medical emergency ce current ho

7/28/2019 Medical Emergency CE Current HO

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Dental Office Medical

Emergencies

Wendy Moore RDH, EFDA, MSA


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Why We Are Here Every 1.2 minutes someone dies of a sudden cardiac

arrest

Every 20 seconds someone has a heart attack Every 45 seconds someone has a stroke Every 3.3 minutes someone dies from a stroke Every 3 minutes someone has a seizure for the firsttime Every 6.6 minutes someone has an anaphylactic

reaction

Dental Economics July 2007 Roberson DMD and Rothman DDS


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Objectives Syncope Hyperventilation Asthma Emphysema Airway Obstruction

Aspiration

Seizure Diabetes Stroke Angina Pectoris Myocardial Infarction

Allergic Reactions


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Objectives of Dental Medical

Emergencies

Have a understanding of the causes and contributingfactors of dental medical emergencies.

Recognize the signs and symptoms. Describe initial treatment indicated. Knowledge of techniques of prevention. State stress reduction protocols.


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Private Practice Emergencies Syncope 15,407 Mild Allergic Reaction 2,583 Angina Pectoris 2,552 Postural Hypotension 2,475 Seizures 1,595 Asthmatic Attack 1,392 Hyperventilation 1,326 Epinephrine Reaction 913

Insulin Shock Hypoglycemia 890 Cardiac Arrest 331 Anaphylactic Reaction 304 Cerebrovascular Accident 68-J Am Dent Assoc 112:499-501, 1986


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Important Information This course meets the OSDB requirement for

dental hygienists to practice without thedentist being physically present.

Need: 2 years AND 3000 hours.


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PERMISSIBLE PRACTICES DOCUMENTATION

FOR DENTAL HYGIENISTS http://www.dental.ohio.gov/forms.stm Forms (Far Left) http://www.dental.ohio.gov/ Front Page bottom Right Permissible Practices Documentation for

Dental Hygienists Form


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Oral Health Access Supervision Program

Permit Applicant Dental Hygienists: Copy of your most recent license to practice dental hygiene in the State of Ohio; Evidence of completion of at least two (2) years and 3,000 hours of experience in the clinical practice of dental hygiene; Evidence of completion of at least twenty-four (24) hours of continuing dental hygiene education during the two (2) years immediately preceding submission of the application; Evidence of completion of an eight (8) hour course pertaining to the practice of dental hygiene under the oral health access supervision of a dentist that meets the standards established in Ohio Administrative Code Section 4715-9-06.1; Evidence that in the two (2) years immediately preceding submission of this application, you have successfully completed a course pertaining to the identification and prevention of potential medical emergencies that is the same as the course described in division (C)(2) of Section 4715.22 of the Ohio Revised Code.


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Are you prepared? You have an oxygen tank You have an emergency kit You know CPR What could go wrong?


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Why We Are Here Emergencies do occur in dental offices: a

survey of 4,000 dentists revealed an incidence

of 7.5 emergencies per dentist over a 10-yearperiod.

http://www.cda-adc.ca/jcda/vol-65/issue-5/284.html

ADA survey of 4000 dentists- 45 deaths werereported

http://www.jefferson.edu/omfs/research/powerpoint/medical_files/frame.htm


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Why We Are Here Question What is the emergency plan in the office? Where is the emergency kit in your office? Do you know how and when to administer oxygen? Is the oxygen readily available? What is in your emergency kit? Are the meds all up to date? What is the emergency plan when the doctor is not there?

Does everybody else in your office?


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Minutes CountCall 911

However, that can take 3-45 minutes!Physiology studies indicate if the brain is

deprived of oxygen for:

4-6 minutes- possible brain damage

6-10 minutes- probable brain damage Over 10 minutes- likelihood of irreversible

brain damage or death. Access 11/2006


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Minutes Count EMS/911 response times average more than

nine minutes in urban centers and more than

15 minutes in rural areas.

Failing to prepare is preparing to fail formerUnited States Secretary of Health Tommy Thompson.

Dental Economics July 2007 Roberson DMD and Rothman DDS


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Why We Are Here Ethical Duty to protect and help our patients Standard of Care 7-8% of dentists are sued yearly Good Samaritan statutes help free an office from

liability in most states if the dental team renders apatient life-saving treatment in good faith withoutexpecting compensation for the service. But if it isyour patient it is your responsibility. GSL coversfamily members in the waiting room. Malamed 2002, pg 103

Jury decides and where does the burden of proof lie?


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There has never been a successful lawsuitagainst a lay rescuer who attempted to provide

CPR for a victim of cardiac arrest.

-American Heart Association 2006


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If In Doubt

CALL

911But this is only PART of the plan.


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Calling for 9111. Exact location of building with cross streets, landmarks,

name of building, and room number

2. The telephone number from which the call is being made3. The callers name and office name4. What happened5. How many people are involved6. The condition of the victim7. The care being given8. The caller should stay on the line until further instructed

while another person waits for them outside, if possible.

9.

They will want to know blood pressure and medications10. Access 11/2006


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Prevention Is The Key 90% of all office emergencies are preventable.

The medically complex patients arent always thehighest concern.


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Straight From Wilkins5-Point Plan to Prevent Emergencies

1. Use careful, routine patient assessment procedures.2.

Document and update accurate, comprehensive

patient records.

3. Implement stress reduction protocols.4. Recognize early signs of emergency distress.5. Organize team management plan for emergency

preparedness.


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Develop an Office PlanDuties of Team Member One

Provide BLS as indicated Stay with victim Alert office staff membersDuties of Team Member Two Bring emergency kit and Oxygen to emergency site (Check oxygen daily) Check emergency kit weeklyDuties of Team Member Three

Assist with BLS Monitor vital signs Prepare emergency drugs for administration Activate EMS system Assist as needed Maintain records Forms are available to follow Meet rescue team at building entrance


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Standard of Care

Minimal level of care that the patient isentitled to while being treated by a healthcare

professional- Manual of Emergency Medical Treatment for the Dental team- Braun, Cutilli

Good Samaritan Statues- differ from state tostate

Informed consent is to promote the patientsbest interest


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Occurrence of Complication

Immediately before treatment 1.5% During or after local 54.9% During treatment 22% After treatment 15.2% After leaving the office 5.5%-Medical Emergencies, Malamed 2000


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Type of Emergency

65% of all cases developed during 2 types oftreatment- Extractions (38.9) and Pulp Extirpations

(26.9)

Sudden, unexpected pain

-Medical Emergencies, Malamed 2000


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Why we are hereCardio and Perio

2003- American Academyof Periodontology declared

link

Atherosclerosis- Reductionof arteries, reducing blood

flow and oxygen to the

brain, heart, and other vital

organs. MI or stroke is likely

Heart and bloodvessel diseases and

conditions claim close

to 100,000 lives

annually. In US,

700,000 strokes occur

each year and someone

dies of a stroke every 3

minutes. Contemporary Oral Hygiene


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Medical HistoryUse open ended questions-

What changes have you had to your healthsince your last appt/ what medications,vitamins, herbals, OTCs do you take?

Closed- Have there been in changes to yourhealth since your last visit?

Encourage them to keep an updated list withthem.


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Medical History

Baseline History Medications Past/ current medical conditions- may

indicate need for precautions

Allergies Need for and results of Medical Consults Pre-Med Vital Signs- baseline then yearly Provides documentation in a legal matter.


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Pre-medication needed Used to be for 2 yearsminimum for total joint replacement, now new recommendation pre-medication for life.

Medical consult: may need to contact orthopedic surgeon

Artificial Heart Valve Previous endocarditis Complex cyanotic congenital

heart defect

Congenital Heart defect repairfor at least 6 months after repair.

With residual effects =

ALWAYS

Heart transplant with valvulardysfunction

Surgically constructed systemic-pulmonary shunts or conduits

From 2007- ALL JointReplacements Titanium,

Knee, Hip, Shoulder,

Elbow, TMJ


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Regiment of Premedication

1 hour prior to appointment Not allergic to penicillin- Amoxicillin - Adult: 2.0

grams, Children: 50 mg/kg

Penicillin allergy:Clindamycin- Adults: 600 mg,Children: 20 mg/kg

Give a different type ifcurrently on the prescribed

antibiotic

When to premed:

Extractions Periodontal procedures Placing implants and

avulsed teeth

Endodontic procedures Orthodontic brackets Intraligamentary injections Prophylaxis Placing antibiotic fibers/

strips


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Medical HistoryAlthough every dental office has its own medical questionnaire,

there are six basic questions that should be asked to detectpotential problems:

1. Do you have any allergies? 2. Is there a history of bleeding? 3. Do you have shortness of breath? 4. Do you have or have you had chest pains? 5. Are you taking any medication?

6. Have you previously been admitted to hospital?A positive answer to any of these questions should be

investigated to determine if treatment needs to be modified.http://www.cda-adc.ca/jcda/vol-65/issue-5/284.html


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Medical History 80% of all adults take at least one medication 25% of the population take 5 medications 80% of all seniors have at least one chronic

condition

50% of seniors have at least 2 chronicillnesses

More than 400 medications cause xerostomia - Ciancio, J Perio, Vol 76;2005 and Lyle ADHA 2006


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Herbal Supplements Patients dont realize the impact of herbal

therapy.

Visits to alternative therapist rose 47% in the90s

Herbals are unregulated by the Food andDrug Administration

Ones to Watch: Echinacea- Numbness of the tongue and breathing difficulty Ginseng- active bleeding, avoid in pregnancy, avoid caffeine Kava- causes sedation, interacts with anti-anxiety meds St. Johns Wart- Drug interactions; Ephedra- Stimulant. Contemporary Oral

Hyg-10/2003


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Herbal SupplementsThe following pose a risk for increased bleeding:

Garlic, Ginseng, Ginko Biloba, and any other thatpromotes increased circulation.Little, J. Oral Surg 2004; 98:137-45

The American Academy of Anesthesiology suggestspatients avoid herbal therapy 2 weeks prior to any

surgery.


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Herbal Supplements

Niacin- increase risk of postural hypotension Kava, Valerian, St. Johns wort-

interference with sedative drugs

Ephedrine- hypertension


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Herbal Supplements

Side Note:

If you take birth control or know someonethat does, advice them not to take thefollowing:

Black Cohosh (also linked to liver damage) St. Johns Wort

Both are shown to decrease the effectiveness of the birthcontrol.


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Drugs that contain aspirin or affect blood clotting

Advil Aleve Alka-Seltzer Bufferin CAMA Dextran Doloxene Echinacea Ephedra Garlic Ginkgo Ginseng

Heparin Ibuprofen Kava Lasix Midol Motrin Nonsteriodal anti-

inflammatory agents

Nuprin Sine-Aid St. Johns Wort Triaminicin Vitamin E* May take Tylenol - Dr. Avva, M.D, FACS


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Vitals

Pulse-

Below 50 or above 120 is considered serious

Irregular or Regular and Full or Weak If less then 50 or greater then 120 it is distressRespiration- Rapid or Shallow, Deep/Labored,

Gurgling- Airway Obstruction, Snoring-Stroke.

If less then 10 or greater then 20 it is distress


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Vitals

Blood Pressure- 120/80 Great

We do not treat 160/100 or over 180/120 isdistress

Under 90/60 is typically shock Associated with stroke, heart attack, cong heart

failure, end stage renal disease, diabetes, andhyperthyroidism


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Hypertension in a Dental School Patient

Population: A review of 500 patient records.-Kellogg, J Dent Ed, 2004

32% of patients were hypertensive 49% were unaware 9% had a BP that required an immediate

medical consult

Determined that it is crucial that dentalproviders take BP readings.


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Vital signs are key to assessing a patient in trouble.

Respiratory rate, pulse and blood pressure are what need to bemeasured, nothing more sophisticated than that. If all thesevital signs are normal, chances are the patient will be fine.

If they are not normal, your goal is to normalize them untilthe patient can receive appropriate medical attention.

http://www.cda-adc.ca/jcda/vol-65/issue-5/284.html


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Answer: If your patient has taken Viagra within thepast twenty four hours, you must never administernitroglycerine.

Why? The patient's blood pressure can fall todangerously low levels. If their systolic blood

pressure drops to below 100, the patient could faintor lose consciousness.

The treatment would be to place the victim into theTredelenburg position, administer oxygen, go toyour A,B,C, D's, and give aspirin if chest paindevelops.

http://www.gotodds.com/updates/index.aspx April 2005


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The antibiotic, erythromycin, is no longer recommended

for premedication use in dentistry. Why?

This antibiotic can cause an adverse drug reaction (ADR)when taken with the following types of medications: blood

pressure meds. (verapamil, diltiazem), antifungal meds.

(ketoconazo, fluconazole), antibiotic (clarithromycin), andthe antidepressant (nefazodone).

If this were to happen, a toxic build up of erythromycin canoccur in the bloodstream and the result could be sudden death

or a heart arrhythmia .

Excerpt from the " New England Journal of Medicine, Sept. 9, 2004


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Medical Classification System

ASA I- A normal healthy patient

ASA II- A patient with mild systemic disease

ASA III- A patient with severe systemic disease

ASA IV- A patient with severe systemic disease that is aconstant threat to life


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General precautions for patients with

questionable health

Limit amount of local anesthetic and numberof injections (e.g., 3 cartridges instead of 5)

Consider preoperative sedationConsider afternoon appointment


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Never Treat A Stranger

Observe physical appearance (walk slow, medicalalert tags).

Reveal possible unrecognized/diagnosed medicalconditions.

Provide insight into emotional, psychological andattitudinal factors- may effect dental needs.

Evaluate the patients anxiety level.


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Signs of Acute Anxiety Cold, sweaty palms or

forehead

Flushed face Altered facial expression Bruxism or clenching Rude demeanor Need to go to the bathroom Unnaturally stiff posture Inability to sitting still,tapping Trembling/ Fiddling Access- July 2004

White-Knuckle syndrome Crying out, moaning Hyperventilation- No Oxygen Nausea Increased respiration, blood

pressure, and heart rate


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Stress ReductionNumber one way to prevent an

emergency

Minimize waiting time. Present them with a smile. Actively listen to a patient's fears Keep patient informed. Dont give them time to think

the worst.

Schedule in A.M. Shorter appointments Regular meals Avoid accidents- Pass

instruments below chin


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Common Observed Changes

Acute changes in demeanor/consciousness Sudden onset of pain anywhere in the body Tight feeling in chest or back Difficulty in breathing Choking Dizziness or feeling faint Numbness or tingling

Dental Office Medical Emergencies, Meiller


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Contributing Factors to Emergencies

Increased number of olderpatients with natural teeth

Medical advancements Essential medications:

certain prescriptions must

be taken on schedule or the

patient is at risk for anemergency

Drug interactions- Herbalsupplements and

medications that interactadversely with drugs usedin dentistry.

More complex dentalprocedures require longer

appointments

Dental diseases that requireinvasive procedures


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The most rapidly growing segment in the US is the 65

and over due to post-World War II baby boomers.Malamed

US population over 65will be over 64 million

by 2030.0

10

20

30

40

50

60

70

1790 1900 1980 2030


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Procedures forAll Emergency Situations

Supine position- Do not move from chair If conscious make them comfortable Reassure the patient Provide Oxygen when not in hyperventilation Check vitals/ maintain open airway Be prepared for the worse


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Why Oxygen?

The most important aspect of nearly all medicalemergencies in the dental office is to prevent, or

correct, insufficient oxygenation of the brain and

heart.

The management of all medical emergencies shouldinclude ensuring that oxygenated blood is beingdelivered to these critical organs. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1586863


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Oxygen

E cylinder- 3 feet high This is enough oxygen to ventilate a

nonbreathing adult for approximately 30minutes.

If it is FULL! www.ineedce.com


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Equipment Fail-safe drug kit- Albuterol,

Ammonia spirit, Glucose,Epinephrine, Histamineblockers- acute allergic reactions

AED

Emergency number call list Oxygen tank- size E Low flow regulator and

nasal cannula

Bag valve, pocket and non-rebreather masks

Syringes

Pen light Blood pressure kits Stopwatch Emergency Report Form First-aid kits


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The following is a list of all the ADA recommended contents:

1) epinephrine in 1:1000 dose with 3 empty syringes forloading or preloaded syringe

2) benadryl in 2 pre-dosed syringes

3) aspirin 325mg, 3 packets4) nitroglycerine spray

5) instant glucose, 2 tubes6) ambu-bags, 1 adult7) ammonia inhalants, 3

8) albuterol inhaler9) CPR disposable masks, 1 adultAll of the above items are packaged in a centralizedemergency kit.


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Albuterol Inhaler

Treats severe asthmatic attack Causes relaxation of the smooth muscle of the

bronchioles.


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Nitroglycerin

A venous and arteriolar dilator that results inincreased cardiac output and reduced left

ventricular filling pressure.


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Nitroglycerin

If exposed to oxygen/light it is only effectivefor 12 weeks.

Most cases- 6 month shelf life When using it should produce a bitter taste or

impart a sting if still effective.

The translingual nitro spray has a longer shelflife. (2 years)


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Epinephrine 1:1,000 Concentration

For severe allergic reaction and acuteasthmatic attacks.

Adult Dose: 0.3mg. Delivery: auto-injector Pediatric size auto-injector is available.


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Epinephrine 1:1,000 Injection Use: to reverse hypotension, bronchospasm, and laryngeal edema that

result from an acute anaphylactoid type reaction. Also used to reducebronchospasm resulting from an acute asthmatic episode that is refractoryto inhaler therapy.

Dose: Supplied in vials, ampules, or pre-loaded syringes in concentrationof 1:1000, 1mg/ml. IV give 0.5-2.0mg (0.5ml-2.0ml) depending onseverity of hypotension, titrate to effect repeat in 2 minutes if needed. IMgive 0.3mg (0.3ml) repeat in 10-20 minutes as needed.

Pharmacology: Causes vasoconstriction that in turn increases bloodpressure, heart rate, and force of contraction. Reduces histamine release.

Adverse Effects

Cardiovascular: Tachycardia, Tachyarrhythmias, and hypertension. Central Nervous System: Agitation, headache, and tremors. Endocrine System: Increased blood glucose. Pregnant Female: Can decrease placental blood flow. Drug Interactions: Nasal decongestants, antihistamines, asthma inhalers

will increase incidence of adverse effects. Can be ineffective if the patientis taking beta-blockers.


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Diphenhydramine (Benedryl) 50mg Injection

Use: To reduce the affects of histamine release that is associated with allergic reactions,anaphylaxis, and acute asthma attack precipitated by exogenous causes.

Dose: 50-100mg IM or IV. For mild cases of pruritis, urticaria, or erythema an oraldose of 50mg every 6 hours can be used.

Pharmacology: Benedryl is an antihistamine that blocks the release of histamine in the body.It does not prevent the action of the histamine once released and thus must be givenquickly. Prevents histamine responses such as bronchospasm, hypotension, rash, andedema.

Adverse Effects:

Cardiovascular: Tachycardia (Fast heart rate.) Central Nervous System: CNS depression (Sedative effects including drowsiness, lethargy,

and mental confusion.)

Gastrointestinal: Xerostomia (Dry mouth.)

Drug Interactions: Any drugs causing CNS depression will increase the sedativeeffects of Benedryl. Can also exaggerate this effect in other drugs suck as Atropine,

Antipsychotics, Demerol, and Tricyclic Antidepressants.


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Patient Positioning

Respiratory difficulty Upright

> Cerebral blood flow Upright < Cerebral blood flow Trendelenberg Unconsciousness Trendelenberg Cerebral blood flow indicators:

color changes, blood pressure,

pulse, respirations,

levels of consciousness

If the face is redraise the head.

If the face is

pale

raise the tail!


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Figure 14-1 Supine position. Place patient so head is equal to heart level.

Mary Danusis Cooper and Lauri Wiechmann

Essentials of Dental Hygiene: Clinical Skills

Copyright 2006 by Prentice-Hall, Inc.

Upper Saddle River, New Jersey 07458

All rights reserved.

Supine Position


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Unconsciousness is determined by performingthe shake and shout maneuver, gently shaking

the shoulders and calling the victims name. Head Tilt Chin Lift Look, Listen and Feel for Breath


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Loss of Consciousness

Most Common

Syncope Postural Hypotension Hypoglycemia (Insulin

shock)

Less Common

Anaphylactic Shock Stroke Seizure Disorders


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Syncope/ Fainting


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Syncope/ Fainting

Loss of consciousnesscaused by a reversibledisturbance in cerebralfunction.

Decreased circulation ofblood to the brain.

Hypotension- decrease ofblood pressure

Most common emergency in the office

Recovers in seconds to 1-2 minutes

Causes: Anxiety, fear, pain,hunger, rising fast, exhaustion


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Syncope/ FaintingPossibilities to consider

Hypotension Hypoglycemia Cerebral Vascular Accident Seizure Arrhythmias Anaphylaxis Anxiety Attack Hyperventilation Adrenal insufficiency Myocardial infarction


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Syncope/ Fainting

Symptoms: Rapidpulse, decreased pulse

rate (below 40 bpm),

light headiness,

diaphoresis (sweaty/

clammy), nausea, pale

(deathlike look),gasping breath


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Drugs and Stimulants Postural Hypotension-

Low BP causing loss of

consciousness

Cause: Supine positionfor more then 15-20

minutes.

At risk drugs:

Any that lower BP Nitroglycerin- so do

not administer

Erectile-dysfunction(Viagra- 24 hrs,

Cialis-3 days, Levitra) Niacin supplements (to

lower cholesterol)


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Postural Hypotension

Prolonged periods of reclining, positioning Late stage pregnancy Advanced age Venous defects in legs-Varicose veins Exhaustion Starvation Nitrous oxide -Malamed 2000


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Syncope/ FaintingTreatment: Trendelenburg position-

supine position with feetup, head down.

Left side for pregnancy. Maintain an open airway. Give oxygen. Monitor vital signs. Intermittent use of crushedammonia capsule. Face

will get red which is a goodsign. Blood is returning.

Cold compress on foreheador back of neck

Record all events and timeline

Activate EMS if patient isunstable or theres a delayin response

Comfort patient uponawakening


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Syncope/ FaintingSigns patient is

recovering:

Patient awakens

Vitals are stable

Signs patient is deteriorating:

Patient does not awaken after

one minute

Falling BP- unstable vitals

Bradycardia

* Reevaluate diagnosis- consider

hypoglycemia, seizure,cardiac arrest, anaphylaxis,

stroke.


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Hyperventilation


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Hyperventilation

Excessive exhaling ofcarbon dioxide, blood

drops in CO2.

Increased ventilation(breathing) in excess of

what is required tomaintain normal carbon

dioxide levels.

Causes:

Fear/anxiety (injections),apprehension, panic

attacks, overdose ofmedications, stimulants.

Symptoms:

Rapid shallow breathing,suffocation feeling,confusion, vertigo

(dizziness), paresthesia

(numbness of extremities),

chest tightness, increased

heart rate.


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HyperventilationTreatment: Position upright or semi-reclined

(comfortably).

Terminate procedure. Tell the patient There will be

no more dental treatment today.

Do NOT administer oxygen. Have patient hold breath for 10

second intervals (breath into

hand to warm up) to enrichCO2 levels.

Monitor vitals. Reassure the patient. Talk to them in a slow, quiet and

calm voice


Patient loses consciousness, vitalsare unstable


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Asthma


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Asthma Spasm and constriction of

the bronchi

Affects more than 20million Americans-Cont Oral Hyg08/2005

Hyperactivity of theTracheobronchial tree

Bronchial musclescompletely or partially

contract.

Causes: Extrinsic: Allergic reaction

(younger people),

Intrinsic: Respiratory infection(after 35, acute episodes)

Emotional stress/anxiety


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Asthma

Symptoms:

Labored breathing,tightness in chest,

coughing spasms,

wheezing, anxiety,

increased heart rate,

vagus nervestimulation (gagging).


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Asthma

Treatment: Upright position,

comfortable.

Utilize inhaler(2-4 puffsinitially, repeat in 15 minutes).

Maintain open airway Reduce anxiety Monitor vitals Administer oxygen Activate EMS if normal

breathing does not return.

Epinephrine if needed Supplemental cortisone if

patient has been on

corticosteroid.


Breathing does not improve,Patient is tiring or slows

breathing dramatically.


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Asthma

Prevention: Identify history of asthma. Know what a typical attack is like for them Have inhaler accessible Avoid inhalation of irritating agents Risks

Dry mouth from meds Dental stress


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Emphysema


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Emphysema Usually found in older

adults

Form of chronicobstructive pulmonarydisease

Patient has decreasedrespiratory reserve when

the body requires moreoxygen.

Causes: Loss of elasticity of the

lung tissue, over distention

of the lungs, chronicrespiratory infections,

smoking, pollutants.

Symptoms:

Laboredbreathing,shortness of breath


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Emphysema

Treatment: Sit slightly upright Encourage proper

breathing

Utilize inhaler Be cautious of the amount

of oxygen given

Activate EMS if normalbreathing does not return

Prevention: Identify history of Have inhaler accessible Keep patient slightly

upright


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Airway Obstruction


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Airway Obstruction

Partial or completeobstruction of the airway.

Foreign body causingmechanical blockage in thelarynx pharynx.

Blockage does and notallow adequate air

exchange in the lungs.

Causes: Dental objects (crown, head of

mirror, prophy angle, rubber

dam clamp, amalgam, etc.),

food, balloons, marbles.Symptoms: Choking, gagging, violent

expiratory effort, not able to

speak, panic, labored breathing,rapid then decreased pulse,

respiratory and/or cardiac arrest.


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Airway ObstructionTreatment: Supine position if patient becomes

consciousness

Roll them to the side for head to belower then the throat

Encourage patient to cough Perform foreign body airway

maneuver (thrust from behind)

Call EMS as soon asunconsciousness occurs

Perform abdominal thrusts untilunconscious then perform CPR.

Attempt to clear airway If partial obstruction let the ER

handle it so you do not tear tissues.

Prevention: Utilize rubber dam Assure all equipment is fastened

tightly

Keep patient upright forimpressions

High volume suction Appropriate chair and head

position

Gauze partition Floss attached when able.


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Airway Obstruction Because total airway

obstruction usually

occurs during

inspiration, there isusually adequate

oxygen in the cerebral

blood to permit up to

two (2) minutes ofconsciousness.

If foreign body is NOTrecovered or passes, refer

patient as soon as possible

for radiographic

localization.


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Ingested/ Aspirated Items Institute emergency assistance as indicated

(Universal sign of choking).

Notify the Doctor/ Other Office Personal toAssist

Temporize procedure if applicable.

Follow-up radiographs Surgery? Necessary paper work completed.


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Acute Bleeding

Intraoral- Evaluate every 2-3 minutes whileapplying pressure.

Consider hemostatic agents and primarywound closure

Extraoral- Apply direct pressure, pressurebandage and transport via EMS


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Seizure


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Seizure Abnormal brain activity Intermittent disorder of the

nervous system

Sudden/ excessiveneurological discharge

Idiosyncratic reaction to adrug.

Partial/petit Mal- conscious Tonic-clonic/Grand Mal-

loss of consciousness

Causes: Epileptic seizure, brain

damage, drug reactions,triggers (light, stress,

fatigue, hormonal)Symptoms: Aura, tremor followed by

clonic-tonic convulsions(tonic= rigid muscles;

clonic- convulsions,frothing), excitement,trance-like, confused,sleepy


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Seizure

Things to ask the patient during the medicalhistory interview:

What kind do you have? What happens? How long do they typically last? When was your last one? If within one week, call

their physician.

Did you take your medications today? What can we do for you if one comes on? Is their someone we should contact if you have one?


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Seizure

Treatment:

Leave patient in chair, supine

Clear area for safety Loosen clothing Maintain open airway Administer Oxygen Do NOT restrain patient Allow patient to rest following

According to the American Red Cross


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According to the American Red Cross,

summon the EMS when:

seizures occur repeatedly a seizure lasts longer than five minutes the victim appears injured the victim has no history of a seizure the victim is pregnant the victim is diabetic the victim does not regain consciousness

immediately after the seizure.

if the episode lasts longer than 10-15 minutes


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Allergic Reactions


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Allergic Reactions Hypersensitive state caused

by an exposure to aparticular allergen.

Urticaria (red) Pruritus (itching) Rapid onsetCauses:

Antibiotics (penicillin) Anesthetics Local irritants (latex)

Symptoms:

Rash, itch, edema (swelling) Bronchial constrictionTreatments: Position comfortably Administer oxygen Monitor vitals

Withdraw irritant Administer Benadryl 25-50 mg

orally


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Anaphylactic Shock Severe allergic reaction Immediate hypersensitivity Cardiovascular collapse Severe hypotension Life threatening

Causes:

Antibiotics (penicillin) Anesthetics Local irritants (latex)

Bee Stings

Symptoms:

Itching of nose and hands,flushed face, coughing

Sudden hypotension Labored breathing Respiratory and circulatory

failure

GI upset

Shock Cardiovascular distress Swelling of the tongue and

oropharynx


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Anaphylaxis

Typical progression *

Skin reactions

Smooth muscle spasms (GI, GU, respiratory)Respiratory distress

Cardiovascular collapse

*may occur rapidly, with considerable overlap


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Anaphylactic ShockTreatments: Supine position- basic life support Call EMS immediately- Have medical history

to inform EMS

Monitor vitals Administer Epinephrine/ epi-pin Initial doses

0.3 to 0.5 mg intramuscularly or 0.1 mgintravenously. Give through clothes.

(.3 ml injection can be given sublingual iflicensed)

Administer Hydrocortisone (ALS) Administer Oxygen Proceed with basic life support as needed


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EpiPen

Preloaded dose of injectable epinephrine Jr strength for 33-66 pounds. Effects last only 15-20 minutes for each dose Video: www.epipen.com/howtouse.aspx Access 11/2006


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Update: April 21, 2005For those dentists and dental hygienists either using, recommending, and/or prescribing the popular mouth rinse, chlorhexidine gluconate 0.12%,you must be aware that the Asian population can be extremely allergic tothis product.

The incidence of severe anaphylactic shock with this patient group isimmediate and includes upwards of 4% of this population group. If youare using chlorhexedrine as a pre-rinse prior to dental treatment, be awarethat the Asian patient population could have a potentially seriousreaction while in your office.

Source: Dental Hygiene Conference in Washington D.C. 2005.


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Epinephrine Reaction

Symptoms

Rapid elevation in bloodpressure

Increased pulse rate Anxiety Tremor

Treatment Position patient

comfortably

Administer Oxygen Reassure patient Monitor vitals (could be 20

minutes for return to normal bp)

Activate EMS if furthersymptoms develop or if

elevated BP remains


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CLINICAL MANIFESTATIONSof

Local OVERDOSE


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Clinical Manifestations of Local Anesthetic Overdose

(Signs)

Low to Moderate Overdose Levels

Confusion Talkativeness Apprehension Excitedness Slurred speech Elevated BP Elevated HR Elevated RR Generalized stutter Twitching http://www.jefferson.edu/omfs/research/powerpoint/medical_files/frame.htm


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Minimal to Moderate

Low to Moderate Overdose Levels

Restless Visual disturbances Auditory disturbances Numbness Metallic taste Light-headed and dizzy

Drowsy and disoriented Losing consciousness Sensation of twitching (before actual twitching is observed)


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Moderate to High

Generalized tonic-clonic seizure activity

followed by

Generalized CNS depressionDepressed BP, heart rate

Depressed respiratory rate


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MANAGEMENTof

Local OVERDOSE


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Mild Reaction -slow onset

Reassure patient

Administer O2

Monitor vital signs

Allow recovery or get medical help

Get medical consultation, esp. if possibility ofmetabolic or renal dysfunction


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Severe Reaction - rapid onset

Stop all treatment

Place patient in supine position, feet up

Establish airway, give O2 (BLS)If convulsions, protect patient

Summon emergency medical help

Consider anticonvulsant drugs, vasopressors


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Management of Allergy Pts.

If the patient gives a history of allergy to local

anesthetics - Assume that an allergy exists

Elective procedures

Postpone until work-up is completed


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Management of Reactions

Delayed skin reaction

Benadryl - 50 mg stat & Q6H X 3-4 days

Immediate skin reactionEpinephrine 0.3 mg IM or SC

Benadryl - 50 mg IM

Observation, medical consultationBenadryl - 50 mg Q6H X 3-4 days

f i


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Management of Reactions

Bronchial constriction

Semi-erect position, O2 - 6 L/min

Inhaler or Epinephrine 0.3 mg IM or SCBenadryl - 50 mg IM

Observation, medical consultation

Benadryl - 50 mg Q6H X 3-4 days

iff i l i i


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Differential Diagnosis

Pyschogenic reaction (Syncope)

Overdose reaction

HypoglycemiaStroke (CVA)

Acute adrenal insufficiency

Cardiac arrest


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Diabetes


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Diabetic emergencies are the result of diabetesmellitus, a chronic disorder of carbohydrate

metabolism in which insufficient insulin is produced

or insulin is not used effectively.

The emergency conditions associated with diabetesinclude hypoglycemia, the most acutely life-

threatening, and the slower onset hyperglycemia.


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Diabetes Mellitus and Periodontal Disease

More than half of the inflicted population do not know theyhave diabetes.

1/3 of people with diabetes have severe periodontal diseasewith loss of attachment measuring 5 mm or more Give me fever- ADHA 2006,Deborah Lyle, RDH, MS

Effects an estimated 5-10% of all people in the United States.(Over 16 million people)

73% of adults with diabetes have hypertension About 800,000 new cases are diagnosed each year.


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6th leading cause ofdeath in the US-Amer DiabetesAssoc., 2004

Accounts for 1 out ofevery 10 health caredollars spent

In a practice with 2,000patients, about 3

patients per week willhave diabetes-Periodontalogy 2000, Vol32;2003


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The hyperglycemia of uncontrolled diabetes isthe basis for most of the vascular, cellular,and immune changes seen in periodontal

disease.

Uncontrolled diabetes is the most violent tothe periodontal structures. Rate ofdevelopment in uncontrolled subjects is 3times greater.


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Diabetes

Type I, insulin - dependentdiabetes mellitus

Represents about fivepercent of all cases ofdiabetes

It is more common inadolescents, but can

occur in adults In this form virtually

no insulin is produced.

Type II, non-insulin-dependent diabetesmellitus

Mostly seen in adultsbut may occur in somechildren.

http://www.adha.org/CE_courses/course2/additional_emergencies.htm


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Diabetes mellitus A medical emergency of diabetes mellitus, is precipitated by

factors that increase the body's need for insulin.

Dental therapy is a potential threat since stress increasesinsulin needs, which in turn can precipitate hyperglycemiaeven in a person who is normally well controlled.

Simply having a dental appointment may cause the person toalter normal eating habits that could create an insulinimbalance.

Malamed suggests that after extensive dental treatment, thepatient should be instructed to check blood glucose levels atleast four times a day for several days, and make dosageadjustments.

www.adha.org 2007

i b


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DiabetesHypoglycemia-

too little glucose in the blood/braintoo much insulin in the body

Low blood sugar

Symptoms: Sudden onset, clammy, pale, nervousness, full/bounding

pulse, confusion, drooling, nausea, hunger, numbness,argumentative

Causes:

Omission of meals, overdose of insulin, alcohol, excessiveexercise


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Hypoglycemia A result of exogenous insulin therapy, is an acute

life-threatening condition.

It can result from an insulin overdose or failure tomaintain normal food intake, usually by delaying oromitting meals.

It is generally manifested in patients receivinginsulin therapy.

Di b


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DiabetesHyperglycemia-

too much glucose in the

blood

too little insulin in thebody

Symptoms:

Gradual onset, flushed,fatigue, weak/rapid

pulse, sweet breath

Causes:

Lack of insulin, ignoringdisease, obesity, heredity

Di b


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DiabetesHypoglycemia-Treatment:

Give glucose, carbohydrate(icing, juice)

Brain can only survive 5minutes without glucose Position comfortably,

semi-reclining

Maintain open airway Administer oxygen Call EMS as soon as

unconsciousness occurs

Hyperglycemia-Treatment:

Seek medical advice Administer insulinPrevention: Thorough medical history,

Did the patient eat and/ortake insulin today?, AMappointments, do not treat

uncontrolled diabetes


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St. Johns Wort and Type 2

Patients taking rosiglitazone (Avandia) for Type 2diabetes should not take St. Johns Wart.

It has shown to cause the drug to metabolize 35%faster than normal.

Other drugs effected are synthetic estrogen, like thepill thus mixing the two can make the pill less

effective. Health.com 11/2008

Also interacts with antidepressants. Health.com 11/2008Source: www.news.health.ufl.edu

A Two Way Connection Between Diabetes


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y

and Periodontal Disease.

The presence of periodontal disease affects glycemic control,making it harder for the diabetic to control their blood sugarlevels.

One study showed that chronic release of cytokinesassociated with periodontal disease interferes with the actionof insulin, increasing the risk for diabetic complications.

Uncontrolled diabetic patients are more susceptible toperiodontal disease.

Urge the patient to go to their doctor regularly to get theirdiabetes controlled.


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Diabetes Resources

American Diabetes Association/NationalDiabetes Fact Sheet 2005: www.diabetes.org

National Diabetes Education Program:www.ndep.nih.gov

Center for Disease Control: www.cdc.gov

National Institute for Diabetes, Digestive,Kidney Diseases: www.niddk.nih.govGive me fever- ADHA 2006, Deborah Lyle, RDH, MS


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Stroke

St k


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Stroke 3rd leading cause of death

in US

Leading cause of braininjury in adults

Early recognition andintervention is crucial withour advance therapy

Can mirror hypoglycemiaor a seizure

In any given year 28% ofstroke victims are youngerthan 65.

2006 American Heart Association

St k


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Stroke Cerebrovascular Accident Localized neurological

disorder

Decreased blood supply tothe brain

Causes:

Uncontrolled hypertension(high blood pressure)

Head trauma

Types:

Cerebral embolism- floatingblood clot lodges in brain (7%)

Cerebral infarction- decreasedblood flow to the brain(atherosclerosis 80%)

Cerebral hemorrhage- rupture ofa cerebral artery (13%)

Cerebral thrombosis-Obstruction of a cerebral arterydue to clot formation (80%)


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Risk factors for Stroke

High blood pressure Smoking Diabetes: 5 times more

likely to suffer stroke Heart disease Carotid artery disease High cholesterol

Physical inactivity Obesity Heavy alcohol use

Risk factors you cannot change:

Aging- over 55 risk doubles eachdecade

Being male however stroke is thenumber 3 killer of womenLHJ

African-American Ethnicity A family history of stroke A prior stroke or heart attack Sickle cell disease


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Risk Factors

New research shows that certain conditions such as smoking,hypertension, or diabetes produce chronic, low levels of

inflammation.

This inflammation can destabilize cholesterol deposits incoronary arteries, leading to a heart attack or stroke. -RDH 11/2004

Carbon monoxide generated during smoking reduces theamount of oxygen carried in the blood causing blood platelets

to cluster, decreasing clotting time, and increasing bloodthickness.-American Heart Association 2006

St k


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StrokeSymptoms:

Headache- intense Confusion Vertigo Dizziness Loss of control on one side

(paralysis)

Impaired speech Unequal pupils Difficulty breathing

and swallowing

Whirling sensation Ears Ringing Tunnel of flashing lights Body veering to one side Chest pain and shortness of

breath (more common inwomen)

Blurred or double vision Unilateral tingling around

mouth

Aura/ Smells

St k


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StrokeTreatment:

Terminate procedure Position upright Activate EMS immediately! (Ask if the transport can be to a

hospital with a stroke center)

Manage symptoms Administer oxygen Do not give aspirin- (If hemorrhagic it is deadly and women have

this type 2 times as much as man)

S k


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Stroke

1) Ask the person to smile. 2) Ask the person to raise both arms.

3) Ask the person to speak a simple sentence. 4) Ask the person to stick out his tongue.

St k


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StrokePrevention:

Medication (blood thinners) Normal prothrombin time:11-15 Recommended International Normalized Ratio (INR) 2-3

Stress reduction

Do not treat for 6 months do to healing and risk of re-stroke(1/4 of patients die within the year from the TIA or a subsequent stroke-LHJ 6/06)

Ask if their physician gave any warnings to dental treatment Ask for knowledge of increased bleeding Mid afternoon appt.s- BP lower Use cardiac dose of epi

A i P t i (Ch t i )


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Angina Pectoris (Chest pain)

A i P t i (Ch t i )


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Angina Pectoris (Chest pain) Insufficient blood supply to

the cardiac muscle (heart)

Pain varies from mild tosevere

Lack of oxygen to the heart

Causes: Stress and anxiety Exertion Heredity, age, sex (males 2:1) Smoking, obesity, hypertensionSymptoms: Crushing or squeezing pain in chest,

Intense

Excessive sweating History of angina pain (lasting more

then 3-5 minutes but shorter than 20

minutes) Radiating pain to left arm/jaw Feels like indigestion



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Angina Pectoris (Chest pain)Treatment: Comfortable semi-upright

position

Administer oxygen Administer nitroglycerin

sublingually (may repeat in 3-5minute intervals 3 times)

Monitor vitals to have baseline If pain lasts longer then 8-10

minutes or is atypical for patient

activate EMS immediately. Then administer aspirin 325 mg

orally to be chewed. Utilized 20minutes faster.

Prevention: Complete medical history Have nitroglycerin pills

available (check expiration date)

Stress reduction Cardiac dose of local: no more

than 2 carpules of 1:1000,000 epi

Pacemaker: keeps heart regularContraindications

Ultrasonic: if unshielded (before1985)

* If any doubt about the type ofattack call 911 for a possible

heart attack

Nit l i


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Nitroglycerin

Spray is not to be inhaled Spray under the tongue If systolic BP decreases

below 100 mm Hg,

discontinue administering

because it will furtherdecrease.


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Nitroglycerin 0.4mg Tablets or 0.4mg Metered Dose Spray

Use: To relieve or eliminate chest pain associated with angina pectoris, todifferentiate between angina and a myocardial infarction.

Dose:

Tablet: 1 tablet sublingually repeat after 2 minutes if no relief up to 3 doses. Metered Dose Spray: 1 spray sublingually repeat after 2 minutes if no relief

up to 3 doses.

Monitor blood pressure after each dose; do not repeat if systolic BP dropsbelow 100. Average drop in BP is 11-16 mm Hg after one dose. Patientshould be sitting or supine when Nitroglycerine is administered.

Adverse Effects:

Cardiovascular: Rapid heart rate, facial flushing, and orthostatic (Postural)hypotension.

Central Nervous System: Dizziness and headache.

Drug Interactions: Anti-hypertensive drugs may exaggerate the hypotensive effectof Nitroglycerine.



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Angina Pectoris (Chest pain)Ask patient if they have taken any erectile-

dysfunction drugs within the last 24 hours.

Viagra, Levitra- 3 days, Cialis

These drugs+ Nitro= No Blood Pressure

Niacin + Nitro= No Blood Pressure Simply state if you dont tell me you will die.


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Myocardial Infarction

H t Di


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Heart Disease

1 in 4 deaths will occur in persons younger than 65. Single largest killer of both men and women. Stroke and chronic heart disease #1 killer among US

women. Research shows unique factor is theinfluence of their hormonal status (Endogenous Estrogens increasepostmenopausal)

This year approximately 1,200,000 persons will havea new or recurrent heart attack or fatal episode of

coronary heart disease. Cigarette smokers have a 2-3 fold greater rate of

death of CHD than nonsmokers. American Heart Association 2006



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Myocardial Infarction 35% of all deaths occurring in men between

the ages of 35 and 50 years.

27% of men and 44% of women die within 1year after having a heart attack.

25% do not exhibit obvious clinical symptomsbefore the onset of death.

-Malamed 5th edition



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Myocardial InfarctionHeart Attack

Death of a portion of themyocardium

Lack of oxygen to the heartcaused by a blockage to anartery

Coronary artery disease(90%)

Occurs at rest (52%) Occurs with modest exertion

(18%)

Time is critical

Causes: Stress and anxiety Exertion Heredity, age(50-70?), sex

(males?) Smoking, obesity,

uncontrolled hypertension



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Symptoms: Severe crushing or squeezing pain in chest, Sharp Sudden onset, cold sweat Radiating pain to left arm/jaw, back Nausea, vomiting, light headedWomen: Fatigue and back pain

Diabetics are more likely to have silent MI.55% of patients who experience a heart attack can go

into cardiac arrest and die within the first 2 hours.Access 11/2006



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Myocardial InfarctionTreatments: CALL EMS IMMEDIATELY!! Position comfortably Proceed with basic life support as

needed

Administer oxygen Have the patient chew to crush an

aspirin- if not allergic- 325 mg adultdose

Administer nitroglycerin Give 50-50 Oxygen and Nitrous

oxide to help relieve the acute pain.

Monitor vitals- every 5 minutes Accompany patient to hospital

Prevention: Thorough medical history Stress reduction Appt in late morning/ afternoon

better. Research shows highestMI time is during endogenousepinephrine peaks- 8-11 AM

Medical clearance Do not treat a pt with history of

MI within 6 months prior



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Myocardial Infarction Denial- If a victim starts giving reasons why

they couldnt be having a heart attack, that is

a signal to us that it is and we should call 911!

Many times it isnt just the victim that is indenial.

Sudden Cardiac Arrest


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Sudden Cardiac Arrest Strikes about 1000

victims per day in US

This is the equivalentof 3 full 747

s crashing

daily.

10% (100 of these) arein people younger than

40. Dental Economics 10/07

Dental Therapy Considerations in the Patient

i h Hi f MI


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with a History of MI

Review Changes in Medical History includingMedication Doses

Stress Reduction Supplemental Oxygen Sedation Pain Control Minimize duration of Appointment- late morning, early

afternoon

Only Emergency procedures if MI is within six months medicalconsultation recommended

http://www.jefferson.edu/omfs/research/powerpoint/medical_files/frame.htm

Cardiovascular Disease and Periodontal

i


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Disease

Individuals withperiodontitis have nearly

twice the risk of having a

fatal heart attack than a

person without periodontaldisease.Periodontics, Neild-Gehrig, Willmann

Oral bacteria may infectblood vessel walls, causing

a buildup of deposits inside

heart arteries.

Oral bacteria can enter theblood causing small blood

clots that clog arteries.

Phen Phen


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Phen-Phen

Over 30% of the past users of Phen-Phen can develop aortic stenosis. Thisliterally means "narrowing of the aorta". What results is the aortic valvestarts to lose its flexibility and becomes more rigid. This in turn causes theleft ventricle to work harder since the blood will re-enter the ventricle dueto the loss of a tight seal by the aortic valve. The left ventricle will start to

hypertrophy due to the increased work load. In time, the increased size of the left ventricle can lead to possible strokes,

MI's, arrhythmias, and tachycardia.

The primary result of aortic stenosis is an aortic valve infection. This willrequire pre-medication with the appropriate antibiotics!

The symptoms of aortic stenosis are: chest pain (angina), fainting, andshortness of breath. One point to realize is that 4% of the patients withaortic stenosis can go to sudden death!

LECTURE AUGUST 21, 2004 SPEAKER: BETSY REYNOLDS, RDH., M.S.

How do you know the difference?


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How do you know the difference?Acute Myocardial Infarction

Pain lasts 30 minutes tohours

Associated witharrhythmias

Pain during exertion or rest Pain is not relieved by rest Pain returns after Nitro Patient may have reduced

or normal BP

Angina Pectoris

Pain lasts 3-5 minutes

Not associated witharrhythmias

Pain follows exertion/stress Pain is relieved by rest

Pain is relieved by Nitro Pain is uncomfortable not

acute


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Sudden Cardiac Arrest - Chain Of Survival

Basic Life Support


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Basic Life Support Are you OK? Call 911 and get the AEDRemember CABs now-

Circulation- Check for a pulsein 10 seconds or less

Airway Breathing- Get the AED Defibrillation

AED monitors heart rhythm


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AED- monitors heart rhythm

Year 1947Claude Beck,

defibrillator

Today

h // i d / d h l


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http://www.americanaed.com/aed_resources.html

AED stands for Automated ExternalDefibrillator

What is a Defibrillator?A machine that administers a controlled

electric shock to the chest or heart to correct a

critically irregular heartbeat that cannot drivethe circulation.

AED


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AED

Chances of surviving a cardiac arrestdiminishes 10% every minute.

Survival rates can exceed 90% if AED is usedin the first 1-2 minutes. Dental Economics 10/07

After 8-10 minutes, the survival probability isnear zero. Dental Economics 10/07

AED saves lives!

AED Where are they?


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AED- Where are they?

Wal-mart? Giant Eagle? Airplane? Airport? Disney Resort? A cruise ship? In a school? The Bottom of the Grand Canyon? Is the area locked? Is the battery working? Where is it in your office?

AED Is it the Standard of Care?


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AED- Is it the Standard of Care?

Section 64B5-17.015 of the FloridaAdministrative Code states:

As part of the minimum standard of care,every dental office location shall be requiredto have an automatic external defibrillator by2/28/2006. Any dentist practicing after this,without an AED on site shall be considered tobe practicing below the minimum standard ofcare. Dental Economics 10/2007

AED- Automated External Defibrillator


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AED- Automated External DefibrillatorUse AEDs when the victims

have the following 3clinical findings:

No response No breathing- Remember

agonal breaths are not effectivebreaths

No Pulse

Do not move or touch thevictim while AED isanalyzing.

If the adult is a drowningvictim the rescuer shouldgive 2 minutes of CPR

before getting the AED

htt // i d / d ht l


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http://www.americanaed.com/aed_resources.html

AED Cautions


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AED Cautions

Water- remove the victim from water and wipe thechest dry

Hairy chest- Press the pads firmly, if prompt tocheck pads is given then pull off the pads and thenapply pads. If hair still remains shave area with a

razor form the AED case.

Implanted pacemaker- Place pad at least 1 inch fromdevice

Medication patch- Remove the patch and wipe clean

http://www.americanaed.com/aedspecial_onsite.html

Special Offer: $1250 00


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Special Offer: $1250.00

Special Offer : $1395 00


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Special Offer : $1395.00

Shopping results for AED prices


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Shopping results forAED prices AED CR Plus Semi Responder VP - RVP-CRPLUS-S $1,954.00 newAmazon.com DEFIBTECH LifelineAED Automated External Defibrillator $1,299.99 new Overstock.com

Philips HeartStartAED Home Defibrillator + $100 Bonus eGift Card $1,267.00 new Walmart AED 5 Year Business VP (Alarm Cabinet) - BVP-LIFELINE5-A $1,402.16 newAmazon.com ZOLLAED Defibrillator $1,299.00 usedDOTmed.com



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AED Automated External Defibrillator

AED can now be usedon children. Use childrenpads when available. You may useadult pads as long as the pads do not

touch. Flipping a child switch or button

may be indicated on some units.

If using an AED on a child,perform 2 minutes of CPR

prior to attaching and usingthe AED.



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AED Automated External Defibrillator

To get a program started in your office:www.redcross.org/services/hss/courses/aed.html

Basic Life Support- Update


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Basic Life Support Update

One rescuer

30 compressions to 2breathes

CAB from ABCTwo rescuer

Children and Infants-15 to 2

Moving away from thebreathing portion

Develop an Office Plan


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Develop an Office Plan

Every office employee should have a role. Document, Document, Document What is your plan?

If In Doubt


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If In Doubt

CALL

911

Sources-


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Sources

From any questions over material in this course contact: [email protected]

Advanced Protocols for Medical Emergencies- Lewis, McMulln; Lexi-Comp, Inc. Dental Office Medical Emergencies- Meiller, Wynn; Lexi-Comp, Inc. Manual of Emergency Medical Treatment for the Dental team- Braun, Cutilli Medical Emergencies- 5th edition, Malamed- 2000 The Health History, Gurenlian and Pickett- 2005 Dr. Mark Castle, D.D.S. www.gotodds.com-2007 Pocket Guide To Medical Emergencies in the Dental Office. LCDR V.C. , DC,

USN 2007

Medical Emergencies- Essentials for the Dental Profession Ellen B. Grimes

medical emergency ce current ho

Documents