General Surgery 11

Mosul university- College of dentistry-oral & maxillofacial surgery department

Dr.Ziad H. Delemi B.D.S., F.I.B.M.S. (M.F.)
General surgery
Medical Emergencies in dentistry

Mosul university- College of dentistry-oral & maxillofacial surgery department

Unconsciousness
Respiratory difficulties
Chest pain
Medical Emergencies

Mosul university- College of dentistry-oral & maxillofacial surgery department

Syncope Shock Cardiac arrest Diabetic coma Adrenal insufficiency Convulsion CVA LA & drug toxicity
Unconsciousness

Mosul university- College of dentistry-oral & maxillofacial surgery department

-Most commonly observed potentially life-threatening emergency -Psychogenic shock or vasovagal attack Trendelenberg position Protect the airway Monitor vital signs Oxygen If not resolved conservatively -low blood pressure IV dextrose & Ringer lactate +adrenaline 0.5mg IM, IV, SC. -Bradycardia 0.4mg Atropine till 1.2mg
Syncope

Mosul university- College of dentistry-oral & maxillofacial surgery department

Syncope
Psychogenic Fright Anxiety Emotional stress Pain Site of Blood
Nonpsychogenic Prolonged sitting or standing Hunger Exhaustion Poor physical condition Hot humid crowded environment

Mosul university- College of dentistry-oral & maxillofacial surgery department

-Airway (secure) -Breathing (mouth to mouth) -Circulation (start CPR) -Drugs (Dextrose + Ringer lactate Adrenaline 1mg every 5minute Sodium Bicarbonate 1mEq/Kg Atropine 0.5mg every 5minute Oxygen 10L/min.
Cardiac arrest

Mosul university- College of dentistry-oral & maxillofacial surgery department

Head-Tilt/Chin-Lift

Mosul university- College of dentistry-oral & maxillofacial surgery department

Diabetic coma



Mosul university- College of dentistry-oral & maxillofacial surgery department
Adrenal crysis Hydrocortisone 100mg or dexamethasone 4mg Adrenalin 0.5mg Oxygen 10L/min.
Adrenal insufficiency

Mosul university- College of dentistry-oral & maxillofacial surgery department

hypoglycemia CVA Epilepsy Syncope drugs
Convulsion
valium 5-20 mg IV

Mosul university- College of dentistry-oral & maxillofacial surgery department

CVA
occur due thrombus or emboli that closed major artery in the cerebral circulation also called apoplexy or stroke

Mosul university- College of dentistry-oral & maxillofacial surgery department

Stimulation followed by depression Oxygen Maintain blood pressure & pulse rate Treat convulsion
LA & drug toxicity



Mosul university- College of dentistry-oral & maxillofacial surgery department
Unconsciousness
Supine- check pulse check respiration Open airway
still
Full recovery Syncope (Psychogenic shock)
No pulse CPR Cardiac arrest
Altered bizarre behavior
CVA
Alcohol overdose
There is pulse
Slow Adrenal insufficiency
Rapid Insulin shock

Mosul university- College of dentistry-oral & maxillofacial surgery department

Respiratory difficulties
Respiratory failure (Heart failure) Asthma Foreign body Allergy Hyperventilation (HYS)

Mosul university- College of dentistry-oral & maxillofacial surgery department

ChockingDrug overdose (narcotics, sedatives, …) Respiratory failure


Mosul university- College of dentistry-oral & maxillofacial surgery department
Adrenalin 0.5mg Hydrocortisone 100mg Aminophylline 250-500mg Ventoline inhaler Oxygen

Asthma

Mosul university- College of dentistry-oral & maxillofacial surgery department
Aspiration or swallowing -tooth -root -endodontic instruments -dental bur
Foreign body

Mosul university- College of dentistry-oral & maxillofacial surgery department

Maintain airway, breathing Adrenalin 0.5mg every 5-10 min. Hydrocortisone 100mg Theophylline 250-500mg Oxygen

Allergy

Mosul university- College of dentistry-oral & maxillofacial surgery department
Hyperventilation (HYS)
Anxiety Most common Metabolic conditions Pain Metabolic acidosis Drug intoxication Hypercapnia CNS disorders
Treatment: Terminate procedure Position patient Calm patient Rebreathing bag Sedation

Mosul university- College of dentistry-oral & maxillofacial surgery department

Chest pain
Myocardial infarction Angina pectoris hyperventilation

Mosul university- College of dentistry-oral & maxillofacial surgery department

Myocardial infarction
Recognition Airway Breathing Circulation Oxygen - 4-5 L by NC or face mask Monitor VS Position to comfort Pain relief Morphine sulfate 2-5 mg IM/IV every 5-15 minutes Controls pain and reduces anxiety Prepare to perform CPR or provide

Mosul university- College of dentistry-oral & maxillofacial surgery department

Angina pectoris
Treatment Stop procedure Position patient to comfort Oxygen 2-3 L per NC or face mask Nitroglycerin 0.4 mg SL Repeat every 5 minutes x 3 total doses If no response, assume MI or unstable angina transfer to ER