Common Emergencies in Dental Practice
The aim of The Dental Practice Emergencies website is to assist the dentist in the prevention and treatment of emergencies that may occur in the surgery.
(1) Fainting – syncope
(2) Respiratory obstruction.
(3) Respiratory arrest.
(4) Cardiorespiratory arrest.
(5) Fitting - convulsions.
(6) Shortness of breath - dyspnoea.
(7) Hypertensive response.
(8) Cardiac pain - angina pectoris.
(9) Anaphylaxis - allergy.
Assessment of Collapse
In all emergencies, it is important that no time is wasted.
Remain with the patient, ensure safety for the patient and the rescuer and call for help. Read more at www.queensheadcafebar.com.au
The first observation to make is whether the patient is conscious or unconscious. This may be done by shaking him by the shoulder, asking his name, and giving a simple command: 'Squeeze my hand. Let it go' - the response to 'Shake and Shout’.
The aim of The Dental Practice Emergencies website is to assist the dentist in the prevention and treatment of emergencies that may occur in the surgery.
(1) Fainting – syncope
(2) Respiratory obstruction.
(3) Respiratory arrest.
(4) Cardiorespiratory arrest.
(5) Fitting - convulsions.
(6) Shortness of breath - dyspnoea.
(7) Hypertensive response.
(8) Cardiac pain - angina pectoris.
(9) Anaphylaxis - allergy.
Assessment of Collapse
In all emergencies, it is important that no time is wasted.
Remain with the patient, ensure safety for the patient and the rescuer and call for help. Read more at www.queensheadcafebar.com.au
The first observation to make is whether the patient is conscious or unconscious. This may be done by shaking him by the shoulder, asking his name, and giving a simple command: 'Squeeze my hand. Let it go' - the response to 'Shake and Shout’.
If he is conscious, he will answer the spoken word and obey a shouted.
If the patient does not regain consciousness in a few seconds, he should be turned on his side, the airway should be opened with backward head tilt and jaw support, any vomitus or foreign material removed the breathing and pulse should be checked. If he is breathing, he is left lying on his side in the lateral position and his pulse and breathing checked after 1 minute and at least every 2 minutes. If he is not breathing, appropriate basic life support should be given.
Fainting - Syncope
Fainting is a very common occurrence. Apprehension and pain may result in a sudden fall of blood pressure and slowing of the pulse.
Warning signs consist of restlessness, pallor, coldness, sweating, sighing and vomiting. If the patient does not lie down, there will be loss of consciousness, depression of breathing and perhaps brief convulsive movements. If there is further delay and the patient is not placed in a horizontal position, cardiorespiratory arrest may occur.
Once in progress, this sequence of events takes place in a matter of 4-5 seconds. Recovery is usually rapid when the patient is horizontal: consciousness is regained, colour returns to the face, normal breathing returns and the pulse rate increases. If vomiting takes place, the patient should be turned onto his or her side and the vomitus wiped or sucked away. After recovery, the patient should not be moved for 10-15 minutes.
More serious emergencies may lead to a sudden fall of blood pressure and therefore present the appearance of fainting:
(a) Hypotensive side effects of sedatives, narcotics and tranquillisers.
(b) Toxic effects of local anaesthetics.
(c) Coronary occlusion.
(d) Anaphylactic shock.
In these dental emergencies, the pulse may be very rapid or very slow. Chest pain suggests coronary occlusion, and rashes and facial swelling suggest drug idiosyncrasy. Initial treatment is the same as for fainting; however, after the patient is placed in the horizontal position, recovery may not be as rapid as it is in simple fainting.
If the patient does not regain consciousness in a few seconds, the airway should be opened with backward head tilting and jaw support, and respiration and pulse should be checked. Appropriate basic life support should be given as indicated on page.
Respiratory Obstruction
Constant vigilance and meticulous attention to good technique will prevent respiratory obstruction. Failure to clear obstruction of the upper respiratory passages may lead to inhalation of foreign matter, hypoxia and cardiorespiratory arrest.
Signs
Causes
Depression of the mandible in the unconscious supine patient or during dental manipulations. Impaired protective laryngeal and pharyngeal reflexes due to administration of sedatives, narcotics, regional anaesthesia or general anaesthesia.
Treatment
Turn the patient on his side. Remove any foreign bodies, using suction if necessary. Put the head in maximum backward tilt with jaw support, or Elevate and protrude the mandible (jaw thrust). http://drugsindentistry.blogspot.com.au
If the patient does not regain consciousness in a few seconds, he should be turned on his side, the airway should be opened with backward head tilt and jaw support, any vomitus or foreign material removed the breathing and pulse should be checked. If he is breathing, he is left lying on his side in the lateral position and his pulse and breathing checked after 1 minute and at least every 2 minutes. If he is not breathing, appropriate basic life support should be given.
Fainting - Syncope
Fainting is a very common occurrence. Apprehension and pain may result in a sudden fall of blood pressure and slowing of the pulse.
Warning signs consist of restlessness, pallor, coldness, sweating, sighing and vomiting. If the patient does not lie down, there will be loss of consciousness, depression of breathing and perhaps brief convulsive movements. If there is further delay and the patient is not placed in a horizontal position, cardiorespiratory arrest may occur.
Once in progress, this sequence of events takes place in a matter of 4-5 seconds. Recovery is usually rapid when the patient is horizontal: consciousness is regained, colour returns to the face, normal breathing returns and the pulse rate increases. If vomiting takes place, the patient should be turned onto his or her side and the vomitus wiped or sucked away. After recovery, the patient should not be moved for 10-15 minutes.
More serious emergencies may lead to a sudden fall of blood pressure and therefore present the appearance of fainting:
(a) Hypotensive side effects of sedatives, narcotics and tranquillisers.
(b) Toxic effects of local anaesthetics.
(c) Coronary occlusion.
(d) Anaphylactic shock.
In these dental emergencies, the pulse may be very rapid or very slow. Chest pain suggests coronary occlusion, and rashes and facial swelling suggest drug idiosyncrasy. Initial treatment is the same as for fainting; however, after the patient is placed in the horizontal position, recovery may not be as rapid as it is in simple fainting.
If the patient does not regain consciousness in a few seconds, the airway should be opened with backward head tilting and jaw support, and respiration and pulse should be checked. Appropriate basic life support should be given as indicated on page.
Respiratory Obstruction
Constant vigilance and meticulous attention to good technique will prevent respiratory obstruction. Failure to clear obstruction of the upper respiratory passages may lead to inhalation of foreign matter, hypoxia and cardiorespiratory arrest.
Signs
- Noisy breathing.
- No escape of air from mouth and nose during exhalation.
- Laboured respirations.
- Cyanosis is a late sign.
Causes
- Tongue.
- Vomitus.
- Blood.
- Foreign body e.g. teeth, dental packs or appliances.
Depression of the mandible in the unconscious supine patient or during dental manipulations. Impaired protective laryngeal and pharyngeal reflexes due to administration of sedatives, narcotics, regional anaesthesia or general anaesthesia.
Treatment
Turn the patient on his side. Remove any foreign bodies, using suction if necessary. Put the head in maximum backward tilt with jaw support, or Elevate and protrude the mandible (jaw thrust). http://drugsindentistry.blogspot.com.au
Respiratory Arrest
Respiratory arrest may be:
Diagnosis
In respiratory arrest, there will be NO respiratory movement - and this condition must be distinguished from respiratory obstruction, which may lead to respiratory arrest if not corrected.
Management of Respiratory Arrest
Once respiratory arrest is suspected, the airway must be opened and ventilation commenced.
To clear the airway use:
(a) Posture - turn the patient into the lateral position
(b) Fingers, to scoop out vomitus.
(c) Suction.
(d) Percussion.
Opening of Airway Requires:
(a) Maximum backward tilt of the head and support of the jaw; if this is not successful:
(b) Elevation and protrusion of the mandible (jaw thrust).
Check for breathing by watching for the movement of lower chest and abdomen and listen and feel for the escape of air from nose and mouth.
With the use of these simple manoeuvres, breathing may commence spontaneously. If breathing commences, the patient should remain in the lateral position, facing the attendant, with continued protection of the airway by jaw support and maximum backward tilt, until consciousness is regained.
If breathing does not begin immediately a clear airway is obtained, the patient should be put on his back and given five full inflations within 10 seconds by expired air resuscitation (E.A.R.) (mouth to mouth or mouth to nose and the carotid pulse felt . If the carotid pulse is still present, continue expired air resuscitation at 15 inflations per minute until spontaneous breathing returns.
Check the presence of the carotid pulse by feeling in the groove between the sternomastoid and the trachea at the level of the cricoid cartilage. It the carotid pulse is absent, commence external cardiac compression (E.C.C.) while continuing expired air resuscitation.
Respiratory arrest may be:
- Primary respiratory failure, which may be due to:
- Drug overdose - narcotics or sedative.
- Respiratory obstruction - soft tissue obstruction by the tongue.
- Inhalation of foreign material, e.g. tooth fragments or fillings, blood, vomitus.
- Secondary respiratory failure, due to cardiac arrest.
Diagnosis
In respiratory arrest, there will be NO respiratory movement - and this condition must be distinguished from respiratory obstruction, which may lead to respiratory arrest if not corrected.
Management of Respiratory Arrest
Once respiratory arrest is suspected, the airway must be opened and ventilation commenced.
To clear the airway use:
(a) Posture - turn the patient into the lateral position
(b) Fingers, to scoop out vomitus.
(c) Suction.
(d) Percussion.
Opening of Airway Requires:
(a) Maximum backward tilt of the head and support of the jaw; if this is not successful:
(b) Elevation and protrusion of the mandible (jaw thrust).
Check for breathing by watching for the movement of lower chest and abdomen and listen and feel for the escape of air from nose and mouth.
With the use of these simple manoeuvres, breathing may commence spontaneously. If breathing commences, the patient should remain in the lateral position, facing the attendant, with continued protection of the airway by jaw support and maximum backward tilt, until consciousness is regained.
If breathing does not begin immediately a clear airway is obtained, the patient should be put on his back and given five full inflations within 10 seconds by expired air resuscitation (E.A.R.) (mouth to mouth or mouth to nose and the carotid pulse felt . If the carotid pulse is still present, continue expired air resuscitation at 15 inflations per minute until spontaneous breathing returns.
Check the presence of the carotid pulse by feeling in the groove between the sternomastoid and the trachea at the level of the cricoid cartilage. It the carotid pulse is absent, commence external cardiac compression (E.C.C.) while continuing expired air resuscitation.
Cardiorespiratory Arrest
Cardiopulmonary resuscitation is needed when, in acute collapse, a patient has suffered a cardiac arrest. Emergencies may be due to:
Diagnosis of cardiac arrest is dependent on three criteria. The patient is:
The management of cardiac arrest is the maintenance of:
The sequence must be as follows:
Correctly performed external cardiac compression (E.C.C.) provides only 30-50 percent of normal blood flow to the brain. This is sufficient to save life and to prevent brain damage, but there is no margin for any inefficiency.
Technique of External Cardiac Compression (E.C.C.)
The correct technique requires the following:
1. The upper end of the sternum.
2. The lower end of the sternum.
3. The midpoint of the sternum.
Cardiopulmonary resuscitation is needed when, in acute collapse, a patient has suffered a cardiac arrest. Emergencies may be due to:
- Primary cardiac failure:
- Coronary occlusion.
- Electrocution.
- Drug reaction (due to inadvertent intravascular local anaesthetic injection or anaphylaxis).
- Secondary to untreated hypotension.
- Primary respiratory failure:
- Respiratory obstruction.
- Inhalation of blood, teeth, dental material or vomitus.
- Drug overdose (e.g. sedatives, narcotics) causing respiratory depression.
Diagnosis of cardiac arrest is dependent on three criteria. The patient is:
- Unconscious.
- Not breathing.
- Has no carotid pulse.
The management of cardiac arrest is the maintenance of:
- Airway.
- Breathing.
- Circulation.
The sequence must be as follows:
- Place the patient flat (supine), the resuscitator kneeling alongside. If the dental chair does not recline, the patient will have to be placed on the floor.
- Turn the patient on to his side to clear the airway of vomitus or other foreign material, using fingers if necessary. If breathing does not recommence, turn the patient on to his back.
- Secure and maintain an unobstructed airway, using:
- Maximum backward head tilt.
- Jaw support or jaw thrust (mandibular protrusion).
- Ventilate the lungs with 5 full breaths (expired air resuscitation (E.A.R.)) - in 10 seconds - either the mouth to mouth or mouth to nose method may be used.
- Feel for the carotid pulse.
- If the carotid pulse is present, continue E.A.R. at the rate of 15 inflations per minute (1 every 4 seconds).
- If the carotid pulse is absent, commence external cardiac compression (E.C.C.) and continue E.A.R.
Correctly performed external cardiac compression (E.C.C.) provides only 30-50 percent of normal blood flow to the brain. This is sufficient to save life and to prevent brain damage, but there is no margin for any inefficiency.
Technique of External Cardiac Compression (E.C.C.)
The correct technique requires the following:
- The operator's body, hands and arms must be correctly positioned:
- Kneel at the side of the patient, as close as possible to his chest.
- Locate the correct compression site by identifying:
1. The upper end of the sternum.
2. The lower end of the sternum.
3. The midpoint of the sternum.