Emergency In A Dental Clinic

Ideally the following equipments and drugs should be present in a dental clinic:

• Pulse Oximeter

• Portable defibrillator (incorporating ECG print-out

• Portable oxygen delivery system

• Ambu bag (self-inflating with valve and mask)

• Oro-pharyngeal airways (sizes 1, 2 and 3)

• Cricothyroid puncture needles

• High volume aspiration with suction catheters and Yankauer sucker

• Disposable syringes (2, 5, 10 and 20 ml sizes)

• Needles (19, 21 and 23 gauge) and butterflies

• Tourniquet, sphygmomanometer and stethoscope

• Venous access cannulae (‘venflons’ 16 and 22 gauge)

• IV infusion sets/ Microdrip sets

• ‘BM sticks’ (for rapid assessment of blood sugar levels)

EMERGENCY DRUGS

• Oxygen

• Adrenaline injection (1:1000 or lmg/1 ml)

• Hydrocortisone injection

• Anti-histamine injection (e.g. chlorpheniramine tablets 4 mg, injection 10 mg/ml) Avil 2 ml

• Diazepam ( 5 mg/ml)

• Glucose (10% solution) for injection, and powder for oral use

• Glucagon injection (ideally) 1 mg

• Atropine injection (100 fig/mi)

• Aminophylline amp

• Deriphylline inj

• Colloid solution for infusion (e.g. Haemaccel 500 ml).

• Gelfoam, Hemolock

• Tab sorbitrate 20 Mg for sublingual use

• Tab. Nifedipine (sublingual)

• Ringer's Lactate- 5% Dextrose- Normal saline

FAINTING

Dentistry predisposes to fainting (syncope or vaso-vagal episode) due to fear, pain, unusual sights and smells, anxiety, fatigue and fasting. It is the commonest cause of loss of consciousness in dental practice. It is common in young men. Treat patients supine whenever possible.

Symptoms and signs

• Light-headed feeling (often with nausea) • warm, sweaty

feeling • Pallor * skin cool and moist to touch • bradycardia (with a thready, low volume pulse) • loss of consciousness and collapse with resultant rapid, full pulse.

Differential diagnosis

• Hypoglycaemia • steroid insufficiency • drug reaction • Cerebrovascular accident • myocardial infarction • heart block or other causes of bradycardia • early epileptic seizure.

Management

• Place patient in a semi recumbent postion

• Increase ventilation (ask pt. to take deep breaths)

• Determine bradycardia by taking pulse at major vessel.

• Loosen clothing and open windows.

• Establish verbal encouragement of patient and administer glucose orally.

• If patient continues to go to drowsy state make him smell/inhale aromatic salt (spirit of Ammonia)

• Delay dental treatment unless urgent.

If recovery is slow or delayed — reconsider diagnosis.

• Check blood sugar and, if low, administer IV glucose.

• If bradycardia persists, give atropine IV incremental

doses of 100 micro mili|g.

Maintain airway and administer oxygen. If hypotensive, consider steroid insufficiency administer IV hydrocortisone. Seek urgent medical attention.