Prevention and Management of Medical Emergencies
BOX 2-2
Preparation for Medical Emergencies
1. Personal continuing education in emergency recognition
and mahagement
2. Auxiliary staff education in emergency recognition
and management ‘
3. Establishment and periodic testing of a system to
readily access medical assistance when an emergency
occurs
4. Equipping office with supplies necessary for emergency care
Prevention and Management of Medical Emergencies
BOX 2-1
Medical Emergencies Commonly Provoked by Anxiety
though, that many of these diagnoses were presumptive and not completely verified, so the incidence of problems such as “hypoglycemia” may be overstated. The incidence of medical emergencies is higher in
patients receiving ambulatory oral surgery when compared with those receiving nonsurgical care because of the following three factors: (1) surgery is more often stress provoking, (2) a greater number of medications are typically administered to peri operative patients, and (3)
often longer appointments are necessary when performin; surgery. These factors are known to’ increase the likelihood of medical emergencies. Other factors that increase the potential for emergencies are the age of the
patient (very young and old patients being at greater risk), the ability of the medical profession to keep” unhealthy people ambulatory and able to seek dental· care, and the increasing variety of drugs dentists administer in their offices.
Prevention of medical emergencies is the cornerstone of their management. The first step is risk assessment. This begins with a careful medical evaluation that, in the dental office, requires accurately taking a medical history, including a review of systems guided by pertinent positive
responses in the patient’s history. Vital signs should be recorded, and a physical examination (tailored to the patient’s medical history and present problems) should be performed. Techniques for this are described in Chapter 1.
Although any patient can -have a medical emergency at any time, certain medical conditions predispose patients to medical emergencies in the dental office. These conditions are more likely to turn into an emergency
when the patient is physiologically or emotionally stressed. The most common conditions affected or preclpitated by anxiety are listed in Box 2-1. Once those patients who are likely to have medical emergencies are
recognized, the practitioner can prevent most problems from occurring by modifying the manner in which oral surgical care is delivered.
Medical Emergencies Commonly Provoked
by Anxiety
CHAPTER OUTLINE
Serious medical emergencies in the dental office are fortunately, relatively rare. The primary reason for the Iimitcd frequency of emergencies in dental
practice is the nature of dental education that prepares practitioners tu recognize potential problems and mallage them before they cause an emergency. }100\’l’\'(~r, when oral surgical procedures are necess.iry, the increased mental and physiologic stress inherent in such intcrventions
can push the patient with a poorly compensated medical condition into an emergency situation. Similarly the advanced forms of pain and anxiety control tre- ‘quently needed for oral surgery can predispose patients to
emergency conditions. This chapter begins with a presentation of the various means of lowering the likelihood of medic: ~emergencies in the dental office. It also details way) tu ple pall’ fOI clllllgl’lllil’, and dbl:-u~)e~ the linical manifestations and initial management of the more common emergencies.
CHAPTER OUTLINE
PREVENTION
PREPARATION
• Continuing Education
Office Staff Training
Access to Help
Emergency Supplies and Equipment
MEDICAL EMERGENCIES
Hypersensitivity Reactions
Chest Discomfort
Respiratory Difficulty
Asthma
Hyperventilation
Chronic Obstructive Pulmonary Disease
Foreign-Body Aspiration
Gastric-Contents Aspiration
Altered Consciousness
Vasovagal Syncope
Orthostatic Hypotensic n
Seizure
Local Anesthetic Toxicity
Diabetes Mellitus
Thyroid Dysfunctro .
Adrenal lnsufflciency
Cerebrovascular COJl1r- romise