Anesthetic complications and office emergencies


Louise Miclat

‡ anesthetic complication
± Any deviation from the normally expected pattern during or after the securing of regional analgesia ± These complications may be classified as:
‡ Primary or secondary ‡ Mild or severe ‡ Transient or permanent

even though it may be caused at the time of insertion of the needle and injection of the solution .Primary complication ‡ One that is caused and manifested at the time of anesthesia Secondary complication ‡ One that is manifested later.

Mild complication ‡ One that exhibits a slight change from the normally expected pattern and reverses itself without any specific treatment Severe complication ‡ Manifests itself by a pronounced deviation from the normally expected pattern and requires a definite plan of treatment .

Transient complication ‡ One that although severe at the time of occurrence. leaves no residual effect Permanent complication ‡ Leaves a residual effect even though mild in nature .

Those attributed to the solutions used 2. Those attributed to the insertion of the needle .Complications may be further be divided into 2 groups: 1.

4. 2. 5.Complications resulting from the absorption of the anesthetic solution: 1. 3. 6. Toxicity Idiosyncrasy Allergy Anaphylactoid reactions Infections due to contaminated solutions Local irritations or tissue reactions due to the solution .

6. 3. 5. 2. Syncope (fainting) Muscle trismus Pain or hyperalgesia Edema Infections Broken needles Prolonged anesthesia other than from the anesthetic solution Hematoma Sloughing Bizarre neurological symptoms . 8. 10.Complications attributed to the insertion of the needle: 1. 7. 4. 9.

Complications Caused by Wrong Technique .

3.1. Primary cause: sudden unexpected movement by patient Smaller needles are more likely to break Previously been bent are weakened and more likely to break Needle breakage is not a significant problem If a broken needle can be a retrieved with out surgical intervention 2. Problem O O . Needle breakage Cause 1.

Keep patients mouth open c) if the fragments is visible.‡ Prevention ‡ Use of long needle injection for injection requiring penetration of significant depths ‡ Don t insert a needle into the tissue to its hub. unless its absolutely essential for the success of the technique ‡ Don t redirect needle once it is inserted into the tissues o Management When a needle breaks: a) Remain calm b) Instruct the patient not to move don t remove your hand from the patients mouth. try to remove it with a small haemostat or a magil incubation forceps .

‡ If needle is lost( not visible ) a) Don t proceed with an incision or probing b) Calmly inform the patient c) Note the incident in the patients chart and then inform your insurance carrier immediately d) Refer the patient to an oral and maxillofacial surgeon for consultation .

rapid deposition it may cause tissue damage .Needles with barbs may produce pain as they are withdrawn from the tissue Problem 1.2. Pain on injection Cause . increasing the risk of the needle breakage.A needle deposition can become dull from multiple injections .Careless injection technique and callous attitude . Pain on injection increases patients anxiety and may lead to sudden unexpected movement . .

Use sterile local anesthetics solution 5.Adhere to proper technique 2.No management required .Use topical anesthetic prior to injection 4.Use sharp needles 3.Prevention 1.Inject local anesthetics slowly Management .

Anesthetic solution contaminated by alcohol 3.When lingual nerve involved.self inflicted injury 2.Hemorrhage into or around the neural sheath is another cause Problem 1. Persistent anesthesia or parasthesia .Trauma to any nerve may lead 2. the sense of taste may also be impaired .3.On occasion a patient will report feeling numb for many hours or days after a local anesthetic injection Cause 1.

Only damaged nerve will be permanent .Most parasthesis resolve within approximately 8 weeks without treatment 3.Prevention 1.Strict adherence to injection protocol and proper care and handling of dental cartridges help minimize the risk of parasthesia 2.

.local anesthetics into which alcohol or other cold sterilizing solutions have diffused that produced irritation of tissue leading potentially into trismus 2. .Also known as fals ankylosis Cause 1. large volume of blood can produce tissue infection. with the difficulty on opening the mouth. 3.HENORRHAGE. especially spasm of the masticatory muscle. which leads to muscle dysfunction as blood slowly resorbed. may lead to trismus.Disturbance of the trigeminal nerve. Trismus .4.Over LARGE AMOUNT OF LOCAL ANESTHETICS solution deposited into restricted are produced distention of tissue.

Prevention 1.Proper care and handle of dental anesthetic cartridges 3.Use sharp sterile disposable gloves 2.CLEAN the site of injection with antiseptic solution prior to needle penetration 4.Use minimal effective volume of local anesthetic solutions .Practice ATRAUMATIC INSERTION and injection technique 5.

Centrally acting muscle such as Diazepam (Valium). slight exercises and drug therapy may be necessary to relieve pain.If the treatment should depend on the cause of trauma. 3. 2.5-5mg 4x per day or Meprobamate (Milrown) 1200-1600 mg per dayin 3 or 4 doses coupled with application of warm moist compress for 15-20 mins. if sufficiently sever.Mild analgesics may also be used for discomfort of the patient . Per hour will usually relieve the sympotms in several days. 2.Management 1.

either an artery or vein during injection of local anesthetic Prevention 1.Inadvent nicking of blood vessels. KNOW the anatomy involved in the proposed injection 2.A common complication of intraoral regional analgesia Cause . Hematoma . MODIFY the injection as indicated by the patients anatomy 3. MINIMIZE the number of needle penetrations of tissue .Effusion of blood into extra vascular spaces .5.

Hemorrhage . Trauma during injection 2. Allergy. angiodema 4.Swelling of tissues Cause 1. Infection 3.6. Edema .

Edema is a seldome intense enough to prduce significant problems such as airway obstruction that results in pain and dysfunction of the region and in personal embarrassment for the patient 2. this represents a potential life threatening that requires vigorous management .Problem 1.Edema of the tongue.Swelling produced by angioneuretic edema in an allergic individual in response to an allergen is capable leading to a comprpmise airway 3. pharynx or larynx may develop.

Complete an adequate medical evalutation of the patient prior to drug administration Management 1.Use atraumatic injection technique 3. edema will resolve slowly over 7-14 days as extravasated blood elements are resorbed into the vascular system . .When produced by traumatic injection or introduction of irritating solutions. become progressively more intense.Prevention 1.Edema produced by infection will not resolve spontaneously but may. institute antibiotic therapy.Properly care for and handle the local anesthetic armamentarium 2. 4.Reduction of the swelling 2. the degree of edema is usually minimal and will resolve in 1-3 days without formal therapy .Following hemorrhage. infact . If signs and symptomsdo not appear to resolve in 3 days. it may be necessary to prescribe analgesics for pain 3.

6. The degree of edema and its location are highly significant. If swelling develops in buccal soft tissues and there is absolutely no airway involvement. Edema is produced by allergy is the most potentially life threatening. When edema occurs in ay area where it compromises breathing treatment consists of the following ‡ Epinephrine 3mg ‡ Antihistamine ‡ corticosteroids . treatment consists of intra muscular and oral antihistamine admistration and medical consultation with an allergy to determine precise of edema.5.

use basic cardiac life support 8. if unconscious.7. Medical assistance summoned patient in supine position. Thorough evaluation of the patient prior to next appointment to determine the cause of the reaction .

Prolonged irritation of ginigival soft tissues may lead to a number of unpleasant complications. Sloughing of tissues . including epithelial desquamation and sterile abscess .7.

Cause ± Epithelial desquamation 1. Secondary to prolonged ischemia resulting ischemia resulting from the use of local anesthetic agent with vasoconstrictors 2. Heightened sensitivity of tissues to chemical agents 3. Application of topical anesthtic agent to ginigival tissues for a prolonged period of time 2. Reaction in area where topical anesthetic is required ± Sterile abscess 1. Almost always occurs in the firm soft tissues of the hard palate .

.Management may be symptomatic.Use topical anesthetics as recommended 2.There is remote possibility of infection developing on the said areas Prevention 1. such as analgesic or aspirin or codeine and a topically applied ointment such as orabase to minimize irritation to the area as recommended 3.Problem 1. do not employ overly concentrated solutions Management 1.Epithelial desquamation will resolve within a few days 4.pain.No formal management is required 2. quite sever 2. for pain.When using vasonstrictors for hemostasis.Record date on patients chart .

8. Lip Chewing
- Trauma to the lips and tongue of the patient caused by unintentionally biting or chewing these structures while still anesthetized. - Occurs most frequently in children and in mentally handicapped children and adults - CAUSE:
- Use of long acting local anesthetic in patients undergoing short dental procedures

PROBLEM: -Trauma that will lead to swelling and significant pain when the anesthetic action dissipate PREVENTION: -If dental procedures are brief, the appropriate local anesthetic solution should be selected -Cotton roll can be placed between the lips of the patient if they are still anesthetized at the time of discharge, tie it in position with dental floss wrapped around the teeth -Tell the patient and adult guardian against eating, drinking hot fluids and biting on the lips or tongue while still anesthetized.

MANAGEMENT: (symptomatic) -Analgesics for pain -Antibiotics for infection -Lukewarm saline rinse to help decrease swelling present -Petroleum Jelly or other lubricant to cover the lesion and minimize irritation

9. Facial Nerve Paralysis
‡ Local anesthetic agent is introduced deep into the parotid gland which terminal portions of the facial nerve runs ‡ CAUSE:
± Directing a needle toward or its unintended deflection in a posterior direction during an inferior alveolar nerve block that may place the needle tip within the substance of the parotid gland.

corneal reflex is intact. however.PROBLEM: Loss of motor function to the muscles of facial expression by local anesthetic solution is transitory. no treatment Patient may be unable to voluntary close the eye. . the volume injected and the proximity to the facial nerve Unilateral Cosmetic appearance. It can last from 1 to several hours. Winking and blinking become impossible to perform. depending on the agent employed.

it should be withdrawn entirely.‡ PREVENTION: ± Know your anatomic landmarks ± If the needle deflects posterior during inferior alveolar nerve block. the barrel of the syringe brought posterior and the needle advance until it contacts the bone ‡ MANAGEMENT: ± Reassure the patient ± Advise the patient to periodically close the upper eyelid manually to keep the cornea lubricated ± Contact lenses should be removed until muscular movement returns ± Note the incident on the patient s chart ± Although there is no contraindication in reanesthetizing the patient to achieve mandible anesthesia. it may be careful to forego further dental therapy .

Syncope (fainting) ‡ Most frequent complication associated with local anesthesia ‡ Form of neurogenic shock ‡ CAUSE: ± Cerebral ischemia secondary to a vasodilatation or an increase in the peripheral vascular bed.10. with a corresponding drop in blood pressure .

the pulse. he should be instructed to take a few deep breaths. This will assist venous return while providing adequate oxygenation ± If a patient loses consciousness. respiration and color should be checked to determine the severity of the condition PREVENTION: -Detect early stage of fainting by the change in the patient s appearance.‡ MANAGEMENT ± Reassure and re-evaluate the patient before continuing with the procedure ± Lower chair back while the patient s legs are slightly elevated ± If the patient is conscious. such as pallor -Patient should be placed in a semi reclining position before a local anesthetic solution is introduced .

11. Infection ‡ CAUSE: ± Contamination of the needle ± Improper technique in handling of the anesthetic agent ± Improper tissue preparation for injection PROBLEM: .Low grade infection .May lead to trismus if not recognized and proper treatment initiated .

disposable alcohol wipes .PREVENTION ‡ ‡ Use disposable needles Proper care and handling of needles ± Recap the needle when not in use to avoid contamination through contact with non sterile surfaces ± avoid multiple injections with the same needle ‡ Proper care and handling of dental cartridges of local anesthetic solution ± Single use only ± Store aseptically in original container. covered at all times ± Cleanse the diaphragm with sterile.

MANAGEMENT ‡ Low grade infection ± Seldom recognized immediately ± Patient will report post injection pain and dysfunction 1 or more days. following dental therapy. Rarely will there be any overt signs & symptoms of infection present ± Heart analgesic ± Muscle relaxant & physiotherapy ‡ Record the progress of the patient on the dental chart ‡ Immediate treatment .

crossed eyes. muscular weakness. and many other unexpected complications .12. Bizarre Neurological Symptoms ‡ A rare condition that may occur following the insertion of a needle and the injection of a solution in a given area ‡ CAUSE: ± Inadvertent anesthesia to nerves in approximating the area ‡ PROBLEM: ± Patients may exhibit facial paralysis. temporary blindness.

regardless of how thoroughly the literature is followed. someone somewhere will describe a seemingly impossible neurological complication .‡ PREVENTION: ± To follow closely accepted techniques and to adhere to all the basic concepts of accepted procedures ‡ MANAGEMENT: ± Patients should be diagnosed according to the symptoms manifested. and.

Complications caused by anesthetic solutions .

It is important for the dentist to purchase anesthetic cartridges from reliable manufacturers. . This is primarily because of the high standards of asepsis practiced by the manufacturers of various local anesthetics.Local reactions caused by anesthetic solutions ‡ Infections due to contaminated solutions are rare at the present time.

Cartridges ‡ Should be only used once. any attempt to use a portion on one patient and the remaining amount on a subsequent may induce possibility of cross infection ‡ Stored aseptically as possible ‡ Rubber or metal endings should be protected from contamination ‡ Anesthetic cartridges stored in an alcohol solution ± All cartridges leak to some degree and in time alcohol will seep into the anesthetic solution ± Injection of alcohol-contaminated anesthetic may result to prolonged anesthesia or local irritation .

cartridges should be stored DRY in their original container or in another suitable sterile container that is kept covered at all times .‡ Holding solutions ± Capable of sustaining the growth of various microorganisms leading to contamination of the cartridge and anesthetic solutions ± Once the original container is opened.

‡ The rubber diaphragm should be wiped with a sterile.‡ The operator should handle cartridges only by the way of the stoppered end after thoroughly washing the hands. . disposable alcohol sponge prior to insertion into the syringe and affixing the needle.

Burning of injection ‡ CAUSE: ± pH of the solution being deposited into the soft tissue ± Rapid injection of local anesthetic ± Contamination ‡ PROBLEM ± Tissue irritation ‡ If caused by pH of the solution = rapidly disappear ‡ If caused by rapid injection or contaminated solution = damage to the tissue .1.

‡ PREVENTION: Slow rate of injection ± Ideal rate is 1ml/min ± Don t exceed the recommended rate of 1. . formal treatment is not usually indicated.8ml/min ± Cartridge of anesthetic should be stored at room temperature ‡ MANAGEMENT: ± Since most instances of burning on injection are transient and do not lead to prolonged tissue involvement.

primarily around the site(s) of the injection ‡ The primary presenting symptom is pain. the mouth developed ulceration. Post Anesthetic Intraoral Lesion ‡ Patients occasionally report to a dentist that approximately 2 days following intraoral injection of local anesthetic. usually of a relatively intense nature .2.

Recurrent Aphtous Stomatitis ‡ Intraoral manifestation ‡ It develops on gingival tissues that are not attached to underlying bone such as the buccal vestibule ‡ Not viral but thought to be either an auto immune process or an L-form bacterial infection .

Herpes simplex ‡ Develop intraoral but most commonly observed extra oral ‡ It is viral and develops intraoral on tissues that are attached to underlying bone such as soft tissue of hard palate ‡ Trauma to tissue by needle. cotton swab or any other instrument that may reactivate the latent form of the disease process that has been present in tissues prior to the injection . local anesthetic solution.

‡ PROBLEM: ± Acute sensitivity in ulcerated area ± Risk of developing a secondary infection is small in both these situation ‡ PREVENTION: Extraoral herpes simplex . either applied topically with a cotton swab 3-4 times daily.May be effectively treated if it is in its prodromal stage .Prodrome consists of a mild burning or itching sensation at the site where the virus is present. .Effectively minimizes the acute phase process .Not effective intraoral .

is not be applied as needed to recommended because the painful areas its anti-inflammatory actions provide an ‡ A mixture of amounts increased risk if either of diphenhydramine. viscous lidocaine. without kenalog. . effectively coats the ‡ Duration of ulcerations ulcerations and provide is approximately 7-10 relief from pain days with or without treatment.Management: ‡ Topical anesthetic ‡ Orabase. viral or bacterial and milk of magnesia. can a cortocosteroid. involvement rinsed in the mouth. such as paste. a protective solutions.

a chemical cauterizing agent. is often used to provide dramatic effect on tissues. its use in the management of herpetic or aphtous lesions can not be recommended ‡ Keep adequate records in the patient s chart ‡ Symptomatic ± Pain : major presenting symptom ± Reassure patient that the situation is not due to a bacterial infection secondary to the local anesthetic injection but in fact is an exacerbation of a process that has been present.‡ Negatol. However. in the tissues prior to injection. ± the objective of the treatment is to keep the ulcerated areas covered and/or anesthetized . in latent form.



.Symptoms manifested as the result of over dosage or excessive administration of a drug. a sufficient amount of plasma cholinesterase should be enough to hydrolyze the drug.Toxic overdose . .TOXICITY .Ester type of local Anesthesia. ‡ Central Nervous System ‡ Respiratory System ‡ Circulatory System .The concentration of the local anesthetic in the plasma should be at an equilibrium so that there is a favorable relationship between the amounts being absorbed into and diffusing out of the plasma.

the more rapid the absorption. and the greater the possibility of a toxic reaction** .TOXICITY Causes: ‡ Amount of the drug ‡ Unusually rapid absorption or intravascular injection ‡ Unusually slow biotransformation ‡ Slow distribution ‡ Slow elimination Factors: ‡ Patient s general physical condition ‡ Rapidity of injection ‡ Route of administration ‡ Amount of the drug ‡ Age **the more the vascular the area.

enhances the absorption of the drug therefore less dosage is needed ‡ Vasoconstrictor slows down the absorption thus causes longer duration of the effect of the drug .TOXICITY Vasodilators VS Vasoconstrictors ‡ Vasodilators .

‡ Procaine and Lidocaine. A PROPORTIONATE PERIOD OF CNS DEPRESSION OCCURS ‡ Subtoxic doses produces anticonvulsant effects.TOXICITY TOXIC EFFECTS ON THE CNS ‡ Amygdala ‡ Biphasic effect: AFTER CNS STIMULATON. .

slurred speech. MEDULLARY STIMULATION ‡ Increased heart rate ‡ Increased blood pressure . apprehension. tinnitus. ‡ Light headedness. tremor of the hands and feet. drowsiness and numbness of the tongue. disorientation. ‡ Generalized numbness of the tongue due to its highly vascularized tissue of the oral cavity.TOXICITY Mild Degree Toxicity CORTICAL REGION STIMULATION ‡ Talkativeness. difficulty focusing the eyes. localized muscular twitching.

For moderate toxicity ‡ 5 to 10 mg Diazepam. Pentobarbital. . Not indicated for seizure control lest excessive postictal depression be produced. intravenously administered to prevent development of seizure. intravenously administered to prevent and control a seizure.TOXICITY ‡ And increase respiratory rate Pharmacological Management of CNS Stimulation ‡ 50 to 100 mg of Barbiturates.

drowsiness.TOXICITY Mild Degree Toxicity CORTICAL REGION DEPRESSION ‡ Lethargy. . and muscular weakness. MEDULLARY DEPRESSION ‡ Slight fall in heart rate and blood pressure ‡ Mild depression of the respiratory rate Pharmacological Management of CNS Depression-mild to moderate ‡ Airway-by extending the head maximally ‡ Respiration.position the patient that allows gravity to alter the venous return. unresponsiveness. ‡ Pharmacological support is not really providing artificial ventilation ‡ Circulation. lack of movement of the extremities. sleepiness.

.TOXICITY SEVERE TOXICITY-Generalized tonic-clonic seizure ‡ 7. ‡ Muscle contraction of respiration-rapid consumption of O2 Cyanosis ‡ Increased metabolic rate and ineffective respiratory elimination.5 to 10.increased CO2. Artificial ventilation is a must.(or double the dose for intramuscular)Paralyzes all voluntary muscle for a period of 5 to 7 mins.metabolic and respiratory acidosis increased duration of the seizure Pharmacological Management of CNS Stimulation(SEVERE) ‡ 20 to 40 mg of Succinylcholine -intravenously administered to control the seizure.0 µg/ml of the local anesthetic agent ‡ Due to continues redistribution and biotransformation of the local anesthesia while seizure is occurring.

. ‡ Severe medullary depression manifested by: depression of cardiovascular function. stupor. and coma. respiratory depression and hypoxia. unconsciousness.TOXICITY SEVERE TOXICITY-Postictal Depression ‡ Occurs after a tonic/ clonic seizure ‡ Severe cortical depression manifested by: unresponsiveness.

Conservative dose of Phenylephrine if further support is needed.Severe ‡ A combination of mechanical and pharmacological support is needed. intravenously or intramuscularly administered. ‡ Mechanical support for consciousness and respiration ‡ Pharmacological support for circulation. ‡ Bradycardia -0.2 mg glycopyrrolate.5 mg atropine or 0.4 mg of atropine sublingual tablets v . ‡ Hypovolemia -can be corrected by a combination of positional changes and the infusion of 250 to 500ml of 5% dextrose in water or 5% dextrose in lactated Ringer s solution that is intravenously administered.0.TOXICTY Pharmacological Management of CNS Depression. ‡ Hypovolemia and Bradycardia must be considered and treated.

severe depression of the cardiac function (slowed conduction.5 to 5µg/ml of lidocaine. close observation after injection is a must.slow the rate of impulse of conduction-prolong the refractory period *direct relationship between the dose and effect* ‡ 1. ‡ Direct depression of the myocardium.TOXICTY Toxic Effects on the Cardiovascular System ‡ Depression effect only.massive cardiovascular collapse *Therefore.* .low dose and is used as antiarrythmic (Anticonvulsants on the CNS) ‡ More than 5µg/ml. decrease cardiac output) ‡ More than 10µg/ml.bradycardia.

TOXICTY Management of Toxic Reactions ‡ Mild reaction. . Dental procedure may be carried out as planned. All dental procedures must be stopped and must concentrate on protecting the patient from any accidental injury.requires no specific treatment and will generally subside in a few minutes.requires immediate and specific attention. ‡ Severe reaction.

TOXICITY PREVENTION ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Adequate evaluation prior to regional anesthesia Proper anesthetic drug Least possible amount of drug Least possible concentration Slow deposition Aspiration Vasoconstrcitor Proper technique .

GROUP 4 Naral, Pauline

‡ A specific hypersensitivity to a drug or chemical agent brought about by an alteration in the body s reaction to an antigenic substance that may be acquired or familial. ‡ The skin, mucous membrane and blood vessels are the common shock organs. ‡ Asthma, rhinitis, angioneurotic edema, urticaria and other skin rashes are just some of the reactions. ‡ Respiratory, cardiovascular system as well as the smooth muscle of the gastrointestinal tract are only occasionally involve. ‡ Antigen-(destroyed/neutralize)-antibody=NR ‡ Antigen-(binds)- antibody= histamine or histamine like substance.

Histamine or the histamine like substance: ‡ Capillaries becomes more permeableextravasation of plasma- urticaria/ angioneurotic edema ‡ spasm of smooth muscles-asthma ‡ vasodilation of the microcirculation-pooling of blood

‡ Mepivacaine(Carbocaine) . ‡ Responsible for allergic reactions provoked by injection of pharmaceutical agents containing them.ALLERGY AND ANAPHYLACTOID REACTIONS Methyl Paraben ‡ The preservative content of the cartridge to prevent contamination of the solution caused by multiple punctures of the rubber diaphragm with the needle and solution withdrawal.

‡ Anaphylactic reactions. respiratory system.affects the skin. GIT. most common in dentistry .serum sickness.transfusion reactions. and acute viral hepatitis. hemolytic anemia. and cardiovascular system. lupus nephritis.ALLERGY AND ANAPHYLACTOID REACTIONS Immediate Reactions ‡ Develop within seconds to hours of exposure ‡ Cytotoxic Reactions. autoimmune hemolysis. Mucous membrane. and membranous glumerulonephritis ‡ Immune complex reactions.

Common ‡ Asthma. and larynx are involved when the upper tracheobranchial tree is involved.OBSTRUCTION.Involves the lower tracheobronchial tree. pharynx. face . . lips. ‡ Angioedema. elevated patches of skin.respiratory distress of the expiratory type including prolonged expiration accompanied by audible wheezing. ‡ Angioedema of the tongue.localized swelling of the soft tissues of the hands. and larynx.ALLERGY AND ANAPHYLACTOID REACTIONS Localized Immediate Reactions Most Common ‡ Urticaria. wheals which are accompanied by intense itching.production of smooth. pharynx. tongue.

no treatment necessary but rather acknowledgement.ALLERGY AND ANAPHYLACTOID REACTIONS Management of Localized Immediate Reactions IMMEDIATE MILD AND LOCALIZED REACTION ‡ -50 mg of diphenhydramine every 3 to 4 hrs a day that is administered orally. . SEVERE LOCALIZED REACTION ‡ 25 to 50 mg of diphenhydramine IV or IM administered.administered subcutaneously or IM. ‡ 0. ‡ EXTREMELY MILD CASES.5 mg of epinephrine. To decrease upper airway edema and prevent respiratory malfunction.3 to 0.

‡ Only done when there is any slightest suspicion of lifethreatening airway obstruction may it caused by foreign object or edema. . Cricothyrotomy ‡ Creation of an opening into the airway through the cricothyroid membrane.. ‡ Severe upper airway edema. ‡ Delay the dismissal of patient for atleast an hour for further observations and be under the care of an adult.mechanical measures in addition to pharmacotherapy is used.ALLERGY AND ANAPHYLACTOID REACTIONS EMERGENCY ‡ Administration of 100% Oxygen and antihistamines.

2. A vertical incison may be made with a scalpel that is then rotated perpendicularly to maintanin patency.Cricothyrotomy Procedure 1. 5. The palpating fingers moves inferiorly down the midline of the thyroid cartilage until a small depression is felt with the tip of the finger until the cricoid cartilage. 6. 4. Palpation of the thyroid eminence or Adam s apple with the head extended. an opening may be created in the airway by inserting a suitable device that will not only enter the airway but maintain patency of the newly created opening. The depression or cricothyroid membrane marks the proposed point of entrance into the airway. At this point. Large gauge intravenous needles( 14 to 16 gauge) may be inserted into the airway: a scalpel is not required. 3. .

3.Inhalation of Aerosols that contain isoproterenol or epinephrine.IV 250 to 500 mg of aminophylline that relxes vascular and bronchiole smooth muscle.produce profound and instantaneous relaxation of bronchiole smooth muscle.Mechanical Means 2. . Hypotension must be observed.ALLERGY AND ANAPHYLACTOID REACTIONS Management of Asthmatic Attacks 1.

‡ Sudden cardiovascular collapse.3 to 0. vasopressors and corticosteroids. ‡ O. ‡ 15 mg of ephedrine followed by 4 to 12 mg of dexamethasone administered IV for rapid absorption.ALLERGY AND ANAPHYLACTOID REACTIONS Generalized Immediate Reaction ‡ Occurs minutes after exposure to the agent.5 mg Epinephrine. severe respiratory distress.drug of choice ‡ External cardiac compression . Administer intravenous fluids. ‡ Gastrointestinal involvement ‡ Management of Generalized Immediate Reactions: ‡ PROMPT ACTION is necessary ‡ Mechanical means of support to respiration and circulation. pruritis and appearance of erythema and severe urticaria.

. tenderness. joint pain.ALLERGY AND ANAPHYLACTOID REACTIONS DELAYED REACTION ‡ Occurs more than 48 hours after exposure to the allergen. Allergy Testing ‡ It is not within the scope of the dentist s to attempt to approve or disapprove the accuracy of a patient s statement of a previous allergic reaction. This should be the responsibility of the allergists. and malaise. ‡ More annoying than serious ‡ Manifested by localized edema in the are of injection.

Prevention ‡ Adequate preanesthetic evaluation ‡ No drug or drugs should be used if the patient gives a history of previous allergic reaction to them. ‡ No patient should be tested to attempt to disprove his allergic history.

GROUP 4 Naral, Pauline

Infection Caused by Contaminated Solution and Local Irritation Caused by the Solution-LOCAL REACTION
INFECTION CAUSED BY CONTAMINATED SOLUTION ‡ Primarily rare due to high standards of asepsis of the manufacturer. Reliable manufacturer is therefore the best protection of the dentist. ‡ The cartridge should only be used once and specially on one patient only. ‡ The cartridge should be stored as aseptically as possible. Once the container is opened, cartridges should be stored dry in any suitable container that is kept covered at all times.. ‡ A sterile, disposable sponge is wiped on the rubber diaphragm prior to insertion to the syringe and affixation of the needle.

excessive pressure and excessive volume.a local tissue damage may result.Infection Caused by Contaminated Solution and Local Irritation Caused by the Solution-LOCAL REACTION LOCAL IRRITATION CAUSED BY THE SOLUTION ‡ Prolonged anesthesia may be a complication resulting from the injection of solution other than the local anesthetic agent. such as alcohol. sterilizing solution or others. . ‡ If the injection is injected too rapidly on confined areas.

Idiosyncrasy ‡ Refers to any reaction to a local anesthetic or drug that cannot be classified as toxic or allergic ‡ Reaction shows no relation to the pharmacology of the drug and may vary in degree from day to day ‡ Can occur as the result of emotional interplay causing an array of unusual symptoms ‡ Treatment is almost impossible to outline in advanced ‡ Patient s airway must still be maintained and adequate oxygenation should be assured ‡ It is important that the dentist observe all patients closely and try to diagnose an untoward situation as accurately as possible so that proper treatment can be instituted .

Restlessness ‡ Overdose reaction is quite 7. Tenseness Throbbing headache Tremor Weakness . Respiratory Difficulty rare 8. 11.000 2. Dizziness 1:250.Epinephrine Overdose ‡ Optimal concentration for Clinical manifestations: prolonged pain control: 1. Fear and anxiety 3. Perspiration directly to the area 6. Palpitation bleeding when applied 5. 10. 9. Pallor ‡ Employed to control 4.

ventricular fibrillation ± possible cardiac arrythmias . ventricular tachycardia.Epinephrine Overdose ‡ Signs ± Sharp elevation in blood pressure (primarily systolic) ± Elevated heart rate ± Premature ventricular contractions.

Epinephrine Overdose ‡ Management: ± Short duration: no formal management required ± Terminate dental procedure ± Remove source of epinephrine ± Conscious patient: position in a comfortable position. do not discharge the patient . is not indicated ± Permit patient to remain in the dental chair as long as necessary ± If there is doubt about the ability for self-care. supine position should not be done because of its accentuation of cardiovascular effects ± Semi-sitting or erect position minimizes the elevation in cerebral blood pressure ± Reassure patient that effects will subside ± Monitor blood pressure & heart rate every 5 minutes and administer oxygen ± If patient is hyperventilating.


 Dentists need not accurately diagnose the cause of the emergency but should give essential medical treatment until the services of a physician can be secured  Dentists are expected to be able to safeguard the life and welfare of patients during an emergency  Pre-treatment physical evaluations should forewarn the dentist of those patients most likely to present emergency problems .


Cardiovascular Conditions  Mostly results from a combination of preexisting pathologies and increased work requirement of the heart  Brought about not only by physical exertion but also by catecholamine release following emotional stress or pain  Dentist s concern: Welfare and comfort of the patient .

reassured and put at rest ± Give 1 or 2 Nitroglycerin tablets (0. oxygen and IM or IV meperidine (Demerol) or morphine can be given to ease the pani and anxiety .6mg) sublingually ± Patient should be asked to inhale a broken ampule of amyl nitrate ± If relief is not obtained. shouler or neck ± Patients complains of subsequent discomfort or a feeling of fullness or pressure Management: ± Patient should be comforted. Angina Pectoris Signs/ Symptoms: ± primary characteristic: sudden onset of pain localized or radiated to the arms.Cardiovascular Conditions 1.

Coronary Artery Occlusion May vary from mild to very severe Signs / Symptoms: ± Most common: substernal pain (mild to severe) ± Severe: Patient may feel that his head is about to burst ± Mild: pain is manifested as digestive crisis or heart burn Management: ± Administer oxygen to alleviate any myocardial ischemia and may help relieve the pain ± Patient should be placed in a supine position with head and thorax elevated ± Give Morphine (8 to 15 mg) or meperidine (50 to 100 mg. depending on severity) via IM or slowly via IV .Cardiovascular Conditions 2.

moist cough.Cardiovascular Conditions 3. Congestive Heart Failure ‡ More often a chronic than an acute condition ‡ Patient gives a history of some cardiac disease Signs / Symptoms: ± Patient becomes anxious. has severe dyspnea. produces pink-tinged sputum and rapid pulse Management: ± ± ± ± Discontinue all procedures Patient kept at semisitting position Oxygen should be administered Give small doses of Morphine (8 to 10mg) or Meperidine (50 to 75mg) via IM for relief ± Rapid digitalization should not be attempted by the dentist and movement only done after consultation with a physician .

Cardiovascular Conditions 4. shortness of breath. or syncope Management: ± Patients are treated with oxygen. proper positioning or administration of narcotic analgesics ± Medical consultations should be sought if indicated . Hypotension Signs/ Symptoms: ± Minor alterations in cardiac activity will show no demonstrable symptoms ± Usually unobserved unless accompanied by obvious symptoms such as pain. headache. Hypertension. dizziness. Cardiac Arrythmias.

Cardiovascular Conditions 5. supine postion but with legs and thorax slightly elevated ± Patient is adequately breathing oxygen is administered with a face mask (note the vital signs) ± Persistent hypotension with signs of cold and clammy skin intravenous infusion of 5% dextrose in water or lactated ringer s solution give Mephentermine sulfate ± To elevate blood pressure (Wyamine) or Phenylephrine (Neo-Synephrine) ± Provide adequate spontaneous ventilation or artificial ventilation . Shock Management: ± Resulting from a hypotensive episode patient is placed in a semireclining.

Respiratory Conditions  Usually results from a pre-existing condition plus an exaggerating factor (emotion or introduction of allergen)  Dentist s first concern: determine whether respiratory exchange is adequate .


Respiratory Conditions 1. unusual excitement.3 to 0.5 ml of a 1:1000 solution) should be given via IM ± Give Aminophylline (0.5 gm) via IV if Epinephrine is not effective ± Bronchodilator sprays with Isoproterenol in a 1:200 solution may be used (may be repeated in 10 to 20 minutes if necessary) ± Consult a physician if the attack is other than mild . Asthma ‡ Almost 50% results form allergy to external allergens exposure to a specific allergen. emotional stress or infection ‡ Ingested food and drugs may produce the condition ‡ May range from mild to severe Signs/ Symptoms: ± Manifested by wheezing type of respiration with expirations much more affected than inspiration Management: ± For severe conditions where breathing is problem.25 to 0. oxygen should be administered but cautiously so as not to trap air ± Epinephrine (0.

Emphysema ‡ May either be acute or chronic ‡ Characterized by dilation of the alveoli and distal bronchioles Signs/ Symptoms: ± Chronic: coughing spell causing an asthma like attack Management: ± Most effective: Bronchodilator sprays (with 1:1000 epinephrine or 1:200 isoproterenol) ± Emphysematous type: appointments should be during the afternoon to give more time to clear the tracheobronchial tree and reduce possible difficulties .Respiratory Conditions 2.

or tracheobroncheal tree Management: ± Attempt to retrieve any body while still in the pharynx by instructing the patient to hold his mouth open and refrain from swallowing or taking a deep breath ± If object cannot be retrieved: patient should be induced to cough forcefully this may release and expel object ± if breathing is sufficient and partial oxygenation is maintained but cannot dislodge the object. . Mechanical Respiratory Embarrassment ‡ Rare/ unusaul lodging of foreign bodies in the larynx. dentist should not hesitate to perform a cricothyrotomy (needle or tracheome is inserted in the midline through the cricothyroid membrane ) given that the obstruction must be at the level of the vocal cords and superior to the cricothyroid cartilage.Respiratory Conditions 3. trachea. patient must be taken to the hospital ± If effective ventilation is reduced.


severe headaches. hypoxia or hypercarbia .Nervous System Disorders  Usually manifested by a loss of conciousness. muscle weakness or paralysis of specific muscles  Could occur from causes such as: drug toxicity. convulsive seizures.

and muscle soreness after an attack ‡ Petit Mal Convulsions ± Loss of consciousness is the predominant symptom ± The eyelids and sometimes the head move synchronously ± Seizure lasts only for a short while and usually has no afteraffects . vomiting.Nervous System Disorders 1. Epilepsy ‡ Occurs in about 5% of the population ‡ Characterized by loss of conciousness. involutnary muscle movements and disturbances of the autonomic nervous system ‡ Grand Mal Convulsions ± Characterized by excessive muscular activity. loss of consciousness and muscle rigidity ± Patient becomes apneic ± May fall into exhaustive sleep or exhibit headache.

IV Pentobarbital sodium (Nembutal) or Secobarbital sodium (Seconal) is given slowly to prevent the attack  Patients should be ventilated when necessary  Severe convulsions: patient is given 20-40mg of succinylcholine chloride via IV or double the dose via IM .prevent severe injury to lips and tongue .save the patient s life  Impending seizure is warned by the patient.Nervous System Disorders Management:  Maintain patent airway (make sure patient is breathing adequately)  Prevent any bodily injury form occurring during convulsion  Dentist should keep a well-padded tongue blade available .may help establish airway .

Cerebral Vascular Emergencies Signs/ Symptoms: ± Weakness or paralysis of extremities ± Sudden flaccid paralysis of the side of the face or slurred speech ± Severe unilateral headache preceding other symptoms Management: ± Maintenance of patent airway ± Adequate ventilation with oxygen consulted until a physician is 3.Nervous System Disorders 2. Syncope (fainting) ‡ Most common medical emergency .


Diabetes Mellitus ‡ Common condition affecting 1.5% to 2% of the population. ‡ Caused by a disorder of carbohydrate metabolism resulting from insulin deficiency and producing hyperglycemia and glycosuria. .

Non-Insulin dependent Diabetes Mellitus (Type II) .Diabetes Mellitus 2 types: a. Insulin dependent Diabetes Mellitus (Type I) b.

Auto-immunity 3. absolute lack of insulin caused by a reduction in the beta-cell mass.2 2.2. Genetic Susceptibility HLA DQ3. Environmental factors . Triad for islet cell destruction: 1. HLA DR3 HLA DQ 1.Type I (IDDM) ‡ This form of diabetes results from a severe.

Measles. ‡ Viruses: . Has destructive effect on B-cells. Streptozotocin Antibiotic used for treating metastatic cancer of pancreatic islets.Western countries have greater susceptibility than Asian countries. Rubella.Environmental factors ‡ Race: . Coxsackie B virus ‡ Chemical toxins: a. .

Pentamdine Drug used for the treatment of parasitic infections.Oxygenated pyrimidine derivative used to produce purple dye murexide. c. initiating immune-response.b. . Others: ‡ Ingestion of Cow s milk early in life Has higher incidence of IDDM and anti-bodies against Bovine Serum Albumin. Alloxan .

Cell damage Insulin Diabetes Mellitus .Cell Damage (Insulitis) Autoimmunity to B-cells Immune B.Pathogenesis Causative agent B.

2 Metabolic defects: a. Insulin resistance . Derangement in insulin secretion b.Type II NIDDM ‡ Is a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency.

Diabetic Coma 1.Acute metabolic complications of Diabetes mellitus A. Diabetic Ketoacidosis 2. Non-ketotic hyperosmolar coma B. Insulin Shock .

thirst. Liver. Skeletal muscles. warm and dry skin. respiratory difficulties. Kidneys Symptoms: Nausea. xerostomia. . Diabetic ketoacidosis stimulated by severe insulin deficiency coupled w/ absolute or relative increases of glucagon. dehydration Organs affected: Brain.Diabetic Coma 1. Danger: Ketone body formation. vomiting.

IV Insulin . Sodium Bicarbonate 2.Diabetic ketoacidosis Management: 1.

Diabetic Coma 2. Symptoms: Polyuria. Glycosuria. Non-ketotic hyperosmolar coma a syndrome engendered by the severe dehydration resulting from sustained hyperglycemic diuresis. Organs affected: kidneys and body tissues. tremors. seizures. Danger: severe dehydration and shock. . w/c is coupled w/ an inability to drink water.

Indication: Type II DM Contraindication: Type I DM . sulfonylurea oral hypoglycemic drug.Non-Ketotic hyperosmolar coma Management: 1. 3. IV fluid Insulin Sodium and potassium Tolbutamide (Orinase) . 4.a first generation potassium channel blocker. 2.

Cold perspiration .Hunger -Mentally confused .Weakness . Symptoms: .Easily irritated and anger .Acute metabolic complications of Diabetes mellitus B. Insulin Shock (Hypoglycemia) ‡ Critical decreased in blood sugar level ‡ Caused by excessive insulin intake or premedications.

Insulin shock Management: 1. In extreme cases: Glucagon HCL may be given via IV or IM. candy or any sugared drinks. 2. Few lumps of sugar. .

Prolonged paresthesia . . Danger: .Toxicity due to very slow hydrolysis of ester compounds .Convulsion Management: limit the convulsive state by Barbiturates.Cholinesterase inactivity ‡ Caused by an inactive or insufficient Plasma cholinesterase.


‡ More often in women 2. Toxic nodular goiter . Diffuse toxic goiter (Grave s Disease) b.forms: a.Hyperthyroidism (Thyrotoxicosis) ‡ Hypermetabolic state caused by elevated levels of free T3 and T4 in the blood.

Diffused Toxic Goiter ‡ Grave s Disease ‡ Diffusely enlarged. highly vascular thyroid gland ‡ Common in young adults ‡ Disorder of immuneresponse .

Toxic Nodular Goiter ‡ Plummer s Disease ‡ Nodules within the gland while the rest of the glandular tissue is atrophied ‡ Common in older patients ‡ Arises from longstanding nontoxic goiter .

Clinical signs and Symptoms ‡ Exopthalmos ‡ Enlarged thyroid ‡ Muscle weakness and Fatigue ‡ Increased Neuromuscular and sympathetic activity ‡ Increased pain sensitivity ‡ Increased BMR ‡ Excessive perspiration ‡ Tachycardia ‡ Excessive Heat .

Oral Manifestations ‡ Accelerated tooth erption ‡ Marked loss of alveolar process ‡ Diffused demineralization of the jawbone ‡ Progressive periodontal destruction .

Management ‡ Contraindication of epinephrine ‡ Higher dosage of local anesthetics. sedatives and analgesics: Since patient has increased tolerance to CNS depressants In case of impending thyroid crisis: ‡ Sedate the patient ‡ Application of cold packs to lower body temperature ‡ Oxygen mask should be used .

Tapazole 2. Thiocyanate (SCN-) b.Management Thyroid Inhibitors 1. Antithyroid drugs Inhibits the iodination of tyrosin moities and coupling of Iodotyrosines. Perchlorate (Cl0-4) . Propacil b. a. a. Ionic Inhbitors Block the iodide transport mechanism.

4. Radioactive Iodine sequestered by the gland and results in localized destruction of thyroid tissues.Management Thyroid Inhibitors 3. Iodide In large doses. inhibits proteolysis of Thyroglobulin where increasing amounts of thyroid hormone are confined within the colloid and not released in the blood. .

Cretinism .Hypothyroidism 1. . ex. Endemic Cretinism Due to dietary lack of iodine. Sporadic Cretinism Due to congenital developmental failure in gland formation. Diffused nontoxic goiter b. a.Retardation of both physical and intellectual growth in children.Becomes evident over ensuing weeks to months. .

Clinical Signs and Symptoms ‡ ‡ ‡ ‡ ‡ Dry. broad nose Overly large protuberant tongue ‡ Impaired skeletal growth ‡ Retard development of brain . rough skin Widely set eyes Periorbital puffiness Flattened.

Oral Manifestation ‡ Teeth are usually poorly shaped and carious ‡ Gingiva is inflammed or pale and enlarged ‡ Larger maxilla and Mandibular teeth .

Myxedema Hypothyroidism in older child or adult .Hypothyroidism 2.

Clinical Signs and Symptoms ‡ Slowing physical and mental activity ‡ Cold intolerance ‡ Apathy ‡ Periorbital edema ‡ Dry. thickened and enlarged tongue .

Levothyroxine Sodium (Synthroid) b. ‡ Dosage should be adjusted ‡ Thyroid Hormone replacement therapy: a. Thyroid tablets (thyrar) . Narcotics). Liotrx (Euthroid) d. Liothyronin Sodium (Cytomel) c.Management ‡ Hypothyroid patients have difficulty in withstanding stress and tend to be sensitive to all CNS depressants (Esp. Thyroglobulin (Proloid) e.

Primary Chronic Adrenocortical insufficiency 3. Primary acute Adrenocortical insufficiency 2. ‡ Caused by a deficiency of ACTH 1. Secondary Adrenocortical insufficiency .Adrenal Insufficiency (Hypoadrenalism) ‡ Caused by any anatomic or metabolic lesion of the cortex that impairs the output of cortical steroids.

As a crisis in patients w/ chronic adrenocortical insufficiency precipitated by any form of stress that requires an immediate increase in steroid output from glands incapable of responding.From too rapid withdrawal of steroids from patients whose adrenals have been suppressed by long-term steroid administration.Primary Acute Adrenocortical Insufficiency Danger: Adrenal Crisis .From Failure to increase the level of administered steroids during stress in a bilaterally adrenalectomized patient.As a result of some massive destruction of adrenals . . .w .

Clinical Signs and symptoms ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Fatigue High Fever Headache Shaking chills Tacypnea Skin rash Rapid Heart rate Profound weakness Excessive sweating of face and palms Darkening of the skin Dehydration .

Management Risk Factor: ‡ Dehydration ‡ Premature withdrawal of predisone too early ‡ Physical stress Treatment: . .IV fluid or vasoconstrictors in case of hypotension .Immediate injection (IV/IM) of hydrocortisone .Monitor patient s BP every 3 to 5 mins.

. Women Causes:  Atrophy of adrenal glands  Destruction of adrenal glands  Lack of ACTH  Idiopathic .Primary Chronic adrenocortical insufficiency ‡ Addison s Disease .Caused by any chronic destructive process in the adrenal cortex.90% of the functioning cortical cells have been destroyed. (+) Whites.

Clinical Importance ‡ Lack of Aldosterone secretion .Shock .Melanin pigmentation of mucous membrane ‡ Increased MSH secretion .Hyperkalemia and acidosis .Dehydration .Decreased ECF .Decreased Cardiac output .Increased RBC concentration .

Clinical manifestations ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Weakness Hyperpigmentation Nausea Hypotension Weight Loss Anorexia Hypoglycemia Hyperkalemia .

IV fluid or vasoconstrictors in case of hypotension .Sodium Bicarbonate to neutralize Acidity .Management Risk Factor: ‡ Dehydration ‡ Acidosis ‡ Hyperkalemia ‡ Hypotension Treatment: .NSAIDS and ACE Inhibitors for Hyperkalemia .Monitor patient s BP every 3 to 5 mins. .Immediate injection (IV/IM) of hydrocortisone or Predisone tablets .


Hemorrhagic Tendencies .Prolonged clotting or bleeding Causes: ‡ Hemopathology: Leukemia. hemophilia ‡ Thrombocytopenic purpura ‡ Anti-coagulant therapy ‡ local pathology ‡ hypertension .

Management ‡ The dentist should understand the history of bleeding tendencies. as well as the existence of local or systemic conditions that may prolong bleeding ‡ Bleeding and coagulation time should be ordered and evaluated and preventive measures taken accordingly if any bleeding tendencies exists ‡ Obtain medical clearance from a physician prior to any dental procedures .

Management Anti-Hemorrhagic drugs: 1. . usually anhydrous aluminum a short stick of medication. potassium alum (both are types of alum) or titanium dioxide which is used for stanching blood by causing blood vessels to contract at the site of the wound. Styptics .

Management Anti-Hemorrhagic drugs: 2. Chitosan . Chitosan bonds with platelets and red blood cells to form a gel-like clot which seals a bleeding vessel .topical agents composed of chitosan and its salts.


Increases the cardiac output and stroke volume Pharmacokinetics: .Decreased heart rate and venous pressure .Increases the force of contraction of the myocardium on the failing heart .Emergencies resulting from prescribed medications A.Reduction in heart size . Cardiac Glycosides Pharmacodynamics: .

Cardiac Glycosides ‡ Digoxin ‡ Digitoxin ‡ Digitalis leaf .Emergencies resulting from prescribed medications A.

Emergencies resulting from prescribed medications B. Lente) ‡ Tolbutamide (Orinase) ‡ Chlorpropamide (Diabenese) C. PZI. NPH. Anti-Hyperglycemic drugs ‡ Insulin (regular. Anti-Coagulant ‡ Warfarin (Coumadin) D. Thyroid medications ‡ Thyroid extracts ‡ Levothyroxin (Synthroid) ‡ Liothyronin (Cytomel) .

Emergencies resulting from prescribed medications E. Psychosedatives (tranquilizers) ‡ Meprobamate (Equanil) ‡ Diazepam (Valium) ‡ Chlordiazepoxide (Librium) ‡ Chlorpromazine (Thorazine) ‡ Trifluoperazine (Stelazine) .

Anti-Hypertensives: ‡ Reserpine (Serpasil) ‡ Guanethidine (Ismelin) ‡ Methyldopa (Aldomet) . Steroid hormones: ‡ Prednisone ‡ Hydrocortisone (Solu-Cortef) ‡ Dexamethasone (Decadron) G.Emergencies resulting from prescribed medications F.

Anti-Convulsants: ‡ Diphenylhydantoin (Dilantin) ‡ Phenobarbital ‡ Primadone (Mysoline) I. Antiarrhythmics: ‡ Quinidine ‡ Procaine amide .Emergencies resulting from prescribed medications H.


Cardiopulmonary Resuscitation ( CPR ) -All dentists should understand the basic rudiments of CPR. .

A = Airway ‡ The most important aspect of CPR is to establish the airway of the patient ‡ All unconscious require that at least this step be carried out. controlled ventilation is impossible that may result in rapid development of hypoxia and hypercarbia. ‡ Hypoxia the body is deprived of adequate oxygen supply. ‡ Without airway. .

B = Breathing
‡ Breathing is never attempted in the absence airway establishment. ‡ Air or oxygen maybe forced into the patient s lungs by a resuscitator such as an Ambu bag or a mouth-to-mouth or mouth-to-nose breathing. ‡ In using Ambu bag, the dentist or the assistant should be certain that there are no leaks around the mask, which would prevent sufficient air from being forces into the lungs.

In mouth-to-mouth ventilation:
1. The head is tilted backward 2. The nose is compressed between the thumb and forefinger to prevent air leakage. 3. The operator should take a deep inspiration before each expiration into the patient s mouth. 4. One cane readily determine if the air is reaching the patient s lungs by observing the rise and fall of the chest wall.

C = Circulation
‡ After doing steps A and B, check the status of the circulation by palpating for the presence of the carotid pulse in the neck. ‡ While head extension is maintained with one hand, the other hand locates the victim s larynx. The finger are then moved laterally into the groove between the trachea and the muscles at the side of the neck where the carotid pulse can be felt. ‡ Weak pulse = circulatory depression ( not collapsed ) ‡ No pulse = need to initiate CPR.

The fingers then run along the rib cage toward midline to locate the inferior border of the sternum. the lower margin of the rib cage is located with the middle and index fingers of the hand closest to the victim s feet. 2. 5. The clinician should be positioned at the side of the patient. 3. 4. The heel of the second hand is placed in the midline in the lower portion of the sternum. The operator s elbow should be straightened and the shoulders positioned directly over the hands. The victim must always be on his back on a firm surface in the horizontal position for external chest compression to be effective. .Steps in CPR: 1.

9. . 7. The hands should not be allowed to bounce free from the sternum lest the next compression be delivered forcefully that can cause trauma or harm. If possible.Steps in CPR: 6. The time allowed for the release should be equal the time required for compression. If there is still no pulse felt. a ventricular fibrillation should be done. 8. continue CPR until help is summoned. Pressure is then released allowing the heart to refill.

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