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Department of Pedodontic

& Preventive Dentistry


Medical Emergency
used in dentistry

 Guided by – Presented by -

 Dr. RANDHEER Abdul Wahab


Modi
Content
 Introduction
 Common medical emergency in
dental office
 Emergency kit
 Various drugs
 Refrences
INTRODUCTION
 Emergency is a life threatening situation
frequently occurring in dental office.
 Many factors increase such incidence,
that is:-
(1) Older person.
(2) Therapeutic advance in medical
profession.
(3) Long dental appointment.
(4) Increase use & administration of drugs.
 In dental office, these situations are
stress related or involve preexisting
 Common medical emergencies in dental
office –
 1. Unconsciousness –

 Vasodepressor syncope.
 Orthostatic hypotension.
 Acute adrenal insufficiency.

 2. Respiratory distress –
 Airway obstruction
 Hyperventilation.
 Asthma.
 Heart failure and acute pulmonary edema .
3. Altered consciousness
-
Diabetes mellitus ,
hyperglycemia and
hypoglycemia.
Thyroid gland
dysfunction .
Cerebrovascular accident
 4. Seizures
5. drug related emergencies –
 Drug overdose .
 Allergy.
6.chest pain –
 Angina pectoris.
 Acute MI .
7. Sudden cardiac arrest .
Steps to prepare the dental
office for emergency
 Train all office personnel in emergency
procedures before an emergency occurs.
 Post the contact no. of the closer physician ,
emergency services and ambulance.
 Select the items including drugs and the
devices for the emergency in the dental office
and should check them after every 3 months.
Methods to minimizing
emergencies in the dental
office
 Take complete case history including past
medical, dental ,anesthetic experience and
medication.
 Observe the patients stature , built , gait , color
, age , respiration .
 Observe and record the amount of anxiety , use
active listening to determine hidden
nervousness .
 Record blood pressure and pulse.
 Perform any necessary lab investigations.
 Request medical consultant as needed.
Things to remember
 Drugs are not necessary for the management of
most emergencies .
 Primary management of all emergencies is
basic life support.
 When in doubt , never medicates.
 Ideal route of emergency drugs administration
will be IV , as the onset is rapid and the effect
is most reliable using this route.
 Emergency drugs may be administrated IM into
various sites like thigh , the upper outer
quadrant of the gluteal region and the deltoid
region.
 Remember in the absence of effective
Emergency kit
 Module one – basic emergency kit
( critical drugs and equipment).
 Module two – non critical drugs and
equipment.
 Module three – ACLS drugs.
 Module four – antidotal drugs.
Module one
 1. Primary drugs

 Injectable Noninjectable
- Antiallergic Oxygen
-Histamine Vasodilator
blockers
Bronchodilator

Antihypoglycemic
1.Epinephrine
Action:- rapid onset of action, potent
action as bronchial smooth muscle
dilator , antihistaminic properties and
vasopressor properties , increase in
heart rate ,systolic blood pressure
and cardiac output, decrease in
systolic blood pressure.

Side effects – cardiac arrhythmias ,


short duration of action. Pregnancy
,as it reduces placental blood flow
and may lead to premature labor
 . Indications – cardiac arrest ,
anaphylaxis , acute asthmatic attack

 Availability – for IV 1:1000 conc.


And 1:10,000 for IM ---- ADRENLINE
inj.
Dentist may give into the frenulum
under the tongue.
 Dose – 0.3 – 0.5 mg of solution.
 2.chlorpheniramine ,
diphenhydramine
 Action :- prevent histamine access –
receptor in cell----response in
blocked
 Indications – Delayed onset allergic
reactions , definitive management of
acute allergic reaction
 Side effects :-CNS depression,
decrease in blood pressure,
thickening of bronchial secretion
 Contraindications – acute asthmatic
 Availability – chlorpheniramine – 10
mg /ml IV, diphenhydramine – 10 mg
/ ml and phenramine maleate ( Avil )
– amp 1-2 ml IM .
 Noninjectable drugs ;-
 1. Oxygen – important drug.

 Supplied as Compressed gas


cylinders ( E cylinders),provide O2 for
30 min.
Indication :- in respiratory distress.
 Patient with COPD should be given
with caution because apnea may
result
 2. nitroglycerine or amyl nitrate.
 Indications - acute anginal attack or
acute hypertensive episodes
 Contraindications – in hypotensive
patient .
 Action – when it place sublingually , it
acts in 1-2 min.
 Availability – tablet 0.1 , 0.3 , 0.6 mg.
nitroglycerine spray – 0.4 mg /dose
and amyl nitrate vaporous or – 0.3
ml.
 As NITROCONTIN,
NITROCIN,NITROLINGUAL…..
 3. Albuterol/ Metaproterenol:-
 Action :- Bronchial smooth muscle
relaxant property
 Indication;- Acute asthmatic attack
and allergic reaction with
bronchospsm
 Availability:- Albuterol inhaler
(VENTOLIN, PROVENTIL)
 Metaproterenol INHALER ( ALUPENT)
 4.Antihypoglycemic –
 Drug of choice – 50% dextrose
solution .
 Indications – IV dextrose is used to
manage hypoglycemic episode when
diabetic patient is unconscious and
cant swallow.
 Administration – can be given IM or
IV.
 5. Aspirin :-
 Action :- antiplatelet activity--- stop
production of production of
proaggregatory throboxane A2 and
acylation of platelet cyclooxygenase
 Indication ;- Myocardial infarction or
unstable angina
 Availability :- ASALITE, ASPENT,
SPRIN…
 50-100mg /day
Module two
 A). Secondary Injectable drugs
2. Midazolam :-

action :- anticonvulsant activity


Indication :- Prolonged seizures, Local
anesthetic induced seizures,
hyperventilation ,thyroid storm
Availability:- MIDAZ, MIDOSED,
FULSED..
5mg/ml in 1,2,35,10 ml vial
2. Morphine sulphate
 Indications – acute MI .also given in

CHF and intense prolonged and


anxiety.
 Side effects – CNS and respiratory

depressant
 Availability – morphine sulfate 10 mg

/ ml
3. Methoxamine
Action – i adrenergic agonist with almost
exclusively alpha – adrenergic agonist ,
produces mild increase in BP due to
peripheral vasoconstriction.
Indications – treatment of acute adrenal
insufficiency , Syncopal reactions , drug
overdose reaction or allergy.
Contra indication :-high blood pressure
or ventricular tachycardia
Availablity and dose – 10 mg /ml IV or
IM
as VASOXYSL
 4. Antihypoglycemic:-
 5. Hydrocorticosone sodium
succinate .
 Indication – allergic reaction ,
anaphylaxis and adrenal crisis.
 Action – slow onset of action so
epinephrine is still the drug of choice
 Availability :- 50mg/ml 2 ml vial as
 SOLU- CORTEF
 6. Esmolol/ Propanolol ;-
 Action – beta adrenergic blocker

 Indication:- Hypertension, angina

pectoris,
cardiac arrhythmia, post myocardial
tachycardia.
Contraindication ;- COPD, Partial or
cmplete heart block.
Availability :-2.5 mg in 10 ml ampule
as ESOCARD, MINIBLOCK….
 7. Atropine :-
Action/Indication:- in bradyarrythmias
and asystole that is refractory to
epinephrine.
Side effects ;- large doses > 2 mg ----
overdose ----hot, dry skin, headache,
blurred vision, dry mouth and throat,
disorientation, hallucination
Availability:- .5 mg/ml in 1ml vial
 B. Secondary Injectable drugs :-
 1. Aromatic ammonia spirit – it
is used to treat syncope .
 Action – it acts by irritating the
membrane of the upper respiratory
tract ,resulting in stimulation of
respiration and BP.
 Contraindication – in asthma or COPD
may precipitate bronchspasm
 Availability - in silver – grey vaporole
0.3 ml .
 2. Nifidepine:-
Indication:- Hypertension, acute
anginal pain
Side effects :- Excessive hypotension
Availability:- 10mg , 20 mg capsules
as PROCARDIA
Module Three
 1. oxygen
 2.Lidocaine:-

 Action /indication.:- Local anesthetic

and antiarrhythmic action , used in


ventricular
Tachyarrhythmias 1mg/kg body
wt.slow iv bolus over 5-10 min.
Contraindication:- Hypersensitivity,
Bradycardia, Serious conduction
disturbance.
Availability:- GESICARD anhydrous
XYLOCARD
 3.Atropine:-

Action/Indication:- in bradyarrythmias
and asystole that is refractory to
epinephrine.
4. Dopamine :-
Action :- stimulates alpha and beta
adrenergic receptors , release of
norepinephrine
Indication :-Hemodynamically
significant hypotension in absence of
hypovolemia.
Side effects :- Increase heart rate,
ventricular dysrhythmias, nausea ,
vomiting.
Availability:- as INTROPIN 200mg,
400mg, 800mg in 5ml ampules
 5. Morphine :- for ischemic chest
pain.
6. Verapamil :-
Action :- Ca blockade --- effect on
smooth muscle of coronaries ----
increase myocardial blood flow.-----
decrease in peripheral resistance.
Indication:-Paroxysmal
supraventricular tachycardia
Side effects :- transient decrease in
blood pressure, nausea, constipation,
headache, flushing.
Avai lability:- as CALAPTIN, VASOPTEN,
VERAMIL
Module four
 Antidotal drugs :-
2. Naloxane

Action:-Reverses all action of


opoids…. Competitive at receptors.
Indication :- Antagonizes opiod
action like respiratory depression,
sedation .
Availability :- .4-2mg/ml in 1ml
ampule IV ,IM or SC every 2-3 min.
Contraindication:- Hypersensitivity
Alternative drug :- Nalbuphine.
Side effects :-
Nausea, vomiting, hypertension.
 2.Flumazenil:
Action/ Indication :- reverses excessive
sedation caused by benzodiazepine
Side effects :- rebound anxiety
Availability:- .1 mg/ml in 5ml and 10ml
multidose vial as ROMAZICON
 3.Physostigmine:-
Action/ Indication:- reversible
cholinsterase
----crosses blood brain barrier---
reverses emergence delirium.
Side effects:-
-Increased salivation -bradycardia-
emesis
-involuntary urination and defecation
Availability:- 1 mg/ml in 2ml ampule
as ANTILIRIUM
 4.Procaine :-
Action :- Local anesthetic and
vasodilatation.
Indication :- to manage vasospasm and
compromised circulation by
intrarterial inj. or by irritating drug
Availability:- 1% sol. In 2ml and 6ml
ampules as NOVACAIN
CONCLUSION
 Proper management of a patient in
almost all emergency situation does not
require drug administration.
 First & foremost in the management oe
emergency situation are steps of basic
life support.
References
 Medical emergencies in dental office
– malamed
 Emedice.com
 Google.com