Medical emergenicies in OMF surgery

1. Diagnosis & Management of
Common Medical Emergencies in
OMF Surgery
Dr. Anushan Madhushanka..BDS, MD(OMFS), MFDRCSI
Senior registrar in OMFS.
Colombo north teaching hospital, Sri Lanka

2. What is Medical Emergency ?
• Definition
• Basically two components
1.Serious medical problem
2. Need prompt action to save the life

3. Predisposing factors
1. Poor PMH
2. Undiagnosed medical problems- Eg- DM
Murmurs, Arrhythmias,
3. Poor perioperative management of medical
condition eg - DM

4. Common Medical Emergencies in
Surgical ward
• Acute severe asthma
• Anaphylaxis
• Ischemic chest pain
• Status epilepticus
• Hypoglycemia
• Syncope

5. Main aim
Manage emergency untill
specialists comes

6. The role of HO/SHO
***First person in the situation
1.Assemble ward team & equipments
2.Primary survey - A,B,C,D,E & resuscitation
3.Quick Clinical Diagnosis
4.Do proper treatment & procedures
5.Inform – Consultant
6.Communicate other specialties – ICU, Medical ward
7.Transfer pt to ICU, Meddical Ward

7. Acute Severe Asthma
Symptoms and Signs
Wheezing
Inability to complete sentences in one breath.
Respiratory rate > 25 per minute.
Short inspiration & long expiration
Tachycardia.
Rhonci on auscultation
PEFR < 30%

8. Treatment
1. Connect pulp oxymeter
2. Give 100% - O2 – 15L/min
3. Salbutamol 5mg Nebuliser
4. Ipratropium Br - 0.5mg
5. Hydrocortisone 100mg – IV
6. Monitor Spo2, HR, RR,BP

9. • If not improving within 15 min
1. Continue 100% O2
2. Repeat salbutamol nebuliser – every 15 min
3. Inform consultant, transfer to ICU

10. Anaphylaxis
Signs and symptoms
• Urticaria, Rashes,Erythema..
• Flushing
• Laryngeal oedema & bronchospasm
stridor, wheezing and/or a hoarse voice
• Relative hypovolaemia & Hypotension - Shock
• Ultimate cardio respiratory arrest

11. Treatment
1.Primary survey
2.Secure airway, give 100% O2 - 15L/min
3.Remove cause – IV drugs, Blood transfusion
4.Give adrenaline 0.5mg- IM/ 1:1000- 0.5ml - IM
5.Repeat adrenalin – every 5min untill
BP,pulse,Spo2 better
**** DO NOT FEAR FOR ADRENALINE

12. Cont..
6. Give 0.9% saline 500ml/15min up to 2L
7. Give - Chlorphenamine 10mg IV
Hydrocortisone 200mg IV
Salbutamol Nebulier
8. Inform Consultant & handover to specialist

13. Chest Pain
Features of cardiac ischaemic chest pain
• Central chest pain – gripping, constricting
• Lasting for 15-30 min
• Triggered with anxiety, exercise or at rest ?
• Radiating to L/S arm or lower jaw
• Tachycardia & tachypnoea
• Relief with rest, GTN tabs
• PMH – Angina,MI
**Differentiate with other causes of chest pain – Need ECG
If pt complaint chest pain, DO ECG

14. • Stable angina – Ischaemic pain on excertion
• NSTEMI - Ischaemic pain at rest, ST depression, Enzymes +/-
• STEMI – Ischaemic pain at rest
Severe pain, sweating, Breathlessness, Vomiting
Arrhythmia, Hypotension, Altered consciousness
ECG – ST elevation, Cardiac enzyme + ve
Cardiac arrest & death – finally
NSTEMI – Unstable angina, Evolving MI, Subendocrdial MI
STEMI – Frank acute MI

15. Treatment
1. Rest
2. GTN - I tab SL – stable angina usually resolves
3. Aspirin 300mg orally - chewed/Crushed
4. 100% O2 via face mask 15 L/min
5. Morphine 5- 10mg/ SC + metclopramide
10mg/IV
6. Check ECG – Any changes.
7. Inform medical ward / transfer to ICU/ETU

16. ECG changes
• STEMI/Acute MI

17. Status Epilepticus
• Clinical features
1.Brief warning
2.Sudden loss of consciousness
3.Rigid & Jerking limbs - Seizures
4.Bitten tongue & Frothing mouth
5.Spontaneous remission in few minuets

18. Treatment
• Seizures > 5 min – Start treatment
• Secure airway & give O2
• Give IV – Lorazepam 4mg over 2min or
IV – Diazepam 10mg over 2 min
Difficult Canulation ?
Rectal root or Buccal Midasolam

19. • If not improved
IV – Diazepam infusion –
100mg in 500ml of 5% Dextrose
Rate - 3mg/kg/24hr
*** Caution – All IV Benzodiazepines –
Respiratory depression
***Monitor respiration, SpO2, Pulse, BP

20. Hypoglycemic attack
Features
• Tremor
• Weakness
• Sweating
• Headache
• Fitting / seizures
• Unconsciousness

21. Treatment
• Conscious - Oral glucose
• Unconscious - 50% Dextrose, 50ml – IV
Buccal glucose paste
• Check – RBS – Rise up to 5mmol/l
• Check in any hypoglycemic drugs?
Sulphonylurea over does
Insulin over dose

22. Syncope/Simple faint
Features
• Cold peripheries
• Slow pulse rate
• Pallor and sweating
• Vomiting
• Loss of consciousness
• Low BP

23. Treatment
• Immediate supine position
• Primary survey
• Raise legs up
• Loosen any tight clothing in neck
• Start IV - 0.9% saline if canula in situ
• Check BP, Pulse, RBS

24. Shock
• Definition – Generalised inadequate perfusion
Features
• Systolic BP < 90mmHg
• Central & peripheral cyanosis
• Pallor
• Tachycardia
• Delayed capillary refillig

25. Treatment
• Primary survey
• 100% O2, 15L/min
• Fast IV crystalloid/colloids – Use 2 Wide bore
needles
• Infusion rate 500ml/15min up to 2L
• Monitor BP, Pulse, SpO2, RR
• Call emergency team, transfer to ICU

26. Thank You