Emergencies in

dental practice
Instructor
– Dr.Jesus George

1

Common emergencies in
dental practice
 Syncope
 Chest pain
 Cardiac arrest
 Anaphylactic shock
 Stroke

2

 Asthmatic attacks  Drug reaction  Bleeding  Injuries as a result of surgical procedure 3 .Cont.

pain .fasting .hot & humid weather 4 .fatigue .Syncope  Syncope or fainting or loss of consciousness  Fainting refers to sudden loss of consciousness  Predisposing factors – fear. anxiety.

weakness .  Signs & symptoms – cold & moist skin .Cont.loss of consciousness 5 .dizziness .pale skin .slow pulse initially followed by rapid pulse .nausea .

 Management – monitoring pulse .loosening of tight cloths at neck .if not recovered other causes of collapse should be considered 6 .Cont.lowering head to improve cerebellar circulation .reassurance of patient .smelling of salt of aromatic ammonia .

Other causes of collapse  Anaphylaxis  Hypoglycemia in diabetic patient  Myocardial infarction  Uncertain causes 7 .

rapid pulse .Collapse of diabetic patient  Hypoglycemia .weak pulse .disorientation .dampness of skin .irritability .urine sugar is -ve  Hyperglycemia .urine sugar is +ve 8 .decreased blood sugar .increased blood sugar .dry mouth & skin .drowsiness .aggressiveness .

monitoring vital signs 9 .  Management (hypo)  If patient can take orally – 15g oral carbohydrate  If the patient is unable to take orally. i/v 2550ml 50% dextrose or 1mg glucagon  If i/v line is not there.Cont. s/c or i/m 1mg glucagon  Patient is observed for 30-60 min  Management (hyper)  immediate medical assistance  Maintenance of airway & circulation .

v. hydrocortisone sodium succinate 250 mg 10 .administer oxygen .administer oral glucose .Uncertain causes  Management – make the patient lie down flat & monitor pulse .maintenance of airway .i.

Chest pain  Mainly caused by angina pectoris. weak pulse. vomiting. loss of consciousness 11 . dyspneoa. irregular pulse ( MI). myocardial infarction  Angina pectoris – pain lasts for only a short duration  MI – pain persists for long duration  Diagnosis – severe chest pain in retrosternal region.

Management  s/l 0.5mg glyceryl trinitrate. MI  Nitrous oxide & oxygen 50/50 ratio to relieve pain & anxiety. if pain is not relieved by 3 min. immediate medical attention 12 .

severe hypotension .Anaphylactic reaction .hypoxia .Cardiac arrest  Sudden appearance of pallor & respiratory arrest  Etiology – MI .anesthetic overdose 13 .

 Diagnosis – fainting or collapse  Late signs – respiratory arrest. cyanosis. dialatation of pupil.Cont. absence of pupillary response to light. absence of BP  Management – immediate cardiopulmonary resuscitation 14 .

paraesthesia pallor. urticaria flushing of face. edema of face 15 .Anaphylactic shock  Caused by drugs like penicillin  C/Fs – wheezing - abdominal pain nausea. rapid & weak pulse cyanosis.

 Management – make the patient lie down flat with legs raised .i. till improvement .200mg hydrocortisone sodium succinate .i.v.Cont. infusion 10-20mg chlorpheniramine .low i.v.m.oxygen administration & medical help 16 . 1ml in 1000 adrenaline repeated after 15 min.

hospitalization 17 .weakness of arm & leg on one side .Cerebrovascular accidents (stroke)  Usually occurs in hypertensive patients  Clinical features – depends on site & extend of brain damage .loss of consciousness .drooping of one side of face  Management – maintenance of airway .

use of accessory muscles for respiration  Management – reassurance of patient . exposure of allergen.Asthmatic attacks  Causes – anxiety. wheezing. infection  Clinical features – breathlessness.patient should never be allowed to lie down flat .inhalation of salbutamol nebulizer 18 .

oxygen administration . salbutamol .i.hospitalization 19 . 200mg hydrocortisone sodium succinate .if no response slow i.Cont. .v.v.

liver disease. congenital cyanotic heart disease.Bleeding  Occurs mainly after extraction  Occurs in hemorrhagic disorders (hemophilia A. anticoagulant therapy. c/c renal failure)  Management – reassurance of patient .oral cavity is cleaned & source of bleeding is identified 20 . Christmas disease. K deficiency. Vit.

socket is sutured . .local hemostatic measures – pressure packs .Cont.if bleeding persists hospitalization 21 .

barbiturates with antihypertensive drugs 22 .v.Drug reactions  Anaphylaxis  Allergy to LA solution  Hypotension due to interaction of i.

V. v.allergy to LA LA may cause cardiovascular effects & facial palsy I. injection of LA . injection is caused by – aspiration was not carried out during injection & rapid infusion of LA 23 .Reaction due to LA    Causes – i.

24 .recovery in 30 min.loss of consciouness .Management – make the patient lie down flat .Clinical features – drowsiness .agitation .maintain airway .Cont. .

caused by tackling of LA to facial nerve 25 .  Allergy to LA – management similar to anaphylaxis  Cardiovascular effects Manifested as palpitation .Cont.If MI – manage MI  Facial palsy – temporary effect .

.Cont.management – wears of gradually -reassurance of patient 26 .

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 27 .

Hypertension  Management – medical assistance 28 .

Traumatic injury  Burns  Laceration  Fractures of jaw 29 .