Medical Emergencies in Dental Office

Diabetics should be scheduled in the morning

Hx of MI or other cardiac, late morning/early afternoon

Oxygen - 4-6L/min

Ammonia Inhalant - for: vasodepressor, syncope, respiratory depression

one 0.3ml vaporole

Benadryl - Diphenhydramine - delayed allergy, 2nd drug in anaphylaxis

histamine antagonist

50mg followed by 2 25-50mg oral tablets (50mg = 1mL vial)

Albuterol - for acute asthma, bronchospasm (1-2 puffs)

Epinephrine - acute alergy, asthma not responsive to inhaler

EpiPen adult: 0.3mg child: 0.15mg

repeat every 5-10min

Glucose - hypoglycemia, need conscious pt.

20g of sugar

hypoglycemic <70mg/dL

Asprin - acute MI, unstable angina 2-4 tablets of 81mg chewable

Nitroglycerin - angina, acute MI 1-2 sprays on tongue, do not exceed 3 doeses/15min


What to do first:

1) Terminate procedure

2) Activate office response - call for help

3) Position pt appropriately

Upright - asthma, angina, acute MI, hyperventilation, hypoglycemia

Supine - unconscious pt, syncope, seizure, orthostatic hypotension, severe anaphylaxis

Trendelenburg - vomiting pt, foreign body obstruction,


When to call 911

-syncope - incomplete recovery after 10 minutes

-whenever epinephrine has been administered

-first time chest pain

-suspected acute MI

-atypical seizure

-hypoglycemic with loss of consciousness


Syncope - sudden drop in bp to brain

1) supine position

2) ammonia inhalant vaporole

3) O2

4) BLS - assess vitals every 5 min

5) call 911 if no recovery after BLS or incomplete recovery after 10-15min


Postural Hypotension

1) supine w/ feet elevated

2) O2

3) BLS - vitals /5min, raise in incrememnts


Asthma

1) upright position

2) calm pt.

3) 1-2 puffs of albuterol

4) O2

5) BLS


Angina

1) what ever is most comfortable for pt.

2) Nitroglycerin

3) O2

4) BLS

-if longer than 15min consider MI, call 911


MI

1) position most comfortable

2) call 911

3) BLS

4) O2

5) asprin 2-4 tablets

6) consider 35-50% NO for pain releif


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