1. Copyright 2003, Elsevier Science (USA). All rights reserved. Chapter 31 Assisting in a Medical Emergency Copyright 2003, Elsevier Science (USA). All rights reserved. No part of this product may be reproduced or transmitted in any form or by any means, electronic or mechanical, including input into or storage in any information system, without permission in writing from the publisher. PowerPoint ® presentation slides may be displayed and may be reproduced in print form for instructional purposes only, provided a proper copyright notice appears on the last page of each print-out. Produced in the United States of America ISBN 0-7216-9770-4

2. Copyright 2003, Elsevier Science (USA). All rights reserved. A medical emergency is a condition or circumstance requiring immediate action for someone that has been injured or has suddenly taken ill. Introduction

3. Copyright 2003, Elsevier Science (USA). All rights reserved.  Know Your Patient! Open communication Updated medical history  Know Your Patient! Open communication Updated medical history Preventing an Emergency

4. Copyright 2003, Elsevier Science (USA). All rights reserved.  Assigned roles  Front desk staff Call for emergency services Stay on line with emergency services Respond to patients in reception area  Assigned roles  Front desk staff Call for emergency services Stay on line with emergency services Respond to patients in reception area Emergency Preparedness

5. Copyright 2003, Elsevier Science (USA). All rights reserved.  Clinical staff Remain with patient Respond to other patients in office Provide medical assistance  Dentist Assess patient Provide medical care  Clinical staff Remain with patient Respond to other patients in office Provide medical assistance  Dentist Assess patient Provide medical care Emergency Preparedness  cont’d

6. Copyright 2003, Elsevier Science (USA). All rights reserved.  Routine drills Training with “mock emergency” Learn each other’s roles  Emergency telephone numbers 911 Local police Local fire station Emergency medical service  Routine drills Training with “mock emergency” Learn each other’s roles  Emergency telephone numbers 911 Local police Local fire station Emergency medical service Emergency Preparedness  cont’d

7. Copyright 2003, Elsevier Science (USA). All rights reserved.  Symptom: Something that the patient tells you regarding what he or she feels or is experiencing.  Sign: Something that you observe in a patient, such as a change in skin color or an increased respiration rate.  Symptom: Something that the patient tells you regarding what he or she feels or is experiencing.  Sign: Something that you observe in a patient, such as a change in skin color or an increased respiration rate. Recognizing a Medical Emergency

8. Copyright 2003, Elsevier Science (USA). All rights reserved.  Each member of the dental team must be current in: Cardiopulmonary resuscitation (CPR) Heimlich maneuver Taking and recording of vital signs  Each member of the dental team must be current in: Cardiopulmonary resuscitation (CPR) Heimlich maneuver Taking and recording of vital signs Emergency Care Standards

9. Copyright 2003, Elsevier Science (USA). All rights reserved. 1. Make a fist with one hand, and place thumb side of hand against the patient’s abdomen, just above the belly button, and below the xiphoid process of the sternum. 2. Grasp the fist with the other hand, and forcefully thrust both hands into the abdomen, using an inward and upward motion. 3. Repeat these thrusts until the object is expelled 1. Make a fist with one hand, and place thumb side of hand against the patient’s abdomen, just above the belly button, and below the xiphoid process of the sternum. 2. Grasp the fist with the other hand, and forcefully thrust both hands into the abdomen, using an inward and upward motion. 3. Repeat these thrusts until the object is expelled Heimlich Maneuver

10. Copyright 2003, Elsevier Science (USA). All rights reserved. Table 31-1: Emergency Supplies and Equipment

11. Copyright 2003, Elsevier Science (USA). All rights reserved.  Automated external defibrillator (AED) Function Monitors the heart rhythm. Analyzes the heart rhythm for ventricular fibrillation. Automatically defibrillates.  Automated external defibrillator (AED) Function Monitors the heart rhythm. Analyzes the heart rhythm for ventricular fibrillation. Automatically defibrillates. Specialized Equipment for Emergencies

12. Copyright 2003, Elsevier Science (USA). All rights reserved.  Physical changes Unconsciousness Altered consciousness Respiratory distress Convulsions Chest pain  Physical changes Unconsciousness Altered consciousness Respiratory distress Convulsions Chest pain Emergency Responses

13. Copyright 2003, Elsevier Science (USA). All rights reserved.  Cardiopulmonary resuscitation (CPR)  ABCs of Basic Life Support Airway must be opened and maintained. Breathing must be evaluated. Circulation must be monitored to determine whether the heart is beating.  Cardiopulmonary resuscitation (CPR)  ABCs of Basic Life Support Airway must be opened and maintained. Breathing must be evaluated. Circulation must be monitored to determine whether the heart is beating. Emergency Care Standards  cont’d

14. Copyright 2003, Elsevier Science (USA). All rights reserved. 1. Approach victim and check for signs of circulation. 2. If no response, get assistance and call 911. 3. Tilt the victim’s head and lift the chin. Look, listen and feel for signs of breathing. 4. If there are no signs of breathing, begin rescue breathing. 5. Give two full breaths. 6. Place the heel of your hand on the chest midline over the sternum. 7. Give 15 compressions, making sure to depress the sternum 1½ to 2 inches for an adult victim. 8. Complete three more cycles of 15 chest compressions and 2 breaths. 1. Approach victim and check for signs of circulation. 2. If no response, get assistance and call 911. 3. Tilt the victim’s head and lift the chin. Look, listen and feel for signs of breathing. 4. If there are no signs of breathing, begin rescue breathing. 5. Give two full breaths. 6. Place the heel of your hand on the chest midline over the sternum. 7. Give 15 compressions, making sure to depress the sternum 1½ to 2 inches for an adult victim. 8. Complete three more cycles of 15 chest compressions and 2 breaths. Adult CPR

15. Copyright 2003, Elsevier Science (USA). All rights reserved. 1. For rescue breathing, give one breath every 3 seconds. 2. The hand position is the same as for the adult chest compressions, but use only the heel of one hand to compress the sternum 1 to 1½ inches. 3. The ratio for breaths and chest compressions change to five compressions to one breath. 1. For rescue breathing, give one breath every 3 seconds. 2. The hand position is the same as for the adult chest compressions, but use only the heel of one hand to compress the sternum 1 to 1½ inches. 3. The ratio for breaths and chest compressions change to five compressions to one breath. Child CPR  CPR procedure is essentially the same as for the adult, with a few specific techniques.

16. Copyright 2003, Elsevier Science (USA). All rights reserved. 1. For rescue breathing, give one breath every 3 seconds. 2. Breaths are given through both the nose and mouth. 3. To complete chest compressions, place the middle fingers in the center of the chest between the nipples, remove the index finer. 4. Compress the sternum ½ to 1 inch. 5. The ratio for breaths and chest compressions change to five compressions to one breath. 1. For rescue breathing, give one breath every 3 seconds. 2. Breaths are given through both the nose and mouth. 3. To complete chest compressions, place the middle fingers in the center of the chest between the nipples, remove the index finer. 4. Compress the sternum ½ to 1 inch. 5. The ratio for breaths and chest compressions change to five compressions to one breath. Infant CPR

17. Copyright 2003, Elsevier Science (USA). All rights reserved.  Syncope: A reduced blood flow to the brain causing the patient to lose consciousness. Psychological factors: Stress and apprehension, fear, the sight of blood or instruments. Physiological factors: In one position for a long time, confined, skipping meals or hungry, and fatigue or exhaustion.  Postural hypotension: Lack of sufficient blood flow to the brain that may occur in a patient immediately after a sudden change in positioning.  Syncope: A reduced blood flow to the brain causing the patient to lose consciousness. Psychological factors: Stress and apprehension, fear, the sight of blood or instruments. Physiological factors: In one position for a long time, confined, skipping meals or hungry, and fatigue or exhaustion.  Postural hypotension: Lack of sufficient blood flow to the brain that may occur in a patient immediately after a sudden change in positioning. Common Medical Emergencies

18. Copyright 2003, Elsevier Science (USA). All rights reserved. Table 31-2: Responding to the Unconscious Patient

19. Copyright 2003, Elsevier Science (USA). All rights reserved.  Angina pectoris: Patient feels severe chest pain because the heart muscle is deprived of adequate oxygen. Pain from angina usually lasts 3 to 8 minutes. Angina pain is relieved or eased promptly by the administration of a commonly prescribed drug, nitroglycerin.  Acute myocardial infarction: Commonly referred to as a heart attack, the muscles of the heart are damaged because sufficient oxygen is not able to reach them.  Angina pectoris: Patient feels severe chest pain because the heart muscle is deprived of adequate oxygen. Pain from angina usually lasts 3 to 8 minutes. Angina pain is relieved or eased promptly by the administration of a commonly prescribed drug, nitroglycerin.  Acute myocardial infarction: Commonly referred to as a heart attack, the muscles of the heart are damaged because sufficient oxygen is not able to reach them. Cardiac Emergencies

20. Copyright 2003, Elsevier Science (USA). All rights reserved. Table 31-3: Responding to the Patient with Chest Pain

21. Copyright 2003, Elsevier Science (USA). All rights reserved.  Stroke is the interruption of blood flow to the brain that lasts long enough to damage the brain and results in the loss of brain function.  Predisposing diseases Arteriosclerosis Heart disease Uncontrolled high blood pressure  Stroke is the interruption of blood flow to the brain that lasts long enough to damage the brain and results in the loss of brain function.  Predisposing diseases Arteriosclerosis Heart disease Uncontrolled high blood pressure Cerebrovascular Accident

22. Copyright 2003, Elsevier Science (USA). All rights reserved. Table 31-4: Responding to the Patient Experiencing a Stroke (CVA)

23. Copyright 2003, Elsevier Science (USA). All rights reserved.  Hyperventilation: An increase in the frequency or depth (or both) of respiration that results in too much oxygen being consumed by the patient. The patient will usually remain conscious.  Bronchial asthma: Attacks of sudden onset, during which the patient's airway narrows, causing difficulty in breathing and coughing and a wheezing sound. Causes: Allergic reaction, severe emotional stress, or respiratory infection.  Hyperventilation: An increase in the frequency or depth (or both) of respiration that results in too much oxygen being consumed by the patient. The patient will usually remain conscious.  Bronchial asthma: Attacks of sudden onset, during which the patient's airway narrows, causing difficulty in breathing and coughing and a wheezing sound. Causes: Allergic reaction, severe emotional stress, or respiratory infection. Breathing Problems

24. Copyright 2003, Elsevier Science (USA). All rights reserved. Table 31-5: Responding to a Patient With Breathing Problems

25. Copyright 2003, Elsevier Science (USA). All rights reserved.  Allergy: An altered state of reactivity in body tissues in response to specific antigens. Antigen:Substance that causes an immune response. Antibodies: Antigen that can trigger an allergic state.  Localized allergic response: Slow to develop with mild symptoms such as itching, erythema, and hives.  Anaphylaxis: Can be life-threatening and develop very quickly.  Allergy: An altered state of reactivity in body tissues in response to specific antigens. Antigen:Substance that causes an immune response. Antibodies: Antigen that can trigger an allergic state.  Localized allergic response: Slow to develop with mild symptoms such as itching, erythema, and hives.  Anaphylaxis: Can be life-threatening and develop very quickly. Allergic Reactions

26. Copyright 2003, Elsevier Science (USA). All rights reserved. Table 31-6: Responding to a Patient Experiencing an Allergic Reaction

27. Copyright 2003, Elsevier Science (USA). All rights reserved.  A neurologic disorder characterized by recurrent episodes of seizures.  Grand mal seizure: Temporary loss of consciousness accompanied by uncontrollable muscular contractions and relaxation. Phase 1: Aura Phase 2: Loose consciousness Phase 3: Muscle contractions Phase 4: Sleep/recovery  Petit mal seizure: Brief lapse of consciousness that may last only a few seconds.  A neurologic disorder characterized by recurrent episodes of seizures.  Grand mal seizure: Temporary loss of consciousness accompanied by uncontrollable muscular contractions and relaxation. Phase 1: Aura Phase 2: Loose consciousness Phase 3: Muscle contractions Phase 4: Sleep/recovery  Petit mal seizure: Brief lapse of consciousness that may last only a few seconds. Epileptic Seizures

28. Copyright 2003, Elsevier Science (USA). All rights reserved. Table 31-7: Responding to a Patient Experiencing a Convulsion

29. Copyright 2003, Elsevier Science (USA). All rights reserved.  A metabolic disorder resulting from disturbances in the normal insulin mechanics.  Hyperglycemia: An abnormal increase in the glucose (sugar) level in the blood that results in: Diabetic ketoacidosis Diabetic coma  Hypoglycemia: An abnormal decrease in the glucose level in the blood due to: Missing a meal Overdose of insulin  A metabolic disorder resulting from disturbances in the normal insulin mechanics.  Hyperglycemia: An abnormal increase in the glucose (sugar) level in the blood that results in: Diabetic ketoacidosis Diabetic coma  Hypoglycemia: An abnormal decrease in the glucose level in the blood due to: Missing a meal Overdose of insulin Diabetes Mellitus

30. Copyright 2003, Elsevier Science (USA). All rights reserved. Table 31-8: Responding to a Diabetic Emergency