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Medical Emergencies
Medical Emergencies
MANAGEMENT OF
MEDICAL EMERGENCIES
Dr. Noorul Ain Arshad
Assistant professor
Oral and maxillofacial surgery deptt, MM&DC
Multan
PREVENTION
RISK ASSESSMENT
CONTINUING DENTAL EDDUCATION
TRAINED AUXILIARY STAFF
ESTABLISHING A SYSTEM TO GAIN READILY
activation
Dispersible aspirin 300mg
1.Fainting (vasovagal syncope)
Causes
Anxiety
Pain
fatigue
high temperature and humidity
Manifestations.
Tachycardia and palpitations, generalized warmth,
weakness or nausea
Dizziness and hypotension
Baradycardia
Loss of consciousness
pathophysiology
Anxiety Sympathetic stimulation
HYPERGLYCEMIA
Slow onset
HYPOGLYCEMIA Drowsiness/
Rapid onset disorientation
Irritability/aggression. Dry skin dry mouth
Moist sweaty skin Weak pulse
Pulse full and rapid Blood sugar raised
Blood sugar low Ketonuria
Acetone breath
hyperventilation
Management of hypoglycaemia
Terminate all dental procedures
Lay patient flat or head down the level of legs
Obtain blood sugar levels
If Patient conscious Administer glucose
source by mouth
monitor vitals
If no improvement or unconscious pt then
muscle contusions
Hyperventilation or psychogenic chest pain.
Clinical characteristics of acute chest pain
caused by Myocardial infarction
◦ Squeezing, bursting, pressing, burning, chocking,
or crushing
◦ Substernelly located with variable radiation to left
shoulder, arm, or left side of mandible
◦ Associated with exertion, heavy meal or anxiety
◦ Relieved by vasodilators or rest
Management
Terminate all dental procedures
Position the patient in semi-reclined position
Give nitroglycerin tablet sublingually
Give oxygen
Check blood pressure and pulse
If discomfort is relieved assume angina is
present
slowly taper oxygen over 5 mints. Modify
after TNG
◦ give third dose of TNG and monitor vital signs and
seek medical assistance
If discomfort relived than refer the patient for
further medical evaluation
If discomfort is still not relieved 3 mints after
TNG
◦ Assume myocardial infarction is in progress
◦ Give 352 mg of aspirin
◦ Start IV line and crystalloid solution at 30 ml per hour
◦ If severe discomfort, can titrate morphine sulphate 2
mg subcutaneously or intravenously every every 3
mints until pain is relived
◦ Prepare to transport and assess the need for BLS
If blood pressure ever falls below 90 systolic
or 50 diastolic, withhold TNG and Morphine.
Wait for the medical assistance
Hyperventilation
Frequent cause is anxiety
Complain of inability to get enough air and
position
Reassurance and anxiety reduction protocol
Have patient to breath into co2 enriched air,
diazapam10 mg or midazolam 5 mg IM or IV
slowly until patients calm down
ASTHMA
Reparatory problems caused by drug allergy are difficult
to differentiate from asthmatic attack and their
management and manifestations are similar
Manifestations of acute asthmatic attack
◦ Shortness of breath
◦ Wheezing is usually audible directly or with stethoscope
◦ dyspnea and tachycardia
◦ Coughing and anxiety
◦ In severe form
Intense dyspnea, with flaring of nostrils and use of accessory muscle
of mastication
Cyanosis of mucous membrane and nail beds
Flushing, anxiety and confusion
Minimal breath sounds on auscultation
Management of respiratory problems
◦ Terminate all dental treatment
◦ Position the patient in fully sitting position
◦ Administer bronchodilator by spray
◦ Administer oxygen
◦ Monitor vital signs
◦ If signs and symptoms still continue
Give epinephrine .3 ml of 1:1000 intravenously or
subcutaneously
Start IV line and drip of crystalloid solution
(30liter/hour)
Monitor vital signs
If signs and symptoms still not relieved
◦ Call for medical assistance
◦ Start theophylline 250 mg IV given over 10 mints
and hydrocortisone 100mg IV or equivalent
◦ Prepare to transport for emergency care facility
Chronic obstructive pulmonary
disease(COPD)
These patients depend on maintaining an
upright posture to breath adequately if in
spine position may lead to difficult breathing
Have high co2 and low PO2 in their blood
Patient
Patient remains
become conscious
unconscious