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ACTA Acta stomatol Croat. 2016;50(1):72-80 .
STOMATOLOGICA DOI: 10.15644/asc50/1/10
CROATICA PREGLEDNI RAD
www.ascro.hr REVIEW

Dubravka Negovetić Vranić1, Josipa Jurković2, Jesenka Jeličić3, Antonija Balenović4, Gordana Stipančić5, Ivana Čuković-Bagić1

Hitna stanja u dječjoj stomatologiji

Medical Emergencies in Pediatric Dentistry
1
Zavod za dječju i preventivnu stomatologiju Stomatološkog fakulteta Sveučilišta u Zagrebu, Hrvatska

Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, Croatia
2
Privatna ordinacije dentalne medicine, Zagreb, Hrvatska

Private dental office, Zagreb, Croatia
3
Dom zdravlja Zagreb – Istok, Zagreb, Hrvatska

Health Center Zagreb – East, Zagreb, Croatia
4
Dom Zdravlja Zagreb – Centar, Zagreb, Hrvatska

Health Center Zagreb – Center, Zagreb, Croatia
5
Katedra za pedijatriju Stomatološkog fakulteta Sveučilišta u Zagrebu, Hrvatska

Paediatric Department, School of Dental Medicine, University of Zagreb, Croatia

Sažetak Zaprimljen: 1. veljače 2016.
Hitna stanja opasna za život mogu se dogoditi, i događaju se, i u ordinaciji dentalne medicine. Mogu Prihvaćen: 5. ožujka 2016.
nastati zbog komplikacija osnovne bolesti i kao reakcija na lijekove koja može biti alergijska i toksič-
na. Najčešće toksične reakcije uzrokuju lokalni anestetici, a alergije se pojavljuju uglavnom pri pri- Adresa za dopisivanje
mjeni antibiotika, najčešće penicilina. Kao reakcija na stres najčešće nastaje vazovagalna sinkopa. doc. dr. sc. Dubravka Negovetić Vranić
Ostali uzroci mogu biti povezani s osnovnom bolesti određenog sustava (akutni astmatski napadaj, Sveučilište u Zagrebu
dijabetička ketoacidoza, hipoglikemija, epileptički napadaji itd.), ili su nesretni slučajevi (aspiracija Stomatološki fakultet
stranog tijela, što uzrokuje opstrukciju dišnog sustava). Za sve navedeno propisane su smjernice ko- Zavod za dječju i preventivnu
je je potrebno znati. Ako nastanu komplikacije, a ne poduzmu se potrebne mjere, može se dogoditi stomatologiju
zastoj srca ili prestanak disanja pa je potrebna kardiopulmonalna reanimacija. Sve postupke i doze Gundulićeva 5, 10000 Zagreb
nužno je prilagoditi dobi djeteta. Tel.: 01/4802-110
dnegovetic@sfzg.hr

Ključne riječi
dječja stomatologija; hitni postupci;
prva pomoć; maske; reanimacija

Uvod Introduction
Hitna stanja opasna za život mogu se dogoditi, a i doga- Life threatening emergencies can occur in the dental of-
đaju se, i u ordinaciji dentalne medicine. U dostupnoj litera- fice. Most recommendations for treatment of emergencies
turi većina preporuka za njihovo tretiranje odnosi se na odra- which can be found in the recently published literature refer
sle pacijente (1). No kako djeca nisu odrasle osobe u malom, to adult patients (1). Since children are not miniature adults,
postupke je potrebno prilagoditi (2). Preporuke za liječenje it is necessary to adapt the approach (2). Recommendations
hitnih stanja kod djece nisu dovoljno obrađene. for treating emergencies in children have not yet been suffi-
Doktor dentalne medicine trebao bi obaviti svaki svoj ciently addressed.
zahvat tako da se ne dogode nepotrebne komplikacije. No A dentist should perform each procedure in a way to
kako bismo spriječili komplikacije ili ih barem ublažili, po- avoid unnecessary complications. To prevent or reduce com-
trebno je detaljno proučiti anamnezu, doznati sve o djeteto- plications, it is necessary to take a detailed medical history,
vim prijašnjim i sadašnjim bolestima te se, ako je potrebno, document all of the child’s previous and current diseases,
konzultirati s njegovim liječnikom. Katkad je nužna preme- and, if necessary, consult with the referring general practi-
dikacija. Ako dijete boluje od neke teže bolesti zbog koje bi tioner (GP) or pediatrician. Sometimes it can be necessary to
se tijekom zahvata mogle pojaviti komplikacije koje ugro- administer premedication. If a child suffers from a serious ill-
žavaju život, zahvat se odgađa i poslije obavlja u bolničkim ness, which could lead to life-threatening complications dur-
uvjetima (1). ing the procedure, the surgery should be postponed and per-
www.ascro.hr

Razlike između djece i odraslih očituju se u veličini i obli- formed in a hospital setting (1).
ku tijela, u težini, te u kognitivnim sposobnostima i emotiv- Differences between children and adults are reflected in
noj zrelosti, ali važne su i razlike u fiziologiji njihova orga- the size and shape of the body along with emotional and cog-
nizma – dišnoga i kardiovaskularnoga te imunosnog sustava. nitive maturity, but differences in physiology, such as the re-

represented by the lack of pulse. which are per- prsne kosti izbjegavajući kompresiju ksifoidnog nastavka. bol u slučaju angine pektoris ment. Cardiac arrest is the sudden stopping of the heart. mg in tablets. so that oxygen in the inhaled air is not spasilac siguran da palpira bilo i njegovu frekvenciju višu od derived from his or her own lungs. manifested as a feeling of tightness and an inability to breathe Terapija: potrebno je prekinuti stomatološki zahvat i po. ramena i ruke (slika 4. ipak je najčešće ratory or circulatory failure. sublingually and to stop the pain of angina pec- kt miokarda i dok čekamo hitnu pomoć pacijentu treba dati toris. ako bila nema. avoid- mom od 15 vanjskih masaža srca i dva upuha zraka. rescuer should take a deep breath and supply air to the vic- kom u udahnutom zraku ne bi koristila njegova pluća). oxygen. srednjak i prstenjak. lower jaw.). djece do puberteta. and can be kao osjećaj stezanja i nemogućnost disanja (6).4 će prestati. rit­ formed in children over the lower half of the sternum. while waiting for an ambulance (7.) te orofaringealnoga (slika 2. a može se manifestirati neck. the efficiency is not metodom. 8).hr Pri vanjskoj masaži srca malog djeteta (slika 6. administer dose of nitroglycerin 0. (6). portant.) zamisli. of the size of the tongue in relation to the oral cavity. a odraslima konkavitetom prema nepcu do me. which must be properly select- Orofaringealni tubus (slika 3. a starija djeca i adolescenti oživljavaju se this procedure for reviving children with a rhythm of 15:2 ap- istim postupkom kao odrasli (2). te crtu koja spaja njegove bradavice i položite na prsni koš The procedure for external cardiac massage in a small child tri prsta: kažiprst. i tablica 2. Iako srčani zastoj kod djeteta može biti posljedi.ascro. treba nastaviti s umjetnom ventilacijom do do. ing or has agonal breathing at times. in the respiratory system. adequate. The procedure should Postupak oživljavanja ritmom 15 : 2 primjenjuje se kod consist of 15 external cardiac massages and two breaths of air. Cardiac arrest in children may be a consequence of respi- ca respiratornoga ili cirkulacijskog zatajenja. and because cijenta (5). Treatment: it is necessary to discontinue dental treat- troglicerina u obliku tableta. razlikuju se od onih za odrasloga pa. Negovetić Vranić et al.) i pet pu. 4). Rotation is not recommended for children kao i tehnike aplikacija. The dos- age of medication to be used in emergency situations. if there is no pulse. before each breath of air the udahnuti i upuhnuti zrak žrtvi što je prije moguće da se kisi. if the pain persists. Srčani zastoj Cardiac arrest Zastoj srca nagli je prestanak rada srčane crpke. Therapy: if the child is not breath- vremeno teško diše: treba otvoriti dišni put (slika 5. cardiovascular. tako npr. 8). ble 2) or endotracheal tubes. call an ambulance. The pharmacokinetics of drugs in the body of the Oprema koja se koristi mora biti prilagođena dobi paci. The equipment used must be adapted to the patient’s ka 1. ako je tim as soon as possible. It is ki ga obilježavaju nemogućnost palpacije bila. i tablica 1. ppm. he or she should continue with artificial ventilation un- skom masažom srca. Klinič. cardial infarction. olescents receive the reviving procedure similarly to adults (2). dati pacijentu sublingvalno 0. do. open the airway (Figure ta upuhnuti zrak (prije svakog upuha spasilac treba duboko 5) and apply five breaths of air. the palpable pulse frequency of the patient is greater than 60 laska kvalificirane pomoći. koga nepca i laganom rotacijom za 180° postavlja na mjesto. shoulders and arms (Figure 4). jenta. are different from those of an adult patient (5). Kažiprst mora biti tik is as follows (Figure 6): imagine a line that connects the nipples .) age. postoje različite veličine maski za disanje (sli. tube in adults in which the tube is concavely applied to the nu koji se pri uvođenju tubusa kontrolira špatulom. Ishemijske bolesti srca Ischemic heart disease U ishemijske bolesti srca ubrajaju se angina pektoris i in. child must also be taken into account (3. gubitak svije. možemo posumnjati na infar. Simptomi: nagla retrosternalna bol koja se širi u vrat. and immune systems. Symptoms: sudden retrosternal pain that radiates to the nju čeljust. Ischemic heart disease includes angina pectoris and myo- farkt miokarda.) djeci se uvodi direktnom ed because if the size is not adequate. til the arrival of qualified assistance. it into position. a ako ne prestane. myocardial infarction must be sus- 325 mg aspirina te prema potrebi kisik (7. Medical Emergencies 73 Mora se uzeti u obzir i razlika u farmakokinetici lijekova u spiratory. for example there are different sizes of breathing masks i endotrahealnog tubusa koji moraju biti ispravno odabrani (Figure 1 and Table 1) and oropharyngeal (Figure 2 and Ta- kako bi bili učinkoviti. although usually the problem is problem u dišnom sustavu. loss of consciousness and ap- sti i apneja. as opposed to the way of applying the dišnih putova te zbog veličine jezika u odnosu na usnu šuplji. because of the delicate structure of their airway. he Djeci se vanjska masaža srca obavlja iznad donje polovine or she should begin with chest compressions. if necessary. zvati hitnu pomoć. ing compression of the zyphoid bone. An oropharyngeal tube (Figure 3) should be introduced Ta se rotacija ne preporučuje kod djece zbog nježne strukture directly in children. if the rescuer is sure that 60 u minuti. whereas older children and ad- www. plies to children up to puberty. Terapija ako dijete ne diše ili po. palate to reach the soft palate and then rotated by 180° to put Doziranje lijekova prijeko potrebnih u hitnim stanjima.4 mg ni. pected and the patient given 325 mg aspirin and. nea. treba početi s vanj. as well as the application techniques. are also im- djetetovu organizmu (3. 4).

te ponavljati dozu svakih with one dose containing 40 g of glucose. administer saline at a Terapija: prvi sat ili dva davati od 10 do 20 mL fiziološke dose of 10–20 ml/kg body weight. During the massage. Put the following three fingers on the chest: index. the accumulation of ketones and the development taboličke acidoze. the instructions shown in Figures 5 and 6 must be followed. pacijent može izgubi. tes but can also develop in patients who do not have diabetes. nakon dva sata takve te. palpitations. chocolate). with the two remaining fingers. i 6. headache. comfortable position (usually this means to sit up straight). Therefore. zrak te počnite s masažom pritiskom na sternum s preostala third and fourth finger. Hypoglycemia is a condition of low blood glucose levels. Treatment: in the first hour. rapije uključiti intravensku nadoknadu inzulina (9). konvulzije i blje. obra. sciousness. hunger. a može se pojaviti i poremećaj svijesti. nausea. venously over 2–3 minutes (10). a može se pojaviti i kod It represents the most common acute complication of diabe- pacijenata koji nemaju tu bolest. give oral carbo- oralno (šećer otopljen u vodi. sweat- nje. If obstruction persists it can cause ti svijest. Podignite kažiprst u of a child. of breath and cyanosis. 7): feel with the middle finger the zyphoid bone and place že laktovi moraju biti ispruženi. disturbances of consciousness. red mučnina. anksioznost. cijanozom i inspiracijskim stridorom. glavobolja. nakupljanjem ketona i razvojem me. vulsions and pallor (4). polifagija. weakness. resulting in high hyper- kom hiperglikemijom. shortness i cijanoza.) opipajte sred. pacijenta smjestiti u nje. otežano disanje ness of breath. Symptoms: obstruction of Simptomi: opstrukcija gornjih dišnih puteva klinički se the upper airways is clinically manifested by coughing. hydrates (sugar dissolved in water. glad. and the smell of acetone. Zato je kod vanjske masaže srca nužno slijediti upu. Ksifoidni nastavak može se the index finger on the sternum. Symptoms: tremor. vomiting. Diabetic ketoacidosis can develop in patients with an ab- lutnim ili relativnim nedostatkom inzulina i rezultira viso. . for external cardiac massage. Repeat the dose ev- 10 minuta dok simptomi ne nestanu. glycemia. simptomi. Simptomi: polidipsija. šća akutna komplikacija dijabetesa. hyperventilation. jedna porcija sadržava 40 g glukoze. miris face. dati 1 ery 10 min until symptoms disappear. a u anosis and inspirational stridor. povraćanje. then put hands on the ster- lako slomiti pod izravnim pritiskom. it can lead to disorders of con- daha po acetonu. Akutna respiracijska insuficijencija zbog opstrukcije Acute respiratory insufficiency resulting from dišnih puteva obstruction of the airways Mogu biti opstruirani gornji i donji dišni putovi. anxiety. Dijabetička ketoacidoza Diabetic ketoacidosis Dijabetička ketoacidoza razvija se kod bolesnika s apso. a to može izazvati obil. Ako pod prstenjakom osjetite ksifoidni nastavak. hiperventilacija. orange juice. while in the lower respira- slučaju opstrukcije donjih dišnih puteva prisutni su kašalj. num to the point you had touched with the index finger and no unutarnje krvarenje zbog rupture jetre i drugih unutarnjih start the massage. Simptomi: tremor.expiratory wheezing. umor. inspiracijsko-ekspiracijski stridor. loss of consciousness. ed.ascro. and de- sno o tome gdje je uzrok opstrukcije pojavit će se različiti pending upon where the cause of the obstruction occurs. poremećaji svijesti. Upper and lower airways can be obstructed. and after 2 h of this treat- otopine po kilogramu tjelesne težine. Hipoglikemija Hypoglycemia Hipoglikemija je niska razina glukoze u krvi. solute or relative insulin deficiency. cough is present along with short- www. na sternum. a ovi. Hitna stanja uz zamišljenu crtu koja spaja bradavice. opća slabost. ment. cy- očituje kašljem. polyuria. the elbows are extend- organa.hr gušenje. imaginary line that joins the nipples. move the little finger towards the imaginary line. which may cause profuse internal bleeding because of rupture of the liver and other internal organs. con- dilo (4). tory tract obstruction. The index finger should be close to the dva prsta. The zyphoid bone can be easily broken under direct pres- te na slikama 5. of metabolic acidosis. To je najče. place the patient in a mu udoban položaj. If the fourth fingers feel the zy- njim prstom ksifoidni nastavak i položite uz njega kažiprst phoid bone. the air and start massaging by putting pressure on the sternum Pri vanjskoj masaži srca djeteta (slika 7. Tijekom masa. different symptoms will appear. zatim položite dlan na sternum uz točku koju Procedure for external cardiac massage in a child (Figure ste dodirivali kažiprstom te počnite masirati. mg glucagon intramuscularly or 50 ml of 50% dextrose intra- travenski tijekom dvije do tri minute (10). polyphagia. Raise the index finger in pomaknite malo prste prema zamišljenoj crti. palpitacije. čokoladice). a ako opstrukcija potraje. zažareni obrazi. Treatment: stop all procedures. Terapija: prekinuti sve zahvate. Symptoms: polydipsia. najčešće to znači uspravno sjediti. znoje. sok od naranče. if not effective.74 Negovetić Vranić i sur. titi pozornost na disanje i cirkulaciju. dati ugljikohidrate pay attention to breathing and circulation. give 1 mg glukagona intramuskularno ili 50 mL 50 % dekstroze in. include intravenous insulin (9). sure. poliurija. ing. ako ne djeluje. inspiratory . fatigue.

then chest compression is required (4). do the following: first proceed with 5 strokes on the leđima (slika 8. potrebna je krikotire.). the treatment of obstruction than any other external process. Položaj orofaringealnog tubusa Figure 3 Location of oropharyngeal tube Slika 4. so when the child cannot talk. the obstruction is not ejected with the above treatment proce- dures. pet puta se pri. Orofaringealni tubusi po Guedelu. jednu šaku stavi na njegov tr. encourage the child tani kašalj učinkovitiji u terapiji opstrukcije od bilo kojega to do so. Medical Emergencies 75 1 2 3 4 Slika 1. Treatment: If the child is coughing. kom navedenih terapijskih postupaka. . Otvaranje dišnih puteva naginjanjem glave i podizanjem brade Figure 5 Opening of airways by tilting the head and lifting the chin Slika 6. Vanjska masaža srca kod većeg djeteta Figure 7 Chest compressions in an older child 5 6 7 Terapija: ako dijete kašlje. a ako nema znakova cirkulacije potrebna je i vanj. Ako dijete izgubi svijest i ne diše potrebno ga je strongly press against the child’s belly and move upwards). back with an open palm (Figure 8). treba ga potaknuti jer je spon. Intervenira se kad kašalj postane neučinkovit. ako se opstrukcija ne riješi. if the obstruction is not mjenjuje Heimlichov zahvat (slika 9. if ventilirati. navel while the palm of the other hand holds the fist as they buhu i gore. Negovetić Vranić et al. it is necessary to perform a tracheotomy (11). a dlanom druge ruke obu. cry or breathe between ti: najprije se primjenjuje pet udaraca otvorenim dlanom po coughs. resolved. a ispod ksifoida. a to znači Interventions are needed when coughing becomes ineffec- kad dijete između kašlja ne može govoriti. plakati ili udahnu. vidi Tablicu 2 Figure 2 Oropharyngeal Guedel tubes. Širenje retrosternalne boli Figure 4 Spreading of retrosternal pain Slika 5. If there are no signs of circulation. Maska za disanje Figure 1 Breathing mask Slika 2. sizes marked by colors. Vanjska masaža srca kod malog djeteta Figure 6 Chest compressions in a young child Slika 7. ako se objekt opstrukcije ne izbaci tije. If the object causing otomija (11). ing behind the victim and clasping his hands. needs to be ventilated. one hand is buh iznad pupka. because a spontaneous cough is more effective in drugog vanjskog postupka. made into a fist and placed on the child’s abdomen above the hvati šaku prve ruke te tada obje snažno pritisne prema tr. tive. see Table 2 Slika 3.hr ska masaža srca (4). the child becomes unconscious and is not breathing. the child www. apply the Heimlich maneuver (Figure 9) five times Heimlichov zahvat obavlja se tako da terapeut stane iza (the Heimlich maneuver is performed with the rescuer stand- djeteta i obuhvati ga rukama.). veličine označene bojama.ascro.

thumb and middle finger 3. Pacijent u bočnom položaju Figure 11 Site of vertical incision Figure 15 Patient in the lateral position Postupak krikotireotomije: Tracheotomy procedure: 1. www. Determine the location of the section (Figure 10) a. locate the hyoid bone b. palcem i kažiprstom obuhvatiti podjezičnu kost A. spustiti prste još niže i opipati krikoidnu hrskavicu C. which is located exactly in the middle. Pass the index finger over the cricothyroid membrane. između palca i srednjeg prsta. Make a vertical incision in the thyroid cartilage to the cri- nantnim prstom. i 11. Klonička faza Figure 10 Determination of vertical incision Figure 14 Clonic phase Slika 11.) 1. Odrediti mjesto vertikalnog reza (slika 10. 2. Napraviti vertikalnu inciziju od tiroidne do krikoidne hr. Heimlichov zahvat Slika 13. Hitna stanja 8 9 10 11 12 15 13 14 Slika 8.hr 2. Mjesto vertikalne incizije Slika 15. Place the fingers even lower and locate the cricoid car- d. coid (Figures 10 and 11) . between the skavice (slika 10. B. položiti kažiprst na krikotiroidnu membranu koja se tilage nalazi točno na sredini.76 Negovetić Vranić i sur. D. Move the thumb and middle finger down to feel the skavicu thyroid cartilage c. Određivanje mjesta vertikalnog reza Slika 14.ascro. Tonička faza Figure 9 Heimlich maneuver Figure 13 Tonic phase Slika 10. Udaranje po leđima otvorenim dlanom Slika 12. With a thumb and forefinger. Unutar reza palpirati krikotiroidnu membranu nedomi. spustiti palac i srednji prst niže i opipati tiroidnu hr. Pacijent u Trendelenburgovu položaju Figure 8 Hitting the back with the open hand Figure 12 Patient in the Trendelenburg position Slika 9.).

has cold obično kaže da mu nije dobro. 14). patient gradually returns to consciousness. which results from a sudden.). Medical Emergencies 77 4. along with increased respi- sti. continence may occur because of relaxation of the sphincter Terapija: odmaknuti od pacijenta sve instrumente i izva. Treatment: immediate treatment be- Terapija: hitno liječenje počinje primjenom inhalacije ß. Epileptički napadaj (grand mal) Epileptic seizure (grand mal) Napadaju može prethoditi aura (preiktalna faza) koja se The attack may be preceded by aura (postictal phase). tion of muscles. Zbog relaksacije sfinktera može se dogoditi uri. u slučaju teškoga akutnog napadaja indicira. Akutni astmatski napadaj Acute asthma attack Astma je kronična upalna bolest cijeloga respiratornog Asthma is a chronic inflammatory disease of the entire sustava kod osoba s alergijskom dijatezom. and blood may be visible. becomes irregular. dilatacija. (17). which leads to loss of consciousness. the duration of syncope is short and lasts koliko minuta. the clonic phase occurs. tacks. najviše 0. findings are extended and difficult-expiration. which is characterized by contraction lokupne muskulature (slika 14.03 ml/kg of a 1:1000 solution. expiratory whistle (12). pojačana respiracija. a pacijent se može tije. Then. muscularly or subcutaneously (13. reduction in the delivery of blood to the brain. pacijentu bez svijesti dati od and can be given a sweet drink to prevent hypoglycemia. breathing becomes normal and the vraća svijest. U postiktalnoj fazi disanje postaje normalno i postupno se 2–5 min. Zatim slijedi klonička faza za koju je svojstveno grčenje cje. nom i tu se pojavljuje gubitak svijesti. administration of epinephrine is indicated at a dose of na je primjena adrenalina intramuskularno ili subkutano.01 mL/kg otopine 1:1000.). a ration. occurs. u fizikalnom statusu najvažniji nalaz je lematic breathing. s gubitkom svijesti disanje postaje nepravilno i plitko. Sinkopa Syncope Sinkopa je kratkotrajni reverzibilni gubitak svijesti i po. hladni znoj.ascro. transient difuznog poremećaja moždane funkcije zbog naglog smanje. a uglavnom se is manifested as a change in one of the senses. administered intra- 0. followed by tonic contrac- cije muskulature koje traju od 10 do 20 sekundi (slika 13. može se u bukalnu brazdu utrljati med ili za. Može se pojaviti i pjena na of the whole musculature (Figure 14). bljedilo. respiratory system in patients with allergic diseases.14). turns pale and usually says that he or she is not well. Foaming at the mouth ustima zbog miješanja zraka i sline. this phase lasts for ta. spustiti stolac što patient and remove everything from the mouth that is there at . Ova faza traje dvije do pet minu. gins with the inhalation of beta-agonists (salbutamol). which takes 10 to 20 sec (Figure 13). Sljedeća faza naziva se iktal. the most significant produljeni i otežani ekspirij. it is indicated to give 36–50% muskularno. 3. čujno zviždanje toms: dyspnea. ako osoblje nije osposobljeno za injiciranje lije. pacijentu pri svijesti može se dati slatki napi. Aura mainly oc- kod određenog pacijenta pojavljuje na isti način prije svake curs in the same way in a given patient before each attack and epizode i traje nekoliko sekundi. from a few seconds to a few minutes. Urinary or fecal in- www. i to 0. no oprezno da ne bi došlo do aspiracije (16). bite themselves during the clonic contractions and injure soft traoralno pa može i krvariti. In 36 do 50 % otopine glukoze intravenski ili glukagona intra. the patient may kom kloničkih kontrakcija ugristi i ozlijediti meka tkiva in. Simptomi: zbunjenost. sinkopa traje kratko – od nekoliko sekundi do ne. the staff are not trained to inject drugs or there are not any slađeni napitak. and diffuse disorder of brain function resulting from a sharp nja dotoka krvi u mozak. sition (Figure 12). a bi. which agonista (salbutamol) koji će biti dovoljan ako je u pitanju will be sufficient if the problem is a mild attack. Symp- Simptomi: dispneja. the blood pressure drops and the pulse is weak (15). disorientation and loss of consciousness. it is possible to rub honey or a sweet drink in the buccal fold taking care to avoid aspiration (16). Syncope is a short-term reversible loss of consciousness sturalnog tonusa koji nastaje u slučaju nagloga.).3 mL. Terapija: postavite pacijenta u Trendelenburgov položaj Therapy: if the patient is placed in the Trendelenburg po- (slika 12. pupillary dilation appears. medications available. prolaznoga i and postural tonus. The next phase is termed the ictal phase. Treatment: move all of the instruments away from the diti sve što mu je u tom trenutku u ustima. stezanje u prsima. Učiniti vodoravni rez kroz membranu. glucose solution intravenously or intramuscular glucagon. pacijent Symptoms: the patient shows signs of confusion. Negovetić Vranić et al. dezorijentacija i gubitak svije. Make a horizontal incision through the membrane and turn the blade to expand the cut. zatim toničke kontrak. s mnogo ekspiratornih zviždu. which očituje kao promjena u jednom od osjetila. finger 4. shallow and may be absent.hr narna ili fekalna inkontinencija (17). the patient is conscious tak da se spriječi hipoglikemija. tlak pada. if kova ili ih nema. patients who are unconscious. daje se (13. can occur because of mixing of air and saliva.01 to 0. in severe at- blagi napadaj. chest tightness. bradycardia lo je slabo (15). with a marked ka (12). lasts a few seconds. feel the cricothyroid membrane with the Okrenuti oštricu (proširiti rez). poslije se pojavljuje pupilarna sweat. audible wheezing or prob- ili sipljivo disanje. For physical status. In this section. breathing može i izostati pa se pojavljuje bradikardija. In the last stage. tissue intraorally. Later.

perioral www. eritem i svrbež. do not allow the patient to bude potpuno pri svijesti. Kada exposure to the antigen. call an ambulance. high blood pressure. ja. gastrointestinal. provjeriti Treatment: place the patient in a supine position. the patient is required to go home ac- companied by his or her parents (18). lower the seat as close to the floor as possible. dysrhythmia.hr Terapija: adrenalin (ampule adrenalina pakiraju se u and intraoral sites and on the extremities) (26. then the clonic phase lasts less than one minute. 27). it is necessary to ensure the supply of klonička faza traje kraće od jedne minute. gas- kožni i mukozni znakovi (urtike. disanje i protok zraka. 25). a za razvoj akut. glavobolja. the moment. pnea and whistling sound. leave the clinic until the level of consciousness is fully restored. at a few hours to several days) Simptomi: raspiratorni (kašljanje. Anaphylactic reactions occur because of antigen . 21). If dotok kisika. pneja i zvuk zviždanja. measure the duration of the seizure. perform a brief examination of the oral cavity to establish the te kući obvezno u pratnji roditelja (18). if any phase lasts longer than ti hitnu pomoć (24. during which the mast cells and ba- mastociti tijekom reekspozicije reagiraju s antigenom. the pa- grčevi. pacijent ulazi u acidozu zbog zadržavanja CO2. check cirkulaciju. ortostatska hipotenzija i šok). thetics (19). a latent period occurs after liziraju mastociti i bazofili i ponovna reeksponiranost. 23). two minutes and the patient is not breathing. 27). cutaneous and mucosal signs (rash. zujanje ache.ascro. Hitna stanja niže. patient should lie on their side to reduce the possibility of as- ka 15. visok broj otkucaja i fre. the patient enters aci- obvezno je osigurati dišni put i normalno disanje. sinkopa. doza za djecu je 0. vomiting and se obično pojavljuje periorbitalno.01 Therapy: Adrenaline (epinephrine vials are diluted at a mL/kg tjelesne težine. sophils are sensitized and exposure to the antigen takes place. mučnina.). Reakcija mo. angioedem trointestinal (cramps. ako napadaj traje du. perioralno. ako nije osiguran oxygen. nystagmus. syncope. dezorijentiranost. abdominal pain. omjeru 1:1000 i u količini od 1 mL. loss of consciousness. pacijenta nemojte obuzdavati ili stavljati mu prste u piration of secretions or dental materials in the mouth (Figure usta i obvezno mjerite trajanje napadaja. 25). dia. tinnitus. if a seizure kg diazepama IV. podrhtavanje li. reactions. lasts longer than 5 minutes or frequent seizures occur. dis. ste ustanovili ima li novonastalih ozljeda te pacijenta otpusti. the dose for chil- . existence of new injuries. Uglavnom nastaju zbog prebrze apsorpcije lijeka u tion of the drug into the blood stream. Such a re- riječ o zakašnjeloj reakciji. do not restrain the patient or put your fingers into the pa- od tri minute. the nost aspiracije sekreta ili dentalnih materijala u ustima (sli. dizziness. nerazgovijetan govor. Terapija: pacijenta postaviti u ležeći položaj. nistagmus. povraćanje i proljev). vrtoglavica. znači ako dijete ima 20 kg. latentno raz. abdominalna bol. angioedema usually occurs at periorbital. broj otkucaja i system and experiences a reduction in blood pressure. povišen krvni tlak. Symptoms: confusion. overdosing and in- krvotok. For the development of acute anaphylactic imunosnog sustava formacijama IgE antitijela. if the sei- lje od pet minuta ili su napadaji učestali. pozovite hitnu pomoć. bronchospasm). chest tightness. palpitations. injicirajte 0. if the patient exhibits ton- ko-kloničke grčeve. disritmija. circulation. Anafilaktična reakcija Anaphylactic reaction Nastaje zbog reakcije antigen – antitijelo. nausea. tahikardi. admin- Nemojte dopustiti pacijentu da napusti ordinaciju dok ne ister 0. rate and respiratory rate (22). stezanje u prsima. be sure to secure the airway koja faza traje dulje od dvije minute i pacijent ne diše. ako je napadaj dulji 15). Toxic reactions Toksične reakcije The most common cause of toxic reactions is local anes- Lokalni anestetici najčešći su uzrok toksičnih reakci. gubitak svijesti. after exposure to an allergen. and form IgE antibodies. prva faza je ekscitacijska. a že nastati za nekoliko sekundi. call an ambu- lance (24. potrebno je osigurati dotok kisika – tada ic-clonic convulsions.anti- ne anafilaktične reakcije potrebna je antigenska stimulacija body interaction. ca i ekstremiteta. ako bilo dosis because of CO2 retention. između nekoliko sati do nekoliko action can develop between a few seconds and several hours dana nakon ekspozicije alergena. pruritus. and allow for normal breathing. pozva. nju se otpuštati histamini i vazoaktivni amini. tonic- u ušima. heart frekvencija disanja (22. doza adre. pregledajte usnu šupljinu kako bi. orthostatic hypotension and shock). ali i za nekoliko sati ili. (or if it is a delayed reaction. tachycar- ni (grčevi. intraoralno i diarrhea).25 mg/ zure lasts more than 3 minutes.78 Negovetić Vranić i sur. disorientation. rapid heartbeat and breathing. tremors of the face and limbs. When the mast cells react with antigen during re-exposure. dys- kardiovaskularni (glavobolja. toničko-klonički clonic seizures. Symptoms: respiratory (coughing. erythema and na ekstremitetima) (26. ako je release of histamine and vasoactive amines occurs.25 mg/kg of diazepam IV. slurred Simptomi: zbunjenost. tient’s mouth. bronhospazam). Toxic reactions occur because of rapid absorp- ja (19). ako pacijent ima tonič. prevelike doze i intravaskularne injekcije (20. head- kvencija disanja. laryngeal edema. Following the first phase of excitation. pacijenta položiti na bok kako bi se smanjila moguć. breathing and air flow. tient subsequently passes through a depression of the nervous sija živčanog sustava i smanjuju se krvni tlak. palpitacije. ratio of 1:1000 in an amount of 1 mL. Then. poči. speech. cardiovascular (headaches. 21). antigen is required to stimulate the immune system doblje nakon ekspozicije tijekom kojega se antigenu senzibi. laringealni edem. travascular injection (20. a poslije se pojavljuje depre. the supply of oxygen is not secured.

bljava se kada uz anafilaksiju postoji i bronhospazam. it can lead to cardiac and respiratory arrest. nephrine dose of 0. intravenous epinephrine is administered at a dilution of loške otopine.1 ml/kg). guidelines have been established that need to be known. 2016 Medical emergencies that are life threatening can occur in dental practice. which is not suitable for children. in practice. or seizures) School of Dental Medicine or accidents (aspiration of a foreign body causing obstruction of the respiratory system). University of Zagreb specific pathology (such as acute asthma attack. usually penicillin. corticosteroids hidrokortizon u dozi od 4 mg/kg intravenski) (28. administered slowly and intravenously. Emergency Treatment. Negovetić Vranić et al. vasovagal syncope typically occurs. The most common reactions are toxic reactions to local anesthetics. 29). Address for correspondence gies occur mainly as a consequence of the application of antibiotics.hr www.5 mg for children up to 5 years. ally and quickly. Masks. and should be administered carefully in cases of hypotension treban u slučaju respiracijskih simptoma ili hipotenzije). given at a dose tikosteroidi (kortikosteroidi nisu lijekovi prvog izbora. but they are effective in reducing the late-phase allergic response). Most of the regulations and guidelines for emergency re- nosi se na odraslu populaciju. kor. Preporučuje se u to children to avoid complications or reduce them to a mini- ordinaciji imati napisane terapijske postupke u slučaju hitnih mum and should also have a defibrillator (30). whereas aller. a u praksi se tako primjenjuju (ideally. inhalation of β2- dilatacijski. a od parenteralnih pri.: +385 1 4802-110 dnegovetic@sfzg. and at 5 mg for children efikasni u redukciji kasne faze alergijskog odgovora. Every dentist pijske doze i postupke prilagođene dječjoj dobi kako bi se should know the therapeutic dose and procedures adapted komplikacije izbjegle ili svele na minimum. with a dose of 1–2 mg/kg methylprednisolone or 4 mg/kg hydrocortisone ad- ministered intravenously (28. oksigenacija (kisik je prijeko po. Reactions to medications may be al- lergic and toxic. oni su of 2.5 mg. open) has been registered. the dose can be repeated every 5–10 tako da se u 1 mL tvorničkog pripravka doda 9 mL fizio. treba although the manufacturer can provide half ampoules to be biti oprezan u slučaju hipotenzije jer 2 agonisti djeluju vazo. antihistamines parenteralno i djelovati brzo. Croatia child. doza za djecu tada iznosi 0. diabetic ketoacidosis. In response Dubravka Negovetić Vranić to stress. because β2 agonists have a vasodilatory effect. Complications may arise Accepted: March 5. iako se prema preporuci proizvođača polagano intra. so a 20 kg child has an epi- minuta. If complications occur Preventive Dentistry or necessary measures are not taken. Priznanje Acknowledgment Svi crteži su autorstvo dr. Tel. so 9 mL of saline is added to 1 ml of the factory di- histaminici (idealni antihistaminik trebao bi se primjenjivati lution. cardio. corticosteroids may be administered. oxygenation (oxygen is essential in cases dati metilprednizolon u dozi od 1 do 2 mg/kg intravenski ili with respiratory symptoms or hypotension). The authors deny any conflict of interest. and the dose for children is 0. re- djecu. Working with children žan zbog njihove dobi i razlike u fiziološkom i psihološkom is more difficult because of their young age and differences smislu. (corticosteroids are not the drug of first choice. inhalacija 2 agonista (upotre. garding parenteral formulations. Gundulićeva 5 pulmonary resuscitation is needed. Rad s djecom dodatno je ote. Nota- bly. intravenski se adrenalin daje u razrjeđenju 1:10. only chloropyramine (Syn- venski može dati pola ampule).01 ml/kg body weight. anti.1 mL/kg). u Hrvatskoj je registriran sa.000. Abstract Received: February 1. For all the Department of Paediatric and above conditions. 1:10. Jesenka Jeličić. 2016 because of an underlying disease or a reaction to medication. stanja i antišok-terapiju. a agonists (used when there is anaphylaxis and bronchospasm. Medical Emergencies 79 nalina je 0. in the physiological and psychological senses. First Aid. Other causes may be related to an underlying disease. All drawings are originally made by Dr. Svaki doktor dentalne medicine trebao bi znati tera. starijoj od pet godina 5 mg.2 mL – doza se može ponavljati svakih 5 do 10 dren is 0. 29). Croa- pravaka jedino kloropiramin (Synopen) koji nije predviđen za tia has registered only an oral form of diphenhydramine. Jesenke Jeličić.2 ml. compound is diphenhydramine or chlorpheniramine.000. Zaključak Conclusion Većina pravilnika za reagiranje u hitnim situacijama od. djeci do pet godina daje se u dozi od 2.ascro. an antihistamine should be administered parenter- difenhidramin ili klorfeniramin. All procedures and dosages should be adapted to the age of the HR-10000 Zagreb. hypoglycemia. the parenterally administered mo peroralni oblik difenhidramina. min. sponses refer to the adult population.hr Key words Dental Care for Children. Izjava Transparency declaration Autori opovrgavaju bilo kakav sukob interesa. Resusci- tation . Therefore. može se over 5 years of age). nabaviti defibrilator te kontrolirati rok valjanosti lijekova (30).

2003. Longstreth Jr WT. Lee GL. Dent Clin North Am. 11. 2012 Jan. endocrinopathy. 2–4). duration. izd. ni V. Woronick K. J Allergy Clin Immunol 10.80 Negovetić Vranić i sur. Copass MK. Allergic and toxic reactions to local anesthetics. Jones P. Baker S.Emerg Med 55. Denjoy I. Bellolio MF. Oral Maxillo- 6. 2013 Aug. Malamed SF. 16. Pract 2015.33(1):71-7. DuVal J. Anesthetic emergencies in oral surgery: malignant hy- 1994.108:320–1. 2004 Winter. surgery practice. 29. Hitna stanja References 1. pared with intramuscular epinephrine. Respiratory emergencies in children. Biarent D. 26. ternational consensus on cardiopulmonary resuscitation and 27. Rosenberg MB. Rosenberg M Preparing for medical emergencies: the essential tions. and neurologic events. Oral Maxillofac Surg Clin North Am. 21. Louis: Mosby. Helfaer MA.Oral Maxillofac Surg Clin North Am. atric emergency department. Srinivasan V. Intranasal medications in pediatric emer- mia with intensive care unit mortality in critically ill children.5:329. 141 Suppl 1:14S-9S. Pe. Dent Today. Kenney MA. Beattie T. Rossano JQ. May-Jun.25(3):407-38. 2003 Mar. 56. and intensity of hyperglyce. Cohen DM. et al. Part 6: Pediatric advanced life support: 2015 in. 7nd ed. Zagreb: Libar. Resuscitation 19. Spinella PC.22:114-21.33:443– fibrillation. Malamed SF. Emerg 13. Choi J. Zagreb: Medicin. Malamed SF. Pediatric sedation and anesthesia for the oral surgeon. dental practice. Herlich A. Rauch-Matthews ME. 2013 Aug.Dent Clin North Am. Care. www. Zideman D. Preoperative evaluation of the with compromised airway: part I--congenital. Degoricija V. way management. 15. Bingham R. West J Nurs Res 2011. 2012 May. Obeid G. 25(3):373-83. dose after administration of intra-venous bolus epinephrine com- rology 1993. 2012.56(1):163-81. Survival is not correlated ing and sus-taining evidence-based nursing practice to reduce with defibril-lation dosing in pediatric out-of-hospital ventricular pediatric cardiopulmonary arrest.43:2534–41. et al. 2012 Jan.30:496–501 (quiz diatr Crit Care Med 2004. 2004 Jan.14:e289–97 (a journal of the drugs and equipment for the dental office. 23. Warning Score (PEWS) system for admitted patients in the pedi- 2.30(2):529-63. Medical emergencies in the pediatric patient: air- 12. Knutson BD. 1979 Jun. 2013 Aug. Emergency medicine in pediatric dentistry: prepara. phylaxis: higher risk of cardiovascular complications and over- diopulmonary arrest: a community-based randomized trial. Acad Emerg Med 2014. Schiff L. Krost WS Pediatric pulmonary emergencies. et al. Randhawa S. Epinephrine in ana- Stark MS. Pediatr Dent. 2011. 2003 Oct. Gold DL.25(3):507-14. 2010 Society of Critical Care Medicine and the World Federation of Pe- May.hr . Bingham R. Implement. Roth CL. Circulation (In press). surgical patient.81:1364–88. et al. tion and management.3:76–80. Roberts-Turner R. mendations. Pathophysiological and technical considerations. Dauger S.27:91–105 (1993). 1990 Jul.31(3):236-48.J Am Dent Assoc. Ogle OE. perthermia.25(3):467-78 9. St. Del Pizzo J. Callahan JM. Agarwal R. 20. gency medicine.1(2):115–21. Eich C. 18. Guidelines for paediat. Drott HR. and conduc-tion disturbances during 322 critical care intuba- 14. Pediatr Crit Care Med 2013. Resuscitation 2010. 22. Campbell RL. ska naklada. Petranker S. Circulation 2003. 56(1):163-81. Preoperative evaluation of the 4. diatric Intensive and Critical Care Societies). Todd DW. Anesthesia equipment for the oral and maxillofacial 5. Sedano HO. 2013 Aug. Medical emergencies in the dental office. Nadkar. ing party of the European Resus-citation Council. Serv. Nikoyan L.Common pediatric respiratory emergencies. Associ-ation of timing. Medical emergencies in the pediatric dental patient. fac Surg Clin North Am. European Resuscitation Coun.52(4):46-8. Hitna stanja u pedijatriji. 2009 surgical patient. DeCaen A. Wiryawan B. The effect of atropine on rhythm Anesth Prog. Management of respiratory complications in clinical Med Clin North Am. Petranker S. cil guide-lines for resuscitation 2010 section 6 paediatric life sup.48(3):248-58.Pediatric conditions associated 25. Oral Maxillo- 7.Respir emergency cardiovascular care science with treatment recom. Waage NS. J Calif Dent Assoc. 28. Becker DE. Nikoyan L. Evaluating the Pediatric Early Pediatr Dent. Hitna medicina. Cobb LA. Neu. Porter MH. Chung WL. 8.ascro. 30. Pediatr Emerg Care 2014. fac Surg Clin North Am. fect anesthesia and their anesthetic management.Common medical illnesses that af- port.37(4):169-75. Mihalov LK. Goepferd SJ. 17. J Mass Dent Soc.31(10):749. 2015. et al. Meštrović J. 2. Dennis LK. ric life support: a statement by the paediatric life support work. 24. Intravenous glucose after out-of-hospital car. Ogle OE. Rotta AT. (official journal of the Society for Academic Emergency Medicine). et al. hrv.21:1249–56 3.