2. BE PREPARED……..
The meaning 0f the motto is
that a Scout must prepare himself by Previous
thinking out and practicing how to act on any
Accident or emergency so that he never taken by
surprise
- Robert Baden Powell
3. INTRODUCTION
A medical emergency is an injury or illness
that is acute and possess an immediate risk
to a person’s life or long term health
4. The dental office’s successful management
of medical emergencies requires preparation,
prevention and response not just by the
dentist but by all dental staff.
Adequate preparation for emergencies
reduces the possibility of an emergency
occurring and further complications if it does
occur. .
5. PREPARATION STEPS INCLUDE:
Taking and reviewing a comprehensive medical and dental history.
Providing minimum basic life support (BLS) training for providers
and staff.
Advanced Cardiac Life Support (ACLS) or Pediatric Advanced Life
Support (PALS) training especially for those administering
sedation and general anesthesia.
Initiation and coordination of an office emergency team.
Organizing an emergency drug kit and equipment.
Retraining on a regular bas
6. INTERACTING WITH CHILD PATIENT
Smile
Touch or hold child’s
hand or foot
Do not use equipment
without first explaining
what you will do with it
Let child see your face
Stop occasionally to find
out if child understands
Never lie to child
7. PEDIATRIC AGE CATEGORIES
Newborns and infants: birth to 1 year
Toddlers: 1–3 years
Preschool: 3–6 years
School age: 6–12 years
Adolescent: 12–18 years
8.
9. PREPARATION
Four steps critical in preparing the office
and staff to recognize and effectively manage
medical emergencies
The ability to properly perform BLS
functioning dental office emergency team
Ready access to emergency assistance
The availability of emergency drugs and
equipment
10. PEDIATRIC BASIC LIFE SUPPORT
Defined as
position -Head tilt
chin lift
Airway
Breathing
Circulation
defibrillation
11. AIRWAY AND BREATHING
ASSESSMENT OF VENTILATION
Look-chest moving
listen and feel –exchange of air against rescuer
cheek
IN ABSENCE OF SPONTANEOUS BREATHING
Rescue breath are delivered
infant and child :12 – 20 breath per minute(1
breath every 3-5 seconds)
Pubescent patient :10 – 12 breath per minute
(one breath every 3-5 seconds)
13. CIRCULATION
Palpation of carotid artery(>1 year)
Brachial pulse in infants(<1 year)
Radial pulse in child
In absence of palpable pulse:
Chest compression should be performed with
EMS
16. EMERGENCY TEAM
Team member responsibilities
Member 1 (first person on scene of
emergency)
Remain with victim
Activate office emergency team
BLS as necessary
Member 2 Bring emergency equipment to scene
Member 3(and other members of dental
offices staff)
Assist as necessary
Activate EMS
Meet and escort EMS to office
Assist with BLS
Prepare emergency drugs for
administration
Monitor and record vital signs
22. COMMON MEDICAL EMERGENCIES
Foreign body induced airway obstruction
Allergic reaction or anaphylaxis
Drug over dosage
acute asthmatic attack
Seizures
Hypoglycemic attack
syncope
23. INCIDENCE OF SPECIFIC EMERGENCY SITUATION
Situation # Incidents
Syncope (fainting) 75 (mostly parents)
Hysteria 23 (mostly children)
Allergy, mild 22
Seizures 13
Hypoglycemia 9
Hyperventilation 7
Aspiration 5
Respiratory distress 4
Bronchospasm 3
Airway obstruction 3
Allergy, anaphylaxis 1
Drug overdose 1
Local anesthesia overdose 1
Cardiac arrest 1
Source: 2004 AAPD, “Pediatric Emergencies in the Dental Office”
26. MANAGEMENT
PABCD
Sit patient upright or in a comfortable position
Administer 02 via face mask or Nasal cannula at a
flow rate of 3-5 l/min
Administer bronchodilator
If bronchodilator is ineffective, administer
epinephrine
Call for emergency medical services with
transportation for advanced care if indicated
27. GENERALIZED TONIC CLONIC SEIZURE
Period of muscle rigidity followed by muscle
contraction and relaxation lasting for 1 -2
minutes
Positive medical history
Typical pre seizure appearance –aura
Loss of consciousness
28. MANAGEMENT
P position supine
A,B,C (respiratory and cardiovascular
stimulation noted during seizure)
D(definitive care)
Protect victim from injury gently hold arms and
legs preventing uncontrolled movements do not
hold so tightly
If convulsion last for >5 minutes or reappear at
short interval dial EMC
Administer Diazepam 0.3 mg/kg IV
29. ANAPHYLACTIC SHOCK
Sudden and generalized manifestation of symptoms:
Skin : urticaria
Erythema
pruitis
Respiratory system : dyspnoea
stridor
GI System : nausea
vomiting
GI pain
Urinary incontinence
Tachycardia
cyanosis of nail beds
Unconsciousness
Cardiac arrest
30.
31. MANAGEMENT
D
PABC
Administer 0.15ml 1:1000 adrenaline sc or
IM
Dial EMC to shift child to the hospital
Maintain PABC
Monitor vital signs
Repeat adrenaline in five minutes
32. LOCAL ANAESTHESIA OVERDOSAGE
Manifestation appearing suddenly or during
L.A administration
Inarticulate and confuse state of mind
Dizziness
Generalized seizures
unconsciousness
33. MANAGEMENT
Reassure patient
Assess and support airway, breathing, and
circulation (CPR if warranted)
Administer oxygen
Monitor vital signs
Call for emergency medical services with
transportation for advanced care if indicated
35. MANAGEMENT
Assess and support airway breathing and
circulation
Administer oxygen
Monitor vital signs
Establish iv access and reverse with
Flumazenil 0.01 mg/IV at a rate not to exceed
0.2 mg/min
Monitor recovery (for at least 2 hours after the
last dose of flumazenil) and call for emergency
medical services with transportation for
advanced care if indicated
36. OVER DOSAGE OF NARCOTIC
Decreased responsiveness
Respiratory depression
Respiratory arrest
Cardiac arrest
37. DEFINITIVE TREATMENT
ABC
Monitor vital signs
Reverse with naloxone 0.01 mg/kg IV ,IM
subq
Monitor recovery
Administer oxygen
38. ACUTE AIRWAY OBSTRUCTION
Child grasps his throat
–universal sign of
choking
Unable to breathe
cough speak
Cyanosis
Unconsciousness
Cardiac arrest if not
managed
39.
40. DEFINITIVE TREATMENT
Clearing the airway
If child is able to cough
then child is turned to a
left lateral position on
the dental chair with face
down
Cough encouraged in
this position by back
blow between the
scapulae
This expel the foreign
body
42. If child is conscious
but choking an
attempt is made to
expel the foreign
body with upward
thrust using Heimlich
maneuver
43.
44. If unconscious –dial
EMC ,place the child
n supine position
give inward and
upward thrust 5
times
Finger sweep in oral
cavity
If unsuccessful -
cricothyrotomy
45. ACUTE HYPOGLYCEMIC ATTACK
Positive medical history
type 1 diabetes mellitus
Bizarre and confused behaviour
Loss of consciousness
convulsions
46. DEFINITIVE TREATMENT
If conscious-oral carbohydrate
If unconscious-dial EMC
Administer glucagon 1mg IM
50% dextrose IV
47. SYNCOPE
Extremely tense and rigid
Cold extremities
Nausea and dizziness
Loss of consciousness
48. DEFINITIVE TREATMENT
No drugs usually indicated
Proper supine position with feet elevated
slightly
Loosen clothing
Cold towel at the back of neck
Respiratory stimulant –ammonia
Maintain ABC
49. FOR ALL EMERGENCIES….
Discontinue dental treatment
Call for assistance/someone to bring oxygen
and emergency kit
Position patient: ensure open and unobstructed
airway
Monitor vital signs
Be prepared to support respiration, support
circulation, provide cardio pulmonary
resuscitation (CPR), and call for emergency
medical services
50. CONCLUSION
The dentist and the staff must be trained to
handle any emergency which can arise in a
dental set up . Having medical personnel on
call is very useful under such circumstances .
However ,one should always remember that
the best form of managing a medical
emergency is by prevention.
51. REFERENCES
Malamad.S.F . Medical Emergencies In The Dental
Office ,6th Edition, 2007, Mosby Elsevier
Pediatric Advanced Life Support: 2010 American
Heart Association Guidelines For Cardiopulmonary
Resuscitation And Emergency Cardio-vascular Care
Jimmy R.Pinkham ,Pediatric Dentistry Infancy
Through Adolescence 4th Edition,2005
Emergency Medicine in Pediatric Dentistry:
Preparation and Management ,Stanley F. Malamed,
DDS,October 2O10,VOL:31,NO:10 CDA journal
M.S. Muthu,pediatric Dentistry Principles And
Practice,2nd Edition,2011