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TWENTY-THREE
Dental Emergencies
• Emergency Drugs • Emergency Kits • Various Emergencies
The medicine, which are used as emergency drugs are Syncope: Factors responsible are: • Nitrous oxide (very useful analgesic following MI) • Injection • Adrenaline injection (1:1000 or 1 mg/1 ml) • Hydrocortisone injection (100 mg), injection • Empty stomach Clinical features include pale, perspiration, moist skin, • Antihistamine tablets and injection (e.g. injection dizziness, weakness or nausea and gradually loss of • Diazepam 5 mg/10 mg (injection valium) Preventive treatment includes assurance, diazepam • Glucose (50% solution) for injection, and powder 5 mg half an hour before surgery and on the night • Therapeutic measures supine position of the patient flashing the face with cold water.
• Colloid solution for infusion (e.g. Haemaccel, • Therapeutic oxygen at 10 L flow/min.
Emergency Kits
In case of low blood pressure and pulse start • Portable defibrillator (incorporating ECG print- 5 percent dextrose and lactated Ringer’s by Administered a vasopressor epinephrine 0.3 to • Ambu bag (self-inflating with valve and mask) 0.5 mg. SC/IM route. In case of slow pulse < 60 beats • Oropharyngeal airways (sizes 1,2 and 3) per minute administer 0.4 mg. atropine IV route to • High volume aspiration with suction catheters and Cardiac Arrest
• Disposable syringes (2,5,10 and 20 ml sizes) Sudden loss consciousness and absence of arterial • Needles (19,21, and 23 gauge) and butterflies pulse (the carotid arterial pulse) with avascular • Tourniquet, sphygmomanometer and stethoscope surgical field, dialated pupils with cyonosis.
• Venous access cannulae (‘venflons’ 16 and 22 Management includes inform immediate for emer- gency support. Establishment of airway inflates lungs with mouth-to-mouth resuscitation. If carotid pulse • ‘BM sticks’ (for rapid assessment of blood sugar is absent compress sternum 1 to 2 inches (2 – 3) finger The emergencies may initiate during dental In case of low blood pressure and pulse start 5 procedure. The various emergencies may have to be percent dextrose and lactated Ringer’s by intervenous Synopsis of Oral and Maxillofacial Surgery Administered a vasopressor epinephrine 0.5 to • Myocardial infarction likely if breathlessness, 1 ml. 1:1 thousand is may be repeated every 5 minute.
nausea, vomiting, loss of consciousness, weak/ In case of slow pulse < 60 beats per minute administer irregular pulse and hypotension accompany pain.
0.5 mg may be repeated every 5 minute atropine IV Management
Medical emergency consultancy absolutely • Give patient’s own antiangina medication, e.g.
mandatory to combat to above mentioned acute • Wait 3 minutes and repeat if necessary, then related to bleeding as well as various shock already • Send emergency message for medical assistance discussed in detail in Hemorrhage and Shock chapters. • Do not lie flat as this increases feelings of Collapse of diabetic patient in dental chair maybe due to hyper glycaemia (excess sugar in the blood or • Administer nitrous oxide and oxygen (50/50) as hypo glycaemia less sugar in the blood). These two features represent by the following signs and • Obtain venous access in case CPR is required • Establish verbal encouragement of patient • Administer oral aspirin (one tablet) as anti-platelet Asthma: Predisposing factors are anxiety, tension. The respiratory tract hyper reactivity consequently Usually, the diabetic patient have often severe artherosclerosis and consequently prone to IHD. The Clinical features dyspnea, wheezing, panic and fear, collapse may be due to a myocardial perspective.
Hyperglycemia may result form excessive insulin Management
consumption or a missing a meal associated with excitement and anxiety attending the dentist, stress • Give reassurance but do not crowd the patient or changing insulin requirements due to dental • Allow the patient to use his/her own inhaler or • The patient should assume the most comfortable • The conscious administer oral glucose • The supine position of the patient.
• Give nebulized salbutamol (2.5 mg) if a portable nebuliser is available. Otherwise use high flow oxygen and deliver sulbutamol (6 – 8 actuations) • Administer 50 ml of glucose IV or 1 mg glucagons into the oxygen mask and allow the patient to • Continue high flow oxygen and repeat the above • Obtain IV access and give hydrocortisone 100 to Acute chest pain: This is usually mhyocardial (but exclude collapsed lung or pulmonary embolus).
Adrenal crises may be initiated during surgical pro- cedure in those patients are not covered prophylactic corticosteroides is not given. It is usually seen the long- term steroid users in case of asthma rheumatic disease • Severe, crushing retrosternal pain (‘heavy, and inflammatory bowel disease.
The clinical features include pallor of skin, rapid with pulse, low blood pressure and subsequently • Angina normally relieved by GTN tablet or spray rapid loss consciousness.
Management includes preventive, prophylaxis Management
Therapeutic supine position and raise the legs.
Therapeutic oxygen with steady flow.
Injection decadron IV urgent transfer to hospital • Check blood sugar and assess for other cause of collapse. Example – • Urgent transfer to hospital.
Accidental inhalation of foreign bodies: In supine dentistry inhaled foreign bodies are hazard problems.
Epilepsy may present by various forms. A properly controlled patient with epilepsy does not create The precautions and preventive measures may avoid these problems. The simple coughing does not Predisposing factors includes stress, anxiety, dislodge the offending article. The Heimlich maneuver fasting, hypoglycemia and fainting and all cause a fit helps the problems, the patient is encircled by your arms from behind at the level of the lower border of Tonic-clonic seizures are often preceded by an aura, the rib cage; a sudden forceful squeeze is exerted by followed rapidly by loss of consciousness and a rigid, pulling your arms together with the hands directed extended body (tonic phase) and jerking or flailing upwards towards the chest. With small children, movements (clonic phase). Postictal drowsiness and swinging the patient around by the legs may be the desire to sleep follow. Most fits last less than 5 sufficient to dislodge the article.
minutes and require no intervention except protecting Where the article is lying at the laryngeal inlet, a the patient from self-inflicted damage. Where the fit cricothyrotomy may allow breathing until the is prolonged or repeated, status epilepticus results and obstruction can be physically dislodge. In all cases, a intervention is required to prevent brain hypoxia.

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