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

Size: px

Start display at page:

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

Trevor Shaw
5 years ago
Views:

Medical Emergencies in the Dental Office: Vital Signs for the Dental Professional West Liberty University Sarah Whitaker Glass

Management Non-ardiac rrest P Position irway B Breathing irculation D Definitive are Diagnosis Drugs New PR Guidelines 2010 ardiac

circulation not necessary P B D If unconscious: ssess carotid pulse for max 10 seconds - deemphasized hest compressions if pulse

1 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, RD, BS Oral are onsultant and Speaker Emergency Management Non-ardiac rrest P Position irway B Breathing irculation D Definitive are Diagnosis Drugs New PR Guidelines 2010 ardiac rrest Only P Position irculation irway B Breathing D Defibrillation P B D irculation If conscious and responding, assisted circulation not necessary P B D If unconscious: ssess carotid pulse for max 10 seconds - deemphasized hest compressions if pulse not definite P B D irway If conscious and speaking, airway is open If unconscious: ssess airway Maintain airway as needed (ead tilt hin lift) P B D 1

Breathing P B D P B D If conscious and speaking, breathing is adequate If unconscious: ssess breathing - deemphasized hest compressions SP Ventilations as per PR guidelines Definitive Treatment P B D

2 Breathing P B D P B D If conscious and speaking, breathing is adequate If unconscious: ssess breathing - deemphasized hest compressions SP Ventilations as per PR guidelines Definitive Treatment P B D P B D Diagnosis Drugs Defibrillation Injectables: Non-injectables: Equipment: Basic Emergency Kit Epinephrine istamine blocker Oral istamine Blocker Vasodilator spirin (Baby) nti-hypoglycemic (Sugar) Bronchodilator mmonia Inhalant O 2, BP uff, Barrier Mask, ED omework! ontact me within 2 weeks with your changes and accomplishments: cindy@cindyspeaking.com hest Pain ardiac Related ngina pectoris Myocardial infarction auses Of hest Pain Non-ardiac Muscle strain Esophageal reflux iatal hernia Indigestion Gas pain 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. 2

3 ngina Pectoris 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 B D ngina Pectoris Management omfortable, usually upright Nitroglycerin Oxygen Usually not needed Nitroglycerin Nitrostat tablets Sublingual 0.4 mg Nitrolingual spray Translingual application 0.4 mg/spray Vasodilator Injectables: Basic Emergency Kit Epinephrine istamine blocker onsider Myocardial Infarction if Non-injectables: Equipment: Oral istamine Blocker Vasodilator spirin (Baby) nti-hypoglycemic (Sugar) Bronchodilator mmonia Inhalant O 2, BP uff, Barrier Mask, ED 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 3

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

4 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 Bradycardia to tachycardia Women s Signs and Symptoms Shortness of Breath Weakness Unusual fatigue Indigestion Disturbed Sleep 50% of women have no chest pain Myocardial Infarction Management Vasodilator P B omfortable D all 911 Nitrous Oxide Oxygen Nitroglycerin s Needed spirin (4 Baby, chewed) Nitroglycerin Nitrostat tablets Sublingual 0.4 mg Nitrolingual spray Translingual application 0.4 mg/spray spirin Thrombolytic (lot buster) Tablets, 325 mg 4 Baby EWED dminister if MI is considered ardiac rrest: Basic Life Support - PR P B D Position irculation irway Breathing Defibrillation ontraindicated if allergic 4

Medical lert Bracelet Michael olzberg michaelholzberg@me.com universalmedicaldata.

spirin (Baby) nti-hypoglycemic (Sugar) Bronchodilator mmonia Inhalant O 2, BP uff, Barrier Mask, ED Diabetes Mellitus metabolic

ypoglycemia ypoglycemia ypoglycemia occurs when the body's blood sugar, or glucose, is abnormally low.

5 Medical lert Bracelet Michael olzberg universalmedicaldata.com Injectables: Non-injectables: Equipment: Basic Emergency Kit Epinephrine istamine blocker Oral istamine Blocker Vasodilator spirin (Baby) nti-hypoglycemic (Sugar) Bronchodilator mmonia Inhalant O 2, BP uff, Barrier Mask, ED Diabetes Mellitus metabolic disease that occurs as either a deficiency or a complete lack of insulin in the body Diabetes Mellitus Diabetic Emergency: ypoglycemia 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. auses Too much insulin Too little food Signs and Symptoms Shaking Sweating nxiety Palpitations Restlessness Mental onfusion 5

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?

6 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? 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? ypoglycemia Management onscious P omfortable B s Needed D dminister sugar Glucose gel Fruit juices (Orange preferred by many) ard candy Soft drinks (non-diet) ypoglycemia Management Unconscious P B Supine D all 911 s Needed bsorbable sugar (gel) Under lips, canine to canine? Sugar IV by EMS nti-hypoglycemic Final Word Management of hypoglycemia Orange juice Soft drink No contraindications ll insulin diabetic patients should monitor their blood glucose levels at the end of each dental appointment prior to driving. 6

Injectables: Non-injectables: Equipment: Basic Emergency Kit Epinephrine istamine blocker Oral istamine Blocker Vasodilator spirin (Baby) nti-hypoglycemic (Sugar) Bronchodilator mmonia Inhalant O 2,

7 Injectables: Non-injectables: Equipment: Basic Emergency Kit Epinephrine istamine blocker Oral istamine Blocker Vasodilator spirin (Baby) nti-hypoglycemic (Sugar) Bronchodilator mmonia Inhalant O 2, BP uff, Barrier Mask, ED 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 P B D sthma ttack Management Upright Usually not needed Inhaler Oxygen Epinephrine if critical Bronchodilator for sthma lbuterol rescue inhaler No contraindications sthma ttack Management Summon EMS if Patient requests Episode is continuing with 2 doses of bronchodilator (Status sthmaticus) 7

8 Injectables: Non-injectables: Equipment: Basic Emergency Kit Epinephrine istamine blocker Oral istamine Blocker Vasodilator spirin (Baby) nti-hypoglycemic (Sugar) Bronchodilator mmonia Inhalant O 2, BP uff, Barrier Mask, ED Syncope: Predisposing Factors 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 Syncope Management mmonia Inhalant P Supine, slight elevation of legs B s needed D mmonia inhalant Oxygen No contraindications Recovery 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 Injectables: Non-injectables: Equipment: Basic Emergency Kit Epinephrine istamine blocker Oral istamine Blocker Vasodilator spirin (Baby) nti-hypoglycemic (Sugar) Bronchodilator mmonia Inhalant O 2, BP uff, Barrier Mask, ED 8

llergy n overreaction by the body s immune system to a foreign substance llergy Facts The faster the onset of signs and symptoms after exposure to the allergen, the more severe the reaction llergy

9 llergy n overreaction by the body s immune system to a foreign substance llergy Facts 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 llergy Management Delayed Onset Skin Reaction P B D omfortable Usually not needed Oral histamine blocker ontinue for 2-3 days prn naphylaxis severe, and sometimes fatal, allergic reaction characterized by respiratory distress and hypotension, leading to cardiovascular collapse 9

Usual Progression of naphylaxis naphylaxis Management Skin Eyes, nose, GI Respiratory System ardiovascular System P B Based upon primary complaint: an t breathe upright

required istamine blocker IM drenalin naphylaxis Life-threatening allergy No contraindications Preloaded syringe (EpiPen) Why Epinephrine?

10 Usual Progression of naphylaxis naphylaxis Management Skin Eyes, nose, GI Respiratory System ardiovascular System P B Based upon primary complaint: an t breathe upright Feel faint supine, feet elevated s Needed naphylaxis Management Epinephrine D all 911 Oxygen Epinephrine Every 5 minutes or until EMS arrives Multiple doses usually required istamine blocker IM drenalin naphylaxis Life-threatening allergy No contraindications Preloaded syringe (EpiPen) Why Epinephrine? Reverses 2 components of anaphylaxis which lead to death Bronchospasm epinephrine is bronchodilator ypotension epinephrine is vasopressor (BP ) Works quickly IM top of thigh (EpiPenÜ), works in 1-2 minutes 10

11 auses of Seizures Tonic-lonic Generalized Seizure Epileptic patients Stress induces seizures erebral anoxia Neonatal injury V (stroke, brain attack ) Tumor Previous head injury Idiopathic Is self-limiting Lasts not more than 2-5 minutes Usually does not require IV anticonvulsant therapy Usually does not result in injury Medical istory Interview Tonic-lonic Seizure Management 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? P Supine Protect victim: Rescuer 1: arms gently! Rescuer 2: legs gently! B s needed D all 911 Remove pillow or donut from headrest of chair Do not put anything into the mouth B as needed Post-Ictal Phase Patient is disoriented, sleeping Position Turn on side, if possible ids in airway maintenance Dental hair Maintain supine, maintain airway as needed Remember: The ommon Sense pproach to preventing medical emergencies requires preparation Preparation creates the ability to recognize a problem BEFORE it becomes an emergency 11

12 Medical Emergency Kits and ED Thank you! ealth First indy Kleiman, RD, BS Oral are onsultant and Speaker Physio-ontrol ED Mark Spearman - mspearman@mproassociates.com cindy@cindyspeaking.com 12

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

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