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Management of Emergency in Dental clinic

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drsushant's picture
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 Refer to the attached pdf.

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drmithila's picture
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Management of Emergency in Dental clinic

Medical emergencies happen in dental offices and we must be ready to react and respond. Here is an acronym that could assist you in trying to remember the many emergencies along with the emergency drugs that could potentially be used to treat them.

C = Cardiac

Chest pain: oxygen, nitroglycerin
Myocardial infarction: oxygen, aspirin
Dysrhythmias: ACLS drugs
Sudden Cardiac Arrest: AED
Ventricular Fibrillation: ACLS drugs
A = Airway

Foreign body obstruction: airway techniques
Bronchospasm; albuterol, oxygen, epinephrine
Larygnospasm: oxygen, succinylcholine
Hyperventilation
Aspiration/Emesis: airway techniques
N = Neurological

Seizures: anticonvulsant
Transient ischemic attack
Stroke
Panic attack: antianxiety agent
Anxiety: antianxiety agent
A = Allergic and drug reaction

Latex allergy: diphenhydramine
Anaphylaxis: epinephrine, diphenhydramine, albuterol, dexamethasone
Allergic reaction: diphenhydramine
Epinephrine Overdose:
Benzodiazepine Overdose: flumazenil
Local anesthetic overdose: oxygen
Narcotic Overdose: narcan
L = Loss of consciousness

Syncope: ammonia
Sudden Cardiac Arrest: AED
Hypoglycemia: glucose
Stroke

 

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drsnehamaheshwari's picture
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Management of Emergency in Dental clinic

Anaphylaxis is a life-threatening reaction with respiratory, cardiovascular, cutaneous, or gastrointestinal manifestations resulting from exposure to an offending agent, usually a food, insect sting, medication, or physical factor. It causes approximately 1,500 deaths in the United States annually. Occasionally, anaphylaxis can be confused with septic or other forms of shock, asthma, airway foreign body, panic attack, or other entities. Urinary and serum histamine levels and plasma tryptase levels drawn after onset of symptoms may assist in diagnosis. Prompt treatment of anaphylaxis is critical, with subcutaneous or intramuscular epinephrine and intravenous fluids remaining the mainstay of management. Adjunctive measures include airway protection, antihistamines, steroids, and beta agonists. Patients taking beta blockers may require additional measures. Patients should be observed for delayed or protracted anaphylaxis and instructed on how to initiate urgent treatment for future episodes.

Anaphylaxis and anaphylactoid reactions are life-threatening events. A significant portion of the U.S. population is at risk for these rare but deadly events which cause approximately 1,500 deaths annually.  Anaphylaxis is mediated by immunoglobulin E (IgE), while anaphylactoid reactions are not. Both lead to the release of mast cell and basophil immune mediators (Table 1). Because of their clinical similarities, the term anaphylaxis will be used to refer to both conditions.

TABLE 1                                          
Mediators of Inflammation Implicated in Anaphylaxis and Their Effects



Possible mediators

Physiologic effects

Clinical manifestations

Platelet activating factor Prostaglandins Leukotrienes Tryptase Kinins Heparin Chymase Tumor necrosis factor alpha Interleukin-1 (IL-1) Nitric oxide Histamine

Increased vascular permeability Peripheral vasodilation Coronary vasoconstriction Smooth muscle contraction Irritation of sensory nerves Activation of other inflammatory pathways Recruitment of inflammatory cells Activation of vagal pathways

Angioedema Urticaria Laryngeal edema Hypotension Flush Myocardial ischemia Wheezing Nausea, vomiting, diarrhea, abdominal pain Pruritus



 

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drsnehamaheshwari's picture
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Management of Emergency in Dental clinic

Clinical Presentation

Anaphylaxis may include any combination of common signs and symptoms (Table 2). Cutaneous manifestations of anaphylaxis, including urticaria and angioedema, are by far the most common. The respiratory system is commonly involved, producing symptoms such as dyspnea, wheezing, and upper airway obstruction from edema. Gastrointestinal manifestations (e.g., nausea, vomiting, diarrhea, abdominal pain) and cardiovascular manifestations (e.g., dizziness, syncope, hypotension) affect about one third of patients. Headache, rhinitis, substernal pain, pruritus, and seizure occur less frequently.

Symptom onset varies widely but generally occurs within seconds or minutes of exposure. Rarely, anaphylaxis may be delayed for several hours. Anaphylaxis can be protracted, lasting for more than 24 hours, or recur after initial resolution.

TABLE 2
Frequency of Signs and Symptoms



Signs and symptoms

Frequency (%)

Urticaria, angioedema

88

Dyspnea, wheeze

47

Dizziness, syncope, hypotension

33

Nausea, vomiting, diarrhea, cramping abdominal pain

30

Flush

46

Upper airway edema

56

Headache

15

Rhinitis

16

Substernal pain

6

Pruritus without rash

4.5

Seizure

1.5



 

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drsnehamaheshwari's picture
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Management of Emergency in Dental clinic

As comprehensive oral care becomes more difficult for young adults to afford, more and more of them are turning to emergency rooms for dental treatments, a new study shows.

The total number of dental emergency department visits in the United States nearly doubled from 2000 to 2010, according to a study by Thomas Wall, MA, MBA, and Kamyar Nasseh, PhD, from the American Dental Association (ADA), published online in May on the ADA Web site.

The rate of increase in dental emergency room visits outstripped the increase in overall emergency room visits during this period, the researchers found. "This has nothing to do with the recession," Marko Vujicic, PhD, managing vice president of the ADA's Health Policy Resources Center, told.

To tally dental emergency room visits, the researchers used the National Hospital Ambulatory Medical Care Survey.

To put these visits in the context of overall numbers of dental visits, they used annual dental use data from the Medical Expenditure Panel Survey of the Agency for Healthcare Research and Quality. They found that dental visits as a percentage of total emergency room visits increased from 1.06% in 2000 to 1.65% in 2010, a statistically significant change.

By far the greatest increase came among young adults. As a percentage of all dental visits, emergency room visits by people aged 21 to 34 years increased from 1.5% to 3.0%. The increase among people 35 to 49 years old was from 0.5% to 0.9%. For other age groups, the trend lines were nearly flat.

Young adults may be turning to emergency rooms for dental care because they cannot pay for comprehensive oral care, said Dr. Vujicic, citing previous research.

"The largest percentage that indicate they have financial barriers is the 21- to 34-year-old group," he said.

States, Employers Cutting Benefits

Many states have pared back their adult dental Medicaid benefits; some cover emergency rooms only.

At the same time, many employers are cutting dental benefits, said Dr. Vujicic.

Previous research has shown that a large proportion of dental emergency room visits are for caries and that many of the patients going to emergency rooms for care could be better served in dental offices, the researchers note.

The Affordable Care Act is unlikely to help, the researchers report, because it does not require anyone to purchase dental benefits or make money available for them: It only requires plans in the small-group and individual markets to offer these benefits to children.

The findings in the study echo an earlier report by the Pew Center that also found dental emergency room visits increasing.

"In general, ADA agrees with Pew that [emergency department] visits are increasing and that that's a problem," Shelly Gehshan, MPP, director of the center's Children's Dental Campaign. "There is a big issue with the affordability of dental care."

Gehshan, who was not involved in the ADA study, said 3 policy changes could help with the problem: "I think we need more financing, we need more dental providers, and we need more innovation in the system."

Pew supports a provision of the Affordable Care Act that would have funded demonstration projects using alternative dental providers such as dental therapists in an effort to offer more basic dental care at a lower cost. Congress later blocked funding for the program.

Citing previous research Dr. Vujicic disputed the need for more dental providers: Four of 10 dentists say they could see more patients, he said.

"Dental-Related Emergency Department Visits on the Increase in the United States." ADA Health Policy Resources Center. Published online May 2013.

 

 

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