Medical Emergencies DSUR 532. Donita Dyalram DDS, MD

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1 Medical Emergencies DSUR 532 Donita Dyalram DDS, MD

2 What do you want to learn from this course?

3

4 IN THE BASEMENT!!!!! FRIGHT! FLIGHT! FEAR!

5 Why do we need to know this information?

6 What is our largest growing population? The most rapidly growing segment of the US population is the group 65 and older because of the large number of aging post World War II baby boomers

7 Life Expectancy Year Total White Men White Women African American Men African American Women Na Na Na Na Na Na Na Na Na Na Na Na Na Na 1900 na na 49.0 Na Na

8 What systemic changes will we see in our aging patients? Central Nervous system Decreased brain cell number Dementia Parkinsonism Cerebral arteriosclerosis CVA Decrease memory Emotional changes Cardiovascular System CAD Angina pectoris MI Dysrhythmias HTN Cardiac disease CVA Reno vascular disease Respiratory system Emphysema Arthritic changes in the thorax Interstitial fibrosis Genitourinary System Decrease renal flow Decrease number of functioning glomeruli BPH Endocrine System Decrease response to stress Type 2 DM

9 What are the causes of death by age group? 1-14 years Accidents Congenital malformations Malignant neoplasms Assault Disease of the heart Intentional harm years Accidents Assault Intentional harm Malignant neoplasm Heart disease years Accident Malignant neoplasm Heart disease Intention harm Assault years Malignant neoplasm Heart disease Accident DM CVA 64 and older Heart disease Malignant neoplasm CVA Respiratory disease Dementia

10 Where and when does the emergency happen in the dental office?

11 Occurrence of systemic complications Time of Complication % of total In the waiting room 1.5 During or immediately following local anesthesia 54.9 During treatment 22.0 After treatment ( in the office) 15.2 After leaving the dental office 5.5 Matsurra H. Anesth Prog 36: , 1990

12 Common Medical Emergencies in the dental office Unconsciousness Vasodepressor syncope Orthostatic hypotension Acute adrenal insufficiency Respiratory distress Airway obstruction Hyperventilation Asthma Heart failure/pulmonary edema Altered consciousness DM: hypo/hyper glycemia Thyroid dysfunction CVA Seizures Drug overdose Allergy Chest pain Angina MI Sudden cardiac arrest

13 What emergencies occur in the private practice? Syncope 15,407 Mild allergic reaction 2,583 Angina 2,552 Postural hypotension 2,475 Seizures 1,595 Asthmatic attack 1,392 Hyperventilation 1,326 Epinephrine reaction 913 Insulin shock 890 Cardiac arrest 331 Anaphylactic reaction 304 MI 289 LA overdose 204 Heart failure 141 Diabetic coma 109 CVA 68 Thyroid storm 4 N=4309 reporting dentist. Fast TB, et al. Emergency preparedness: a survey of dental practitioners. J am Dental Assoc. 112:

14 Treatment Treatment performed at time of complication Tooth extraction 38.9 Pulp extirpation 26.9 Unknown 12.3 Other treatment 9.0 Preparation 7.3 Filling 2.3 Incision 1.7 Apicoectomy 0.7 Removal of fillings 0.7 Alveolar plastics 0.3 % of total Matsuura H. Analysis of systemic complications and deaths during dental treatments in Japan. Anesth Prog 36: , 1990

15 Incidence of medical Emergencies in a practicing lifetime Australian Dentist Emergency Number events Incidence in a practicing lifetime Adverse reaction to LA Grand mal seizure Angina Insulin Shock in 2 dentist Severe Asthma 88 1 in 3 dentist Resuscitations 35 1 in 7 dentist CPR 20 1 in 13 dentist Artificial ventilation 15 1 in 17 dentist MI 19 1 in 13 dentist CVA 12 I in 20 dentist Anaphylactic reaction 4 1 in 60 dentist Anaphylactic reaction to LA 4 1 in 60 dentist

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17 DSUR 532: Medical Emergencies Date Topic Presenter March 30 (Mon) Review of Course Materials/Introduction to Course Dr. Dyalram April 3 (Fri) Management of Chest Pain (Room 314/G313) Dr. Murphy April 6 (Mon) Management of Surgical Complications Dr. Brahim April 10 (Fri) Management of Medical Emergencies Dr. Hanna April 13 (Mon) Management of Altered Consciousness Dr. Bergman April 17 (Fri) Management of Respiratory Distress (Room 314/G313) Dr. Ghazali April 20,24 & 29 May 1, 4 & 6 Mock Emergency Lab (small groups) Dr. Dyalram and Residents May 12 (Tues) FINAL EXAM, 9:00 10:50 a.m. (G314/G313) Dr. Dyalram

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