Medical Urgencies and Emergencies

Donald Falace, DMD

Oral Diagnosis and Oral Medicine

UK College of Dentistry

Goals

Develop a sense of vigilance and anticipation

Enable you to respond to an urgent medical need in a reasonably confident and efficient fashion

Urgencies vs. Emergencies Urgency: a problem that requires prompt response; it is not

immediately life threatening but could become so if not resolved promptly Syncope Hypoglycemia Seizure Asthmatic attack Hyperventilation Angina Mild allergic reaction Stroke

Emergency: a problem that is immediately life threatening and requires immediate action Cardiac arrest Anaphylaxis Obstructed airway

Be observant!

Look at and listen to your patient Watch for changes in:

Speech (slurring, halting, excessively talkative, silent)

Behavior (becomes quiet, restless, agitated, anxious, fearful, uncomfortable, nauseated, has difficulty breathing, non-communicative)

Appearance (pale, ashen, flushed, sweating, trembling)

Anticipation, Prevention and Planning

Anticipation: What type of urgency/emergency can you anticipate with this patient?

Prevention: What can you do to decrease the risk of occurrence?

Planning: What would you do if the problem does occur?

Reality Check

It is estimated that about 90% of urgencies - emergencies can be prevented.

This means that 10% will occur in spite of our best efforts

UKCD Urgency/Emergency Response Protocol in Clinic

Attend to the patient If conscious, allow patient to assume a comfortable

position, monitor vital signs, give oxygen as needed, try to determine what the problem is

If unconscious, PABCD Stay with the patient Call for help from your supervising faculty member (or

any faculty member) If not immediately life-threatening and additional help is

needed, call Oral Surgery 3-5279 If cardiac arrest or anaphylaxis, call 3-5200 and report

“code 500” and give location and nature of the problem

Location of Emergency Equipment

Medical Emergencies Equipment in the Clinic

Oxygen tank, ambu bag, tubing and mask

Automated blood pressure cuff and pulse oximeter

Drug box Defibrillator

Drug Box Albuterol inhaler Ammonia ampules Aspirin Diphenhydramine (oral;

injectable) Epinephrine (EpiPen;

ampules) Glucose Nitroglycerine (spray;

tablets) Ephedrine (hypotension) Solucortef (adrenal crisis) Narcan (narcotic overdose) Atropine (bradycardia)

Defibrillator

Located in COD on 2nd, 3rd and 5th floors

Phone

Oral Surgery 3-5749

Cardiac Arrest or Anaphylaxis 3-5200 and report

“code 500” Outside of Medical

Center - 911

Emergency Medicine in DentistryStanley Malamed, DDS

Disk 1: Preparation for

emergencies Emergency drug kit Basic management

protocol

Disk 2: Altered consciousness Respiratory distress Allergic response Cardiovascular problems