medical emergencies in dental practice
DESCRIPTION
Medical emergencies in dental practiceTRANSCRIPT
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Good morning
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MEDICAL EMERGENCIES IN DENTAL PRACTICE
Presented By
Deepika Jasti
1st year PG
Public Health Dentistry
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Contents • Introduction • Classification of medical
emergencies• ASA physical status classification
system• Dental office emergency team• Basic action for every emergency • Most common emergencies and
their Management • Syncope • Postural hypotension • Acute adrenal insufficiency • Hyperventilation• Status asthmatics
• Diabetic emergencies• Epilepsy• Anaphylactic reactions• Angina pectoris • Myocardial infarction• Cardiac arrest • Basic emergency kit• Basic emergency drugs • Emergency management at camps• Conclusion • Recent studies conducted in India • References
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Introduction
The emergency is derived from the Latin, meaning to dip, Plung, Indundate, engulf or to bury.
Definition: A serious and unexpected situation requiring immediate action.
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WHY WE SHOULD READ THIS SEMINAR
“When you prepare for an emergency, the emergency cease to exist”
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Classification of medical emergencies
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ASA Physical Status Classification System
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Dental Office Emergency Team
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Basic action for every emergencyt/B
RR
UNCONSCIOUS - Look-Listen-Feel
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Most common emergencies
• Syncope • Postural hypotension • Acute adrenal insufficiency • Hyperventilation• Status asthmatics• Diabetic emergencies• Epilepsy• Anaphylactic reactions• Angina pectoris • Myocardial infarction• Cardiac arrest
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Syncope
Syncope is defined as a transient loss of consciousness and postural tone due to reduced cerebral flow and is associated with spontaneous recovery
Temazepam 5mg orally
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Postural Hypotension/
• Definition: postural hypotension is defined as a drop in systolic blood pressure of 30 mm Hg or greater or a 10 mm Hg or greater fall in diastolic blood pressure that occurs on standing.
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•Risk factors•Clinical features - %BPangina, lethargy, low back ache •Diagnosis •Management Assessment of consciousness P-A-B-C-DFludrocortisone – to raise BP Discharge- Chair position
Postural Hypotension
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Acute Adrenal Insufficiency
• 25 steroids• Cortisole regulates BP and glucose utilisation. K,ca • Signs and symptoms- how to diagnose• Management – 5-10l/min oxygen
mix-o-vial
100 mg
2ml liquidHydro
cortisone
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Foreign Body Obstruction
Universal choking sign
Heimlich manever
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Hyperventilation
Definition : Hyperventilation is defined as ventilation in excess of that required to maintain normal blood oxygen and carbon dioxide partial pressures.
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Respiratory alkalosis – Hypocapnia
Vasoconstriction in cerebral blood vessels
Feeling of tightness in chestRelease of catecholamines due to
anxiety Respiratory alkolosis – change in
blood pH – alters calcium.
Management P-A-B-C-D
Calm the patientBreath 4-5 times
Co2 -02 Paper bags
Diazepam/ midazolam
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Status Asthmaticus
Hypercapnea –acidosis-respiratory failure
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Status Asthmaticus
Salbutamol -250mg iv
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Diabetic Emergencies
25-50 ml1mg
15 grms
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EPILEPSY
• Definition: disorder of brain characterized by an enduring predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological and social consequences of this condition.
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Classification
Partial seizureSimple partial seizureComplete partial seizurePartial seizure with secondary generalization
Primarily generalized seizuresAbsence seizure (petitmal seizure)Tonic clonic seizure (grandmal seizure)Tonic seizureAtonic seizureMyoclonic seizure
Unclassified seizuresNeonatal seizuresInfantile seizures
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Precipitating factorsSignsManagementStatus epilepticus – 15 min
D/M= 10/5
Tonic phase
Clonic phase
Flaccidity
Incontinence
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Anaphylactic Reactions
10-20 Mg 10ml blood
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Myocardial Infarction
50/50 Nitrous oxide and
oxygen
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Cardiac Arrest 4-5cm80/min50kgs
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Basic emergency kit
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Basic emergency kit
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Basic emergency drugs
• Oxygen • Epinephrine • Nitroglycerin • Injectable
antihistamine • Salbutamol • Aspirin • Oral carbohydrate • Glucagon • Atropine
• Corticosteroid • Morphine • Naloxone • Nitrous oxide • Injectable
benzodiaepine• Flumazenil• Aromatic ammonia
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Emergency Management At Camps
To be forewarned is to be forearmed
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Medico legal considerations
The standard of care can be defined as “what the reasonable, prudent person with the same level of training and experience would have done in the same or similar circumstances.”
“Ignorance of the law does not constitute immunity from liability”
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Recommendations
• When an emergency arises call for EMS immediately • If there is a problem, such as a dental dam clamp falling
into a patient’s throat, be honest with patients as to the nature of the problem.
• Refer patients to medical professionals when necessary. Never attempt to treat situations which require physician or hospital management.
• Be knowledgeable about state dental practice acts and your requirements for dealing with emergencies
• Current basic life support certificate for all dental office staff
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• Take a complete health history for new patients and update it at each visit. Maintain adequate records. Document emergency treatment rendered; generally, courts have maintained that if it wasn’t written down, it wasn’t done.
• Take vital signs, especially if an anesthetic is to be administered.
• Having an emergency kit in the office does not prevent liability unless you know how to use it properly.
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Conclusion
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Recent studies conducted in India
• Gupta et. al, preparedness of management of medical emergencies among dentists in Udupi and Mangalore, India. J. contemp dent practice 2008; 9(5); 92-9.
• Praveen et al, evaluation of knowledge, experience and perceptions about medical emergencies amongst dental graduates of Bangalore city, India. J clin expt dent. 2012; 4(1); 14-8.
• Mainak saha et al, emergency preparedness; a survey of dental practitioners in Indore: JIDA, vol. 5, no. 12, dec 2011.
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Recent studies conducted in India
• Bhavana et al, a survey of medical emergencies in dental practice in India. Paper presentation at 9th world congress on preventive dentistry, 2009.
• Mohan das et al, knowledge, attitude and practice in emergency management of dental injury among physical education teachers: a survey in banglore urban schools. Dent update, 2009, may, 36(4): 202-4. 207-8. 211.
• Santa et al, awareness of basic life support among medical, dental , nursing students and doctors. Indian J. Anaesth. 2010, March-April; 54 (2); 121-126.
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• Gupta T et al, in 2008 conducted a study to assess the preparedness for management of medical emergencies among dentists in the cities of Udupi and Mangalore in India and found that Less than half (42.1%) of the dentists reported having received practical training in management of medical emergencies during their undergraduate and postgraduate education. Only about one-third of the respondents felt competent in performing mouth-to-mouth breathing (39.3%), cardiac compression (35.2%), foreign body obstruction relief (32.8%), and in administering IV drugs (34.5%) or supplemental oxygen (27.4%). The most commonly available emergency drugs in treatment areas were oral glucose (82.2%) and adrenaline (65.8%).
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However, less than one-fourth of the respondents had the following on hand in their treatment facility: oxygen (24.0%), an AMBU bag (17.1%), pocket mask (13.0%), bronchodilator spray (24.7%), diazepam (20.5%), aspirin (20.5%), and glyceryl trinitrate (17.8%). Less than half (39%) of the respondents reported having clinical staff members trained to assist in emergency recognition and management and only 5.8% carried out emergency drills in their workplace.
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Santa et al in 2010, conducted a cross sectional study to assess the awareness of Basic Life Support (BLS) among students, doctors and nurses of medical, dental, homeopathy and nursing colleges and found that no one among them had complete knowledge of BLS. Only two out of 1054 (0.19%) had secured 80 - 89% marks, 10 out of 1054 (0.95%) had secured 70 - 79% marks, 40 of 1054 (4.08%) had secured 60 - 69% marks and 105 of 1054 (9.96%) had secured 50 - 59% marks. A majority of them, that is, 894 (84.82%) had secured less than 50% marks. Thus it is concluded that awareness of BLS among students, doctors and nurses of medical, dental, homeopathy and nursing colleges is very poor.
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References
1. Stanlet F. Malamed, Medical emergencies in dental office, 6th ed. page no: 12, 38, 60.
2. Medical emergencies in dentistry : Prevention and Preparation, dentistry Iq, articles, volume-2, issue -10
3. Haas DA et al., Preparing dental office staff members for emergencies: developing a basic action plan, J Am Dent Assoc, 2010 May;141 Suppl 1:8S-13S.
4. Harrison’s text book of principles of internal medicine, vol. 1, 18th ed.
5. www.dentallearning.org/course/fde0011-10/coursebook_ch09.pdf
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6. Phil Jevon et al., Postural hypotension: symptoms and management, nursing times, vol: 97, issue: 03, PAGE NO: 39.
7. Lapointe et al, Pocket guide to medical emergencies in dental office. www.faculty.ksu.edu.com
8. cowson’s text book of oral pathology and oral medicine , Emergencies in dental practice, – 7th ed. page no ; 385-390.
9. Burket’s text book of oral medicine: diagnosis and treatment, page no. 519.
10. Fisher et al., epileptic seizures and epilepsy: definitions proposed by International league against epilepsy (ILAE) and the international bureau for epilepsy (IBE), Epilepsia, Vol.46, No.4, 2005.
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11. Harrison’s principles of internal medicine, volume II, 16th ed. page no: 2357.
12. Kenneth et al, Allergy & Anaphylaxis, Inside Dentistry, March 2011, Volume 7, Issue 3
13.Daniel A Haas et al., Management of Medical Emergencies in the Dental Office: Conditions in Each Country, the Extent of Treatment by the Dentist, Anesth Prog. 2006 Spring; 53(1): 20–24.
14.Rosenberg M et al., Preparing for medical emergencies. The essential drugs and equipment for the dental office JADA, Vol. 141, May 2010.
15.Roberson et al., Are You (and Your Staff) Prepared for a Medical Emergency?, fall 2009, vol 12, no.2
16.Office emergencies and emergency kits. JADA march 2002, vol 133.
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Thank you