It s an Emergency! Prevention, Preparation and Management when the Unexpected Occurs RDH Under One Roof August 12, 2017

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1 It s an Emergency! Prevention, Preparation and Management when the Unexpected Occurs RD Under One Roof ugust 12, 2017 Team Member Duties Member #1: Stay with the patient Member #2: all 911, bring emergency kit and ED indy Kleiman, RD, S Oral are onsultant and Speaker Member #3: DOUMENT Every team member must be ready ny one of us may be the patient! Emergency Management PR Guidelines 2010 P Position irculation irway reathing D Definitive are Diagnosis Drugs Defibrillation (for PR) ave an automatic blood pressure cuff on hand for emergencies. Injectables: Non-injectables: Equipment: asic Emergency Kit Epinephrine istamine blocker Oral istamine locker Vasodilator spirin (aby) nti-hypoglycemic (Sugar) ronchodilator mmonia Inhalant O 2, P uff, arrier Mask, ED 1

2 Instructions should be written out in the emergency kit. EVERYONE participates in monthly monitoring. ngina Pectoris Do your omework! transient chest pain caused by insufficient supply of oxygenated blood to the heart Often brought on by exertion or emotion Relieved by rest or nitroglycerin Medical istory Interview ow frequently do you suffer angina attacks? ow long do the attacks last? What precipitates your attacks? ow quickly does nitroglycerin relieve your attacks? When was your last attack? * Phone patients day prior to treatment requesting them to bring their nitroglycerin P D ngina Pectoris Management omfortable, usually upright Nitroglycerin Oxygen Usually not needed 2

3 onsider Myocardial Infarction if No prior history of chest pain Patient with history of angina Pain more intense than usual Nitroglycerin x 3 fails to alleviate pain Nitroglycerin resolves pain then pain returns Indigestion is similar to the pain of angina or MI and should not be ignored. Seek medical assistance if chest pain persists for 2 minutes or longer, if episode is the first. Symptoms Pain Myocardial Infarction Severe to intolerable rushing, choking Radiates: L arm, hand, shoulders, neck, jaw Nausea, weakness, dizziness Palpitations old perspiration Sense of impending doom Signs Restlessness cute distress Skin ool, pale, moist eart rate radycardia to tachycardia Women s Signs and Symptoms Shortness of reath Weakness Unusual fatigue Indigestion Disturbed Sleep 50% of women have no chest pain Myocardial Infarction Management P omfortable s Needed D all 911 Nitrous Oxide Oxygen Nitroglycerin spirin (4 aby, chewed) If your facility doesn t have one, purchase an ED. It could save your life! 3

Diabetes Mellitus ave an instructor review how to perform PR in a dental chair. ypoglycemia ypoglycemia occurs when the body's blood sugar, or glucose, is abnormally low.

Diabetic Emergency: ypoglycemia auses Signs and Symptoms Shaking Too much insulin Too little food Sweating nxiety Palpitations Restlessness Mental onfusion Medical istory Interview Do

Dental Treatment Guidelines For Diabetic Patients When did you last eat and when are you due for your next snack or meal?

4 Diabetes Mellitus ave an instructor review how to perform PR in a dental chair. ypoglycemia ypoglycemia occurs when the body's blood sugar, or glucose, is abnormally low. The term insulin shock is used to describe severe hypoglycemia that may result in unconsciousness. Diabetic Emergency: ypoglycemia auses Signs and Symptoms Shaking Too much insulin Too little food Sweating nxiety Palpitations Restlessness Mental onfusion Medical istory Interview Do you use oral medication or insulin? ow well controlled is your diabetes? What was your last blood sugar and how long ago was it taken? (Fasting: normal) What is your 1 reading? Dental Treatment Guidelines For Diabetic Patients When did you last eat and when are you due for your next snack or meal? Do you have a sugar source readily available; if so, could you please get it out? re you feeling okay at this time for treatment? (If they are unsure, ask them to please check their blood sugar before you proceed.) What signs do you exhibit with a low blood sugar? Stanley F Malamed Medical Emergencies in the Dental Office 7 th Edition

5 ypoglycemia Management onscious P omfortable s Needed D dminister sugar Glucose gel Fruit juices (Orange preferred by many) ard candy Soft drinks (non-diet) ypoglycemia Management Unconscious P Supine s Needed D all 911 bsorbable sugar (gel) Under lips, canine to canine? Sugar IV by EMS The sthma ttack onstriction of the airways and formation of thick mucus makes it progressively more difficult to inhale and exhale This leads to one or more of the following symptoms Tightness in the chest Shortness of breath chronic or recurring cough Wheezing, particularly when trying to exhale nxiety Medical istory Interview What brings on an attack? ow often do you get an attack and how long does it typically last? What drugs do you use to prevent acute episodes? What is the usual number of doses needed? ave you ever been hospitalized for your asthma? Do you have your inhaler with you? When was your last attack? *all asthmatic patients prior to day of treatment, requesting them to bring bronchodilator sthma ttack Management P D Upright Usually not needed Inhaler Oxygen Epinephrine if critical sthma ttack Management Summon EMS if Patient requests Episode is continuing with 2 doses of bronchodilator (Status sthmaticus) 5

6 Syncope: Predisposing Factors Syncope Management Psychogenic Factors Fright/nxiety Extraction Injections Pain, especially of a sudden and unexpected nature The sight of blood or of surgical or other dental instruments (such as a local anesthetic syringe) Non-psychogenic Factors Sitting upright or standing unger Exhaustion ot, humid, crowded environment Male sex ge between 16 and 35 years P Supine, slight elevation of legs s needed D mmonia inhalant Oxygen Recovery llergy Facts May continue to be light-headed, weak, pale May be disoriented/confused Pulse & blood pressure should return to normal Takes 24 hours to completely recover Discharge in custody of responsible adult The faster the onset of signs and symptoms after exposure to the allergen, the more severe the reaction llergy involving only skin is NOT life-threatening and requires milder, less aggressive management llergy involving difficulty with breathing IS life-threatening, requiring immediate, aggressive management llergic Reactions What to look for: Sneezing, coughing, or wheezing Shortness of breath Tightness and swelling in the throat, face, tongue, or chest Itching, burning, or rash Dizziness and weakness Nausea and vomiting P D llergy Management Delayed Onset Skin Reaction omfortable Usually not needed Oral histamine blocker ontinue for 2-3 days prn 6

7 naphylaxis e sure to have oral enadryl (diphenhydramine) in your kit. severe, and sometimes fatal, allergic reaction characterized by respiratory distress and hypotension, leading to cardiovascular collapse Usual Progression of naphylaxis Skin Eyes, nose, GI Respiratory System ardiovascular System P naphylaxis Management ased upon primary complaint: an t breathe upright Feel faint supine, feet elevated s Needed naphylaxis Management Why Epinephrine? D all 911 Oxygen Epinephrine Every 5 minutes or until EMS arrives Multiple doses usually required istamine blocker IM Reverses 2 components of anaphylaxis which lead to death ronchospasm epinephrine is bronchodilator ypotension epinephrine is vasopressor (P ) Works quickly IM top of thigh (EpiPenÜ), works in 1-2 minutes 7

8 ll team members should practice with an EpiPen trainer. ll new and temporary employees should be oriented on emergency procedures and equipment. Seizure auses of Seizures n event of altered brain function caused by abnormal or excessive electrical discharges in the brain Most seizures cause sudden changes in behavior or motor function Epileptic patients Stress induces seizures erebral anoxia Neonatal injury V (stroke, brain attack ) Tumor Previous head injury Idiopathic Tonic-lonic Generalized Seizure Tonic-lonic Generalized Seizure Prodromal Phase an be several minutes to an hour May have an aura Is self-limiting Lasts not more than 2-5 minutes Ictal Phase (The ctual Seizure) Tonic rigidity (10-20 seconds) Evolves into clonic contraction relaxations (2-5 minutes) Usually does not require IV anticonvulsant therapy Usually does not result in injury 8

9 Post-Ictal Medical istory Interview Tonic-clonic movements stop Respiration returns to normal onsciousness gradually returns Patient may be disorientated/confused Sphincter relaxation may cause incontinence What type of seizure do you have? ow often do you have seizures? What is your aura? ow long do your seizures last? Did you take your medicine today? Tonic-lonic Seizure Management Post-Ictal Phase P Supine Protect victim: Rescuer 1: arms gently! Rescuer 2: legs gently! s needed D all 911 Remove pillow or donut from headrest of chair Do not put anything into the mouth as needed Patient is disoriented, sleeping Position Turn on side, if possible ids in airway maintenance Dental hair Maintain supine, maintain airway as needed Medical Emergency Kits, P Vitalert Kit ealth First Omron 7 Series lood Pressure Monitor P652 [N] Thank you! indy Kleiman, RD, S Oral are onsultant and Speaker cindy@cindyspeaking.com 9

Medical Emergencies in the Dental Office: Vital Signs for the Dental Professional

Medical Emergencies in the Dental Office: Vital Signs for the Dental Professional West Liberty University Sarah Whitaker Glass School of Dental ygiene pril 11, 2014 Many thanks to my sponsor: indy Kleiman,