Administer sugar source under tongue or buccal fold

53 Angina Pain in chest area, neck, and jaw Five-minute duration Increased blood pressure and pulse Pale and clammy skin Administration of nitroglycerin –Dilates coronary arteries –Heart receives oxygen

54 Myocardial Infarction: Heart Attack Caused by blocked or narrowed arteries Symptoms similar to angina but not relieved with nitroglycerin One third of heart attack victims die Heart tissue dies

55 Treatment of Myocardial Infarction Call Position patient comfortably Administer oxygen Administer nitroglycerin Administer 160–325 mg chewable aspirin

56 Congestive Heart Failure Inability of heart to pump Fluid collects around ankles and legs Heart progressively weakens Administer diuretics

57 Stroke/CVA Leading cause of death and disability in the United States Sudden in onset –Caused by interruption of the blood supply to brain Administer oxygen and call for EMS

58 Dental Emergencies Abscessed tooth Alveolitis Avulsed tooth Broken prosthesis Soft tissue injury Broken tooth Loose crown