CHAPTER 10 Medical and Dental Emergencies
The combination of pain, stress, infection, and anesthesia use in the dental setting may contribute to medical emergencies. Evaluation includes completion of a comprehensive health history, in-depth history of present illness, assessment of vital signs, physical assessment, and thorough emergency preparation in the dental setting. Instances of when to request a medical consult regarding a patient and/or when to consider a situation an emergency and activate the Emergency Medical Service (EMS) system are discussed in this chapter.
Patient’s health history includes BOTH medical and dental history, as well as in-depth history of present illness. Crucial to BOTH the diagnosis and treatment of and prognosis for conditions experienced by dental patients. Modifying dental treatment as indicated by the health history creates less risk of emergencies in the dental setting.
Vital signs include blood pressure reading, pulse rate, respiration rate, temperature reading (if needed), pupil size. Obtained as a baseline for patient. Specific vital signs are retaken as needed. Information in the following is taken from the “7th Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure” (2003).
Emergencies may be minimized or prevented by the pretreatment evaluation of physical classification status. The ASA (American Society of Anesthesiologists) physical status classification is used to determine risks and necessary modifications before treatment.
When emergency situations occur, mandatory that ALL personnel in the dental setting know procedures to be followed, location and use of the emergency kit and oxygen, possibly a portable defibrillator and pulse oximeter, and are able to provide basic life support (BLS). MAIN management of emergency involves BLS; drugs delivered are of secondary importance. Kit can be assembled by personnel or purchased as a unit and must not contain expired drugs. Personnel are MORE likely to be familiar with one they have organized, which is MORE likely to contain articles that meet needs of particular dental setting. Kit MUST be readily available during treatment time.
ALL staff must be trained to use emergency kit’s contents. Periodic emergency drills and posting the telephone numbers of EMS or other appropriately trained healthcare providers is also recommended at the dental setting. Many states require all dental settings to have portable automated external defibrillator (AED).
COMMON medical emergencies that may occur in the dental setting include syncope, hyperventilation, airway obstruction. After emergency, patient should be called at home or at hospital later in the day to ensure well-being. Cardiovascular and other less common emergencies in the dental setting are discussed later.
|Sex|| Male ⌧ Female||The patient dreads dental appointments but currently experiences less anxiety because she has been following 6-month oral prophylaxis schedule and her appointments take less time. Her dental health is good. After her medical history is updated and her vital signs are obtained, bitewing radiographs are taken. While the dental hygienist leaves to process the radiographs, the patient remains seated in an upright position. Upon returning to the patient, the dental hygienist notes that she is breathing rapidly, and she complains of tightness in her chest and tingling in her fingers.|
|Chief Complaint||“I just hate being here and I hate all that happens here!”|