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Medical Emergencies

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by

Margit Strobl

on 13 October 2016

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Transcript of Medical Emergencies

Emergency Prevention and Management
Objectives

1. Explain how a thorough health history applies to the prevention of medical emergencies.
2.Identify factors that increase the occurrence of medical emergencies in the dental environment.
3. Discuss prevention of medical emergencies, including how to recognize persons at high risk for a medical emergency.
4. Identify signs and symptoms of specific medical emergencies and appropriate treatment for each.
5. Explain the Camosun College Dental Clinic protocols for trained emergency care personnel (PERT) to respond to an emergency.
6. Identify the location of clinical emergency equipment in the clinical setting.

Preventing emergencies in oral health care
Examples of emergencies in the dental setting
Syncope (fainting): most common
Shock
Hyperventilation
Asthma Attack
Angina Pectoris
Postural Hypotension
Allergic reactions
Hypoglycemia
Cardiac arrest (heart attack)
Foreign body in eye
Chemical solution in eye
Dislocated jaw
Broken instruments
Reaction to local anesthetic
Excessive bleeding
Seizure

Emergency prevention and management
life threatening emergencies can happen in the dental hygiene setting but they are typically infrequent; however there are some factors that can increase the chance of it occurring:
older, increasingly medically compromised clients
medical advances in drug therapy
longer appointments
increased surgical procedures
increased use of drugs in the dental environment (antibiotics, local anesthetic, etc.)
There is a table on page 140-142 in Darby Walsh that describes these conditions and management
You will need to know how to manage these in the dental hygiene setting
Camosun College protocols
Camosun College has protocols in place should an emergency occur
These protocols can be found on pp. 58-60 in the clinic manual
All students must be familiar with these protocols in the case of an emergency

case scenario
Mrs. Donner presents to her regular dental hygiene appointment. As the dental hygienist reviews Mrs. Donner's health history, she notes type 2 diabetes as a finding. The dental hygienist asks Mrs. Donner what she had for breakfast. Mrs. Donner replies that she just had a cup of coffee because she did not have time for anything else. At the half way point in the appointment, the dental hygienist suddenly notices that Mrs. Donner seems confused and anxious as well as pale and sweaty. What is the most likely cause of this condition? What should the dental hygienist do to manage this situation?
references
Darby M, Walsh M. Dental Hygiene Theory and Practice. 4th Ed. St. Louis, Missouri: Saunders; 2015.
Camosun College Clinic Manual; 2016-2017 Ed.
Health History
Prevention of medical emergencies in the dental environment is based on a comprehensive and thorough health history review and risk assessment
Special attention should be paid to medication usage, vital signs, an oral interview of the health history, anxiety recognition, modifications to care to reduce medical risks and the use of the American Society of Anesthesiologists (ASA) physical status classification system
The health history provides the dental hygienist with valuable information about the client's physical and psychological condition at the time of the appointment. The dental hygienist can then create an appropriate care plan that minimizes the risk of a client having a medical emergency while in the office
Five point plan:
1. Use careful, routine client assessment procedures (Physical assessment, Health History, Vital signs, and sometimes an Extra/Intraoral exam)
2. Document and update accurate, comprehensive client records
3. Implement stress reduction protocols
4. Recognize early signs of emergency distress
5. Organize a management plan for emergency preparedness (PERT)
Recognizing persons at high risk for a medical emergency
Once all information has been gathered ( a physical assessment, health history review, vital signs, and sometimes an extra/intraoral exam), the clinician must determine if it is safe to treat the client. The American Society of Anesthesiologists Physical Status Classification System (ASA) is used to estimate the medical risk of a client.
Refer to p 112-113 in your clinic manual for a table outlining the ASA classification system and for further information
Is it okay to proceed with treatment as normal?
Do I need to modify treatment to minimize the risk of a medical emergency?
Should I postpone treatment until the client's physician is consulted and consent is given to proceed?
Recognizing high risk clients involves a firm understanding of "normal". This includes the physical/psychological assessment, the health history, vital signs and the extra/intraoral examination. If any of these is outside the range of normal, the dental hygienist must consider a number of questions in order to determine risk:
Some of these examples occur more frequently while others do not. You should be familiar with the
bolded
emergencies
Be ready to discuss this case in detail in class
Class activities
Class discussion to clarify material
Answer these questions: What happens if a medical emergency occurs in our dental clinic? Be specific in your answer

What are some ways to recognize an anxious client?

You have an anxious client. What do you do? ( what stress reduction protocols could you implement?
Determine the client's risk game
Emergency scenarios. How would you manage them? group work
Wilkins E. Clinical Practice of the Dental Hygienist. 12th Ed. Philadelphia: Wolters Kluwer; 2017.
Malamed S. Medical Emergencies in the Dental Office. 6th Ed. St. Louis, Missouri: Mosby Elsevier; 2007.
Full transcript