2 – Medical Emergencies

2

Medical Emergencies

Géza T. Terézhalmy, DDS, MA, and Levente G. Batizy, DO

In the past, oral health-care practitioners might have expected to encounter one life-threatening situation among their patients during years of practice. With advances in medicine, and the prevalence of dental disease in a geriatric patient population, the clinician may now be called on more often to provide dental care to medically and/or pharmacologically compromised patients. Being ill-prepared for such eventualities is inexcusable. Being the subject of public censure or accused of negligence in the office is an agony best prevented. Assessment of the patient and recognition of actual or potential problems are imperative in initiating proper treatment and/or summoning proper help. A system of patient classification adopted by the American Society of Anesthesiologists (Table 2-1), with the primary purpose of quickly and easily placing each patient in an appropriate risk category, can provide guidelines for the course of patient management. This classification must be made during the physical evaluation of the patient before any dental treatment is initiated.

Consequently, oral health-care providers must be able to recognize high-risk patients and initiate immediate correction of life-threatening problems. Although there are a number of techniques available for maintaining life in emergency situations, many require sophisticated devices and valuable time that the patient simply may not have. Oral health-care providers must know how to sustain life with no more than their hands, their breath, a few basic supplies and therapeutic agents, and a great deal of common sense.

Table 2-1 Risk Status Classification for Dental Patients

Risk Status Definition Approach
I No overt systemic condition(s) Routine office care
May require sedation
II Moderate systemic condition(s) Routine office care
Medically stable Appropriate minor modifications
III Severe systemic condition(s) Emergency care
Medically fragile Medical consult
Limited activity Modified office care
Not debilitating
IV Debilitating systemic conditions Emergency care
Constant threat to life Medical consult
Care in a hospital environment
V Morbid patient Maintain basic life support
Not expected to live

Source: Adapted from Anesthesiology 1963;24:111.

Basic Emergency Procedures

Patient evaluation procedures in emergency medicine consist of a primary survey and a secondary survey. The primary survey is concerned with the identification of those life-threatening emergencies (respiratory arrest, cardiac arrest, profuse bleeding) that require immediate attention. The most important examination sign is respiration. The patient’s airway must be open and breathing must be spontaneous. In cases of respiratory arrest, artificial ventilation should be started. Should the patient be in cardiac arrest, cardiopulmonary resuscitation should be initiated. The primary survey also considers profuse bleeding. Attempt to control all serious bleeding by direct pressure.

After completing the primary survey, the clinician should turn attention to the discovery of those problems that do not pose an immediate threat to the patient’s survival, but may become critical if allowed to go uncorrected. The secondary survey consists of the subjective interview and the objective examination. The subjective interview is a conversational information-gathering effort between the patient and the clinician to identify the patient’s primary complaint and any previous relevant experiences. The subjective interview is followed by the objective examination. The objective examination consists of determining the patient’s vital signs, the degree of consciousness, and other signs that along with the patient’s medical history will lead to the most likely diagnosis of the medical emergency.

Emergency Steps

The basic emergency procedures include five fundamental steps that should be taken immediately in every emergency as appropriate:

Step 1 Discontinue treatment and assess consciousness
Step 2 Be sure that the patient has an unobstructed airway
Step 3 Check the pulse rate and its character
Step 4 Check the blood pressure
Step 5 Monitor the rate and character of respiration

If the patient becomes unconscious, proceed to cardiopulmonary resuscitation, Steps 6a-h.

Specific emergencies will require the additional steps listed under the emergency situation.

Cardiopulmonary Resuscitation

Jan 5, 2015 | Posted by in General Dentistry | Comments Off on 2 – Medical Emergencies
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