MEDICAL

EMERGENCIES
SOBIA RUBAB
 WHAT’S AN EMERGENCY?

• A serious, unexpected and often dangerous

situation requiring immediate action
Why focusing on Medical Emergencies?

• An emergency is a medical condition that

demands immediate attention and successful
management.
• These are the life-threatening situations of
which every practitioner must be aware of so
that needless morbidity can be avoided.
 How to prevent Medical Emergency?

• Detailed medical history

• Physical examination
• Never practice alone
• Patient monitoring
• Allergies
• Accessibility to emergency drugs box
• Always having accessible the telephone numbers of
the emergency services
 Emergency Drugs
• Glyceryl trinitrate (GTN) spray (400micrograms / dose)
• Salbutamol aerosol inhaler (100micrograms / actuation)
• Adrenaline injection (1:1000, 1mg/ml)
• Aspirin dispersible (300mg)
• Glucagon injection 1mg
• Oral glucose solution / tablets / gel / powder
• Midazolam 10mg (buccal)
• Oxygen
 EMERGENCY EQUIPMENT

• Portable oxygen delivery system

• Ambu bag
• Oropharyngeal airways
• catheters
• Tourniquet, sphygmomanometer
• stethoscope
• Venous access cannulae
• IV infusion sets
• Disposable syringes
• Portable defibrillator
 Emergency procedure
• Call for local assistance
• Check for danger(hazards,risk,safety)
• Access patient..ABCDE,OXYGEN
 COMMON MEDICAL EMERGENCIES

• Fainting
• Collapse of a diabetic patient
• Anaphylaxis
• Acute chest pain
• Asthma
• Epilepsy
• Choking
 SYNCOPE

• Inadequate cerebral perfusion (and oxygenation)

results in loss of consciousness
• This most commonly occurs with low blood
pressure caused by vagal overactivity (a
vasovagal attack,
• simple faint, or syncope)
• This is typically triggered by seeing blood, pain,
emotional stress or prolonged standing
 SYNCOPE SIGNS & SYMPTOMS

• Patient feels faint / dizzy

• Slow pulse rate
• Low blood pressure
• Pallor and sweating
• Nausea and vomiting
• Loss of consciousness
 SYNCOPE TREATMENT

• Lay the patient flat as soon as possible and raise the legs
to improve venous return
• Loosen any tight clothing, especially around the neck
• Open windows/ turn on fan
• Establish verbal encouragement and ask the patient to
take big slow deep breaths
• Consider supplemental Oxygen if recovery delayed and
low O2 saturation
• Give patient a sugary drink /administer glucose
 Hypoglycemia
• PREVENTION

• Plan early morning appointments

• Patients with diabetes should eat normally and take
their usual dose of insulin or oral hypoglycemic drugs
• If food is omitted after having insulin, the blood
glucose will fall to a low level
• Patients may recognize the symptoms themselves and
will usually respond quickly to glucose
 SIGNS & SYMPTOMS

• Shaking and trembling

• Sweating
• Headache
• Difficulty in concentration
• Slurring of speech
• Aggression and confusion
• Fitting / seizures
• Unconsciousness
 TREATMENT
• Confirm the diagnosis by measuring the blood glucose
• Early stages where the patient is co operative and
conscious with an intact gag reflex, give oral
• glucose ( sugary drink, milk with added sugar, glucose
tablets or gel). If necessary this may be repeated in 10
15 minutes
• In more severe cases where the patient has impaired
consciousness, is uncooperative or is unable
• to swallow safely buccal glucose gel and / or glucagon
should be given
 ASTHMA

• A common lung disorder in which

inflammation causes the bronchi to swell and
narrow the airways
• (bronchospasm), creating breathing difficulties
that may range from mild to life threatened.
 SIGNS & SYMPTOMS

• Clinical features of acute severe asthma in adults include:

• Inability to complete sentences in one breath

• Respiratory rate > 25 per minute
• Tachycardia (heart rate > 110 per minute)

• Clinical features of life threatening asthma in adults include:

• Cyanosis or respiratory rate < 8 per minute
• Bradycardia (heart rate < 50 per minute)
• Exhaustion , confusion, decreased conscious level
 TREATMENT

• Whilst awaiting ambulance transfer, oxygen (15 litres

per minute) should be given
• Up to 10 activations from the salbutamol inhaler
should be given using a large volume spacer device
and repeated every 10 minutes if necessary until an
ambulance arrives
• If bronchospasm is part of a more generalised
anaphylactic reaction and there are 'life threatening‘
signs, an intramuscular injection of adrenaline should
be given
 ANAPHYLAXIS
• Anaphylaxis is a severe, life threatening,
generalised or systemic hypersensitivity
reaction
 AGENTS
• Penicillins
• Local anaesthesia
• Latex
• Non steroidal anti inflammatory drugs (NSAIDs)
• Opiates
• Muscle relaxants
• Radiographic contrast media
• Others vaccines, immunoglobulins, insect bites,
various foods peanuts, fish, shellfish, milk and eggs
 SIGNS & SYMPTOMS

Abdominal pain, vomiting, diarrhoea and a sense of

impending
• respiratory arrest leading to cardiac arrest.
• Angeoadema
• anxiety
• Headache
• Nausea
• Voice changes
 TREATMENT

• First line treatment includes managing the airway and breathing and
restoration of blood pressure
• (laying the patient flat, raising the feet) and the administration of
oxygen 15 L/min)
• For severe reactions where there are life threatening airway and/or
breathing and/or circulation problems, i.e., hoarseness, stridor,
severe wheeze, cyanosis , pale, clammy , drowsy , confusion or coma
• adrenaline should be given intramuscularly (anterolateral aspect of
the middle third of the thigh) in a dose of 0.5mg (0.5 mL adrenaline
injection of 1:1000
• Adrenaline dose is repeated if necessary at 5 minute intervals
according to blood pressure, pulse and respiratory function
 CHEST PAIN

• Angina is chest pain or discomfort caused when

your heart muscle doesn't get enough oxygen-rich
blood, commonly due to coronary artery disease
• Patients with ‘unstable’ angina and those with a
recent history of hospital admission for ischaemic
chest pain have the highest risk, and should NOT
be considered for routine dental treatment in
primary care
 CHEST PAIN
MANAGEMENT
• Stop the procedure
• Keep patient out of injury
• Assess ABCDE-give oxygen (10-15L/min)
• Seek assistance call ambulance
• Sit upright to decrease breathlessness, away from harm
• Give glyceryl trinitrate sublingually
• If no relief in 3 mins, suggest MI give Aspirin 300mg
• If cardiac arrest perform CPR
• Shift to hospital
• Reappoint the patient for another day
 EPILEPSY

• Epilepsyis a central nervous system

(neurological) disorder in which brain activity
becomes abnormal, causing seizures or periods
of unusual behaviour, sensations, and sometimes
loss of awareness
• Fits are usually seen in known epileptics
• Various factors may precipitate a fit, including
not eating, cessation of anticonvulsant therapy,
antidepressants, any sound , flashing lights
SIGNS & SYMPTOMS

• Fitting may be a presenting sign of Hypoglycaemia

and should be considered in all patients, especially
known diabetics and children with no history of epilepsy!
• An early blood glucose measurement is essential in all
actively fitting patients (including known epileptics)
• Check for the presence of a very slow heart rate
(<40/min)
MANAGEMENT
• Give high flow oxygen (15 litres per minute)
• Do not attempt to restrain convulsive movements
• After convulsive movements have subsided place the
patient in the recovery position and reassess
• If the patient remains unresponsive always check for
‘signs of life
• If seizures are prolonged (convulsive movements lasting
5 minutes or longer) or recur in quick succession:
• Midazolamgiven via the buccal route in a single dose
of 10mg for adults
• The patient should not be sent home until fully recovered
and they should be accompanied
• CHOKING/ ASPIRATION

• Dental patients are susceptible to choking with the

potential risk of aspiration
• They may have blood and secretions in their mouths
for prolonged periods
• Local anaesthesia may diminish the normal
protective pharyngeal reflexes and dental materials
and equipment is often within their oral cavity and
poses additional risks
• Prevention of inhalation of foreign bodies, including
teeth, crowns, filling materials or endodontic
instruments, is far better than the event occurring
• SIGNS & SYMPTOMS

• The patient may cough and splutter

• They may complain of difficulty breathing
• Breathing may become noisy with wheeze
(usually aspiration) or stridor (usually upper
airway obstruction)
• They may develop ‘paradoxical’ chest or
abdominal movements
• They may become cyanosed and lose
consciousness
• TREATMENT
• If any large piece of foreign material,
instrument or a tooth/ part of tooth have been
aspirated and the patient is symptomatic
following aspiration they should be referred to
hospital as an emergency for possible removal
with a bronchoscope
• If the patient becomes unconscious, CPR
should be started.