Management of medical emergencies in the dental office

Management Of Medical Emergencies In The Dental Office

• 06/26/22

• Fady Faddoul, DDS, MSD,FICD
• Professor and Vice-Chairman
• Department of Comprehensive Care
• Director, Advanced Education in General Dentistry
• Case Western Reserve University
• School Dental Medicine

Management of Medical Emergencies

• 06/26/22

• Medical emergencies can and do happen
• Advances in medicine
• Longer lifespan
• Multiple medications
• Medically compromised
• Longer appointments

Incidence

• 06/26/22

• A survey done in the 90’s showed that, over a 10 year period, 90% of dentists have encountered at least one medical emergencies.

Types

• 06/26/22

TYPE OF EMERGENCY	NUMBER	PERCENT
Altered Consciousness	17,782	59
Cardiovascular	4,280	14
Allergy	2,887	9.5
Respiratory	2,718	9
Seizures	1,595	5
Diabetes-Related	999	3

Management of Medical Emergencies

• Basic Life Support
• Advanced Life Support

• 06/26/22

Management of Medical Emergencies

• 06/26/22

• Emergency situations
• Managed properly most emergencies are resolved satisfactorily
• Mismanaged even benign emergencies can turn disastrous
• Recognize
• Position
• Stabilize
• Diagnose
• Treat
• Refer

Management Of Medical Emergencies

• 06/26/22

• Recognition
• Prevention
• Preparation
• Basic life support (BLS)
• Cardiopulmonary resuscitation (CPR)
• Specific medical emergencies

Prevention

• 06/26/22

• IS THE BEST TREATMENT
• Know your patient
• Never treat a STANGER

Prevention

• 06/26/22

• 90% of life-threatening situations can be prevented
• 10% will occur in spite of all preventive efforts (sudden unexpected death)

Prevention

• 06/26/22

• Medical History
• Physical Evaluation
• Vital Signs
• Dialogue History
• Determination of Medical Risk
• Stress Reduction

Prevention

• 06/26/22

• MEDICAL HISTORY
• Review
• Update
• Medication
• Medical consultation

Prevention

• 06/26/22

• PHYSICAL EVALUATION
• Length of time since last evaluation
• Vital signs
• Visual inspection of patients
• Referral to physician

Prevention VITAL SIGNS

• 06/26/22

• Blood pressure
• Pulse rate
• Respiratory rate

• Temperature
• Height
• Weight

Prevention

• 06/26/22

• DIALOGUE
• HISTORY
• Putting it all together
• Check accuracy of
• medical history
• Recognize anxiety

Prevention

• 06/26/22

• DETERMINATION OF MEDICAL RISK.
• Ability of patient to safely tolerate dental treatment.
• Does patient represent increased medical risk?
• Can patient be managed in the dental office?

Determination Of Medical Risk

• 06/26/22

• American Society of Anesthesiology
• Physical Status Classification System

ASA I

• 06/26/22

• A patient without systemic disease
• A normal healthy patient

• Can tolerate stress involved
• In dental treatment
• No added risk of serious
• Complications
• Treatment modification
• Usually not necessary

ASA II

• 06/26/22

• A patient with mild systemic disease
• Example:
• -Well-controlled diabetic
• -Well-controlled asthma
• -ASA I with anxiety

• Represent minimal risk during dental treatment
• Routine dental treatment
• With minor modifications
• -Short early appointments
• -Antibiotic prophylaxis
• -Sedation

ASA III

• 06/26/22

• A patient with severe systemic disease that limits activity but is not incapacitating
• Example:
• - a stable angina
• - 6 mos. Post - MI
• - 6 mos. Post - CVA
• - COPD

• Elective Dental Treatment is not Contraindicated
• Treatment Modification is Required
• - Reduce Stress
• - Sedation
• - Short Appointments

ASA IV

• 06/26/22

• A patient with incapacitating systemic disease that is a constant threat to life
• Example:
• - Unstable angina
• - M I within 6 months
• - CVA within 6 months
• - BP greater than 200/115
• - Uncontrolled diabetic

• Elective dental care should be postponed
• Emergency dental care only
• Rx only to control pain and infection
• Other treatment in hospital
• (I&D, extraction)

ASA V

• 06/26/22

• A morbid patient not expected to survive
• Example:
• - End stage renal disease
• - End stage hepatic disease
• - Terminal cancer
• - End stage infectious disease

• Elective treatment definitely contraindicated
• Emergency care only to relieve pain

Prevention

• 06/26/22

• STRESS REDUCTION
• Premedication
• Sedation
• Pain control (intra and post-op)
• Early appointments
• Short appointments

Preparation

• 06/26/22

• Team Effort
• BLS for all office personnel
• CPR for all office personnel
• Emergency drills
• Emergency phone numbers (911)
• Emergency equipment

BASIC LIFE SUPPORT (BLS) CARDIOPULMONARY RESUCITATION (CPR)

• 06/26/22

SBE Prophylaxis

• 06/26/22

• In 2012, the guidelines were updated and now premedication is needed for fewer conditions.
• The conditions for which premedication is necessary includes:
• artificial heart valves
• a history of infective endocarditis
• a cardiac transplant that develops a heart valve problem
• the following congenital (present from birth) heart conditions:
• *unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits
• *a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
• *any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device