hypotension and hypertention emergencies in the dental office

Hypotension &

hypertension in

dentistry

Vahid malek hosseini

IN THE NAME OF GOD

The best way to handle an emergency is to be prepared.

Staff should be trained and frequently updated in first aid and

cardiopulmonary resuscitation procedures. A written

emergency plan should be available

Preparation for Emergencies

Obtain a medical history on

every patient and update it at

each visit.

When confirming

appointments, remind patients

to take their normal

medications on the day of

their appointment

All staff members should be

trained in basic first aid

procedures and basic life

support (CPR).

The office should have a

written emergency plan,

emergency telephone numbers

should be posted at each

phone.

Each office should have an

emergency kit readily

available and each staff

member should know where it

is located.

Health Assessment

One key to reducing risk is to take a health history and vital signs to

identify the “at risk” patient. In some cases, extensive procedures

on “at risk” patients might are best performed in a hospital setting

ABC off any emergency

Supine position

100 % Oxygen

Evaluate Airway,, breathing ,, circulation

Vitals

Temperature . Blood pressure . Pulse .

Respiratory rate

estimationIt has been estimated that one or two life threatening emergencies will occur

in the lifetime practice of a general dentist.

What types of emergencies can be

expected in the dental office?

Hypotension

Prevented by proper drug history before procedure

Management – maintenance of airway

- patient is made to lie down flat

- artificial ventilation if required

- medical help

13

hypotension

Following syncope it is the most common

cause off loss off consciousness in the Dental

office

Orthostatic Hypotension

postural

Most common cause off hypotension in the

dental office

It is Syncope when the patient is placed

quickly from a supine to upright position

POSTURAL /ORTHOSTATIC

HYPOTENSION

MANAGEMENT OF MEDICAL EMERGENCIES IN DENTAL PRACTICE - 60 16

Pt attains upright position

SBP falls =<60mm of Hg due to ANS response

failure

Cerebral blood flow<critical level

Loss of consciousness

Supination=revival

PATHOLOGY

Drugs

Prolonged

recumbency /

convalescence

Late stage

pregnancy

Varicosities

Addison’s Disease

Severe exhaustion

Shy-Drager

Syndrome

ETIOLOGY

شایعترین

Why Most likely in elderly ?

Aging decreases baroreflex mechanism

which impairs cardioacceleratory response

to preload reduction during upright posture

May be on medications Most susceptible

گروههای دارویی

پیشگیری

تاریخچه-1

معاینات بالینی-2

ایجاد تغییرات در درمان-3

معاینات بالینی برای تشخیصکاهش فشار خون وضعیتی

مالحظات دندانپزشکی

بیماران با سابقه کاهش فشار وضعیتی-1

حین درمان ارامبخش دریافت کرده اند-2

برای مدت طوالنی روی صندلی دندانپزشکی قرار گرفته اند-3

دو تا سه بار در دقیقه به حالت نشسته قرار بگیرند تا عادت کنند

case

عالئم

تهوع-تعریق-اختالل دبد-گیجی-رنگ پریدگی

از دست رفتن هوشیاری

شبیه به سنکوپ وازودپرسور و برخالف ان اینجا ضربان قلب باال میرود

Vasovagal hypotension

A vasovagal episode or vasovagal response or

vasovagal attack (also called neurocardiogenic

syncope) is a malaise mediated by the vagus

nerve. When it leads to syncope or "fainting", it is

called a vasovagal syncope, which is the most

common type of fainting.Vasovagal syncope more

commonly affects young adults.

Vasovagal Hypotension (syncope)

Initiated by stressful physical ,,

psychological or surgical stimuli ( coughing

pain,, gaging )

The impulses are transmitted directly to

the medula in area closely related to the

nucllei off the vagus nerve

Clinical sign and symptoms

Bradycardia results from Vagal stimulation

and parasympathetic tone

• Vasodilation results from diminished

sympathetic tone

Treatment

• Removing the initiating stimuli

• Trendelenburg position

• Oxygen

• Vitals

Routine treatment for a patient

with hypotension and inadequate

perfusion

Treatment

Place in Trendelenburg position

• Oxygen

• Vitals

• ABC

• Evaluate BP

( if no BP monitor present , remember palpate

pulse, correlated to a systolic of: Radial 80 mm

Hg , Brachial 70 mm Hg , Carotid 60 m Hg )

• Administer: Phenylephrine spray 0.25-0.5 mg IV

2-3mg IM , Ephedrine 10-25 mg IV

Sign and symptoms

Dizziness

Going towards syncope

route

Lay the patient flat as soon as possible and

raise the legs to improve venous return

Loosen any tight

clothing.

Hypertension Medical complex

42

Thank you