Emergency in Emergency in Dentistry: Part II Dentistry: Part II Hypersensitivity Hypersensitivity Chest discomfort Chest discomfort Respiratory difficulty Respiratory difficulty Altered consciousness Altered consciousness Metabolic problems Metabolic problems
Emergency in Dentistry: Part II. Hypersensitivity Chest discomfort Respiratory difficulty Altered consciousness Metabolic problems. Hypersensitivity Reactions. Type I: - immediate, acute and life- threatening - mediated primarily by IgE - PowerPoint PPT Presentation
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Emergency in Emergency in Dentistry: Part IIDentistry: Part II
Chest Discomfort:Chest Discomfort:--- AMI or angina pectoris--- AMI or angina pectoris
Pain patternPain pattern - Characteristics: squeezing, bursting, pressing, burning or choking - Location: substernum - Refer pain: L’t shoulder, arm, neck or mandible - Associated with exertion, anxiety - Relieved by vasodilator (ex. NTG) or rest - May accompanied by dyspnea, nausea& vomiting sensation, palpitation
1.1. Terminate all proceduresTerminate all procedures2.2. Semi-reclined positionSemi-reclined position3.3. Sublingual NTGSublingual NTG4.4. OO22
5.5. Check vital signsCheck vital signs
Still discomfort after Still discomfort after 3min3min
Still discomfort after Still discomfort after 3min3min
Still discomfort after Still discomfort after 3min3min
Discomfort Discomfort relievedrelieved
Give 2Give 2ndnd NTG NTG
Give 3Give 3rdrd NTG NTG
6. Assume angina pectoris was 6. Assume angina pectoris was presentpresent7. Slowly taper O7. Slowly taper O2 2 over 5minover 5min8. Modify dental treatment8. Modify dental treatment
Angina pectorisAngina pectoris
NTG NTG 0.6mg/tab0.6mg/tab
10. Assume myocardial infarction in 10. Assume myocardial infarction in progressprogress11. On IV line11. On IV line12. Prepare transport to ER12. Prepare transport to ER
6. Give Epi 0.3ml of 1: 1,000 I6. Give Epi 0.3ml of 1: 1,000 IMM or SQor SQ7. Build up IV line7. Build up IV line8. Monitor vital signs8. Monitor vital signs
9. Prepare to ER9. Prepare to ER10. Add steroid therapy10. Add steroid therapy
6. Monitor of recovery 6. Monitor of recovery statestate7. Consult physician7. Consult physician
S & S not S & S not relievedrelieved
AsthmaAsthma
Manifestations of Manifestations of Hyperventilation Hyperventilation Syndrome:Syndrome:
NeurologicNeurologic - dizziness - tingling or numbness of fingers, toes or lips - syncope
RespiratoryRespiratory - increased rate & depth of breaths - SOB - chest pain - xerostomia
Manifestations of Manifestations of Hyperventilation Hyperventilation Syndrome:Syndrome:
If absent:If absent:4. Start BLS4. Start BLS5. Prepare to ER5. Prepare to ER6. Consider other 6. Consider other cause cause
If present:If present:4. Ammonia under nose4. Ammonia under nose5. Monitor vital signs5. Monitor vital signs6. Plan anxiety control at next 6. Plan anxiety control at next visit visit
Vasovagal syncopeVasovagal syncope
Atropine 1mg/ampAtropine 1mg/ampUsed in severe Used in severe bradycardiabradycardiaNot exceed 2mgNot exceed 2mg
Manifestations of Seizure Manifestations of Seizure Attack:Attack:
Isolated, brief seizure - tonic-clonic movement of trunk & extremities - loss of consciousness - vomiting - airway obstruction - loss of urinary & anal sphincter control
Repeated or sustained seizure (status epileptics)
After seizure After seizure attackattack
1.1. Place on side and Place on side and suction airwaysuction airway