 Hello everyone, welcome back to another session in dentistry and more Today we have a very important topic not just on academic point On a clinical point of view that is medical emergencies in dental practice So any dentist can face this problem That is a emergency situation while or before or after the dental procedures So understanding the problem or diagnosing the problem as early as possible and knowing the management of the same problem was very much Essential to save the person's life and to have a successful dental practice So let's learn the various medical emergencies and its management in detail so we have classifications broadly into the conditions such as consciousness, seizures, respiratory emergencies, cardiovascular emergencies, drug-related emergencies So we'll go into detail one by one. So what exactly is an emergency? So emergency is nothing but a serious and unexpected situation which requires an immediate action So it is a Foreseen combination of circumstances or the resulting state that calls for an immediate action So we'll start with unconsciousness So we have syncop hypotension and hypoglycemia So syncop. So we'll start with syncop Okay syncop is a short loss of consciousness and muscle strength Which is characterized by a fast onset short duration and spontaneous recovery and the causes of syncope we can broadly classified under CNS symptoms CVS symptoms and Vascular symptoms vascular and other symptoms vascular and other causes So in CNS symptoms CNS is basically related to brain. So we have a synonym that is head HEAD H4 hypoxia or hypoglycemia Hypoglycemia E4 epilepsy sorry Then anxiety Then the disorders of brainstem So one of the courses can be presented as an another medical emergency, but we are talking about Unconsciousness. Okay, so epilepsy can be another medical emergency and hypoglycemia can be another one So we are talking about the causes of Syncope so we have CNS courses that is hypoxia or hypoglycemia epilepsy anxiety and disorders of brainstem Whereas a CVS course we have heart So CNS is related to head and CVS is related to heart So H4 heart attack E4 embolism. So in all these conditions, there will be Syncope so we need to roll out the conditions and get into a proper conclusion Then A4 aortic stenosis Then R4 arrhythmia So we are putting R here Arrhythmia and T4 tachycardia So all will result in Syncope Whereas the vascular and other causes So we will write it here vascular and other causes We have Vascular and other courses we have vessels In which V4 vasovagal courses vasovagal courses Which are common faint Then E4 electrolyte abnormalities such as hypercalcemia electrolyte problem such as hyper Alchemy Then the situational problems situational such as cough sneeze Then S4 subclavian Steel syndrome then E4 ENT courses It can be glosopharyngeal neuralgia glosopharyngeal neuralgia Then L4 low systemic vascular resistance low systemic vascular resistance And the S4 sensitive carotid sinus carotid sinus So all are various courses of syncope. We have CNS course, CVS course and Vascular and other courses. Now, let's see the symptoms. That is what important on it clinical point of view So there will be breathing that is irregular, jerky and gasping type of breathing dilated pupils Convulsive movements bradycardia that means less than 50 beats per minute Tachycardia is increasing manner then the Pulse will be weak 3d pulse There will be loss of consciousness partial or complete airway obstruction. These are the symptoms we may face when a person is Going into unconsciousness So, how do we manage syncope? The first thing is position. Okay We need to position the patient properly. That is a supine position supine position Where the brain and heart at same level with feet elevated slightly by 10 to 15 degree Okay, so Brain and this should be the heart but The feet elevated. Okay feet should be elevated That is 15 degree. This is just a diagrammatic representation Where the brain heart Feet So this is important. We should be kept the patient in a supine position With the feet elevated at 10 to 15 degrees. So don't forget this 10 to 15 degree positioning of feet Then we can go for ABC that is airway checking breathing checking and circulation So, you know how to check airway How to check breathing and how to check circulation? Okay After that we need to go for definite management. So definite treatment That is first we should monitor the vital signs then we can administer aromatic ammonia Aromatic ammonia is Respiratory irritant so it can bring back the person Consciousness or we can administer atropin atropin 0.1 gram per ml So these are the definite management of syncope That is first thing is positioning then the checking airway breathing and circulation then we go for definite treatment that is Aromatic ammonia and atropin that is 0.1 gram per ml Now let's learn about seizure So seizure is nothing but a paroxysmal disorder of cerebral function, which is characterized by an attack involving changes in the state of consciousness motor activity or sensory Phenomena so usually sudden and onset and of brief duration so epilepsy Is a chronic disorder in which nerve cell activity in the brain is disturbed causing the seizure So seizure symptoms include the blank staring look the chewing fumbling Then the wandering patient will be wandering and the patient will be shaking and Patient speech will be very confused So how do we manage this or prevent this? So prevention is always better So if a patient is None for epileptic make sure that the patient has taken the regular dose of anti-convulsant on the day of treatment So many patients might not be telling that they are patient of epilepsy or they are having previous seizure attacks They are hiding the information because they just want the treatment to get done because if they Tell the fact that they are being epileptic Some dentist might not start doing treatment But we need to extract the information from the patient somehow because the emergencies we are the one was supposed to manage So we need to ask the patient if there is any history of epilepsy any history of seizures So the first thing is we need to instruct the patient to alert Yourself or the alert the dentist as aura of impending seizure manifest itself because patient will be having that beginning signs or symptoms So ask them to alert you as soon as the patient is having that aura of impending seizure manifest So keep a life support equipments ready in case of an emergency status epilepticus So we can follow the first stage such as explain to others and Block any hazards in nearby area and speak very calmly always track time and always be near to the patient And we need to Calm the patient once the patient is slowly recovers from the seizure attack So this seizure is a self-limiting emergency The first thing is positioning We should keep the patient in a supine position with Patient placed on a very flat surface. Okay, so the supine position on a flat surface Then remove her dangerous objects from the mouth and around the patient such as sharp instruments Needles so such things should be Shops should be kept away from the patient then loosen any tight clothing avoid restraining the patient In case if the patient is not recovering that is a patient seizure is not getting over within 10 minutes We need to declare status epilepticus and we should start with the definite care So definitive care We should start if it is not Manageable or if the patient is not recovering within 10 minutes So what are what are the definite treatment that does diastere pump the first thing is diastere pump So we should have diastere pump in our clinic That is 10 mg That is basically IV around per minute that is for every 10 minutes. So how many clinics can do this? It's a questionable thing But still this is a definite treatment for the status epilepticus then second one has phenol barbitone so If the patient is epileptic Or if we are suspecting a seizure attack always Keep it ready, but it's better to get the treatment done in a hospital setup and this is 102 200 mg per minute that is all also IV intravenously Then we have carbamazepine and Finitoin so these four drugs can We give one for a epileptic patient on a definitive care Next is hypoglycemia Hypoglycemia is a clinical syndrome in which low serum glucose Which leads to symptoms of simpado adrenal activation. So sometimes patient comes with low Low glucose level that is empty stomach Empty stomach so Or patients with morning insulin Templates or insulin shots which further decreases the glucose level So what happens is blend glucose level will be low Because insulin will be Reducing the glucose level. So it will be less than 15 mg per 100 ml. So usually it is The RBS should be around 110 then it will lead to Anxiety Then that again results into weakness, dizziness, pale skin, depressed respiration Ultimately the patient goes to Syncope or loss of consciousness. So this is the most problem we face. Hypoglycemia patient comes with empty stomach or patients Take an insulin shot or insulin injection or insulin tablets so the symptoms as we said unconsciousness Poor coordination Anger or bad temper pale color Confusion there will be disorientation sudden hunger Excessive sweating trembling So management is a little bit easy compared to other one because glucose and sugar containing Beverage is administered orally to conscious patient for rapidly the patients will recover. So we need to give Glucose that is a concept. So all we can give cantibals fruits cheese, etc That is for the mild cases Or we can go for I-Ved Extrose but facilities should be there. So this I-Ved Extrose should be indicated for patients with altered consciousness and During any restriction of oral intake is there. We can go for I-Ved So that is 20 to 25 ml of 50% 25 ml of 50 percentage dextrose or we can give Glucogon That is 1 mg 1 mg Okay, it can be given Intramuscular or subcutaneous So both routes we can administer glucagon Or we can give Metformin or Sulphonyl ureus Sulphonyl ureus So that is how we manage hyperglycemia. Basically, we can give the glucose containing Vibrages or cantees fruits cheese or something in a mild to moderate cases, but severe hyperglycemia where we Have restriction of oral intake and altered consciousness. We should start I-Ved Extrose 20 to 25 ml That is 50 percentage dextrose I-V Then glucagon or glucagon 1 mg intramuscular or subcutaneous or we can go for metformin or sulphonyl ureus Next we have respiratory emergencies. So airway obstruction comes under respiratory emergency. This occur due to Any pathology on their way? Any entrapment of dental instruments? Dental instrument entrapment Such as vials or even tooth can be falling to trachea the patient Always demonstrates symptoms ranging from cuffing gagging to choking So gasping with pain. So the asperd objects may pass into the trachea or esophagus So we might need to go for a x-ray just x-ray to confirm it And this is very easily manageable. The first thing is Prevention is by rubber damp. So if we have a rubber damp there is zero percentage of falling the Dental instruments or anything into the trachea or esophagus, then we can use oral packing then proper chair positioning or a good dental assistant So all these can help preventing Falling of this dental instruments into trachea So once we have a situation we can manage it by Re-establishing of airway such as back blows We can give back blows And you must have heard about this manual that is hemorrhage manual then chest truss Chest truss time finger sweep Finger sweep forceful cuffing So all these are attempts to take the Objects out of the trachea or esophagus that is back blows We can't give blows to the back side of the patient then hemorrhage manual We need to stand behind the patient and keep one leg between the legs of the patient We need to circle the abdomen that is just below the sternum and We need to push inside that is hemorrhage manual then we can give chest thrust We can go for finger sweep or forceful cuffing Next we have hyperventilation so it is excessive rate and depth of respiration So that leads to abnormal loss of carbon dioxide. So carbon dioxide is lost That is hyperventilation. So we need both oxygen and carbon dioxide So if we lost carbon dioxide in excessive amount, we are in a hyperventilated state So this carbon dioxide will be lost from the blade Which predisposes to stress and anxiety which is characterized by a rapid shot strained breath short rapid and strained breath Then there will be her palpitations, dizziness, chest muscle fatigue and cold sweats So prevention of hyperventilation is reduced patient stress and anxiousness by any means And the operator should stay calm and also make the patient be relaxed Then we can give a paperback where the exhaled air is inhaled using this paperback. So this will Bring certain amount of carbon dioxide back to a system so that it can be properly ventilated So this point of breathing into back is to Re-breathe the exhaled carbon dioxide to bring the body back to normal state So that is a paperback. So simple paperback can help you in this Situation that is hyperventilation or we can manage it with benzodiazepines. That is diazepam 2 to 5 mg intramuscular or intravenously 3 to 4 hours and Lorozepam Lorozepam which is 2 to 3 mg Oral can be given BD or TD twice a day or twice a day Then triazolum triazolum which is 0.252 0.5 mg Then alprazolum Alprazolum Which is again 0.25 to 0.5 mg The next medical emergency is asthma, which is a clinical state of hyper reactivity of the tracheo bronchial tree characterized by recurrent paroxysm of dyspnea and wheezing So basically we need to manage it by recognizing symptoms then we need to stop the dental procedure Pay the patient position should be upright or bending forward with arms straight ahead Then we can administer bronchodilators mostly this asthmatic patients will be carrying a bronchodilator over patient is asthmatic Having a bronchodilator with the patient during the procedure So once a patient uses bronchodilator and this asthma terminates We can continue with dental procedure if it is not we need to declare status asthmaticus and Call for emergency medical service or shift the patient to a better medical facility Next we have the cardio vascular emergencies So in cardio vascular emergency we have the MI that is myocardial infraction It is a clinical syndrome caused by deficient coronary arterial pleats of play which results in ischemia to a region of the myocardium and causing cellulose death and necrosis So the predisposing factors are ethiosclerosis coronary artery disease or coronary thrombosis occlusion and spasm and unnecessary stress so we can prevent it by avoiding over stressing the patient and Supplemental oxygen should be there during the treatment and pain control during the therapy using use of local anesthesia and also we can go for psychocidation psychocidation Then elective dental care is avoided until at least six months after a MI Then inferior alveolar and PSA nerve blocks should be avoided due to high risk of hemorrhage Okay, so inferior alveolar nerve block PSA should be avoided in MI patients because there is high chance of Hemorrhage so management basically by anti platelets So anti platelets we have clopidogrel that is 75 mg Oral dose once daily then ticlopidine Ticlopidine which is 250 mg 12 words that is BD then di pyridomol di pyridomol That is 75 to 100 mg TD oral Or we can go for beta blockers beta blockers they are propanolol propanolol that is 40 mg oral dose tricep tricidae then metaprolol that is 100 mg BD 100 mg BD or at an all we can go for single dose that is 50 mg 50 mg should be given BD twice a day or 100 mg we can give once a day OD That is about myocardial infarction So the next one is anterina pectoris that is a condition marked by severe pain in the chest Often also spreading to the shoulders arms and neck Due to inadequate blitz supply to the heart So there are various types stable variant unstable anterina. So basically prevention is by stress reduction reassuring the patient psychocidation All the things we applied in MI patients also can be applied here in anterina pectoris So the management by Recognize the problem then discontinue dental treatment activate the emergency then positioning the patient upright comfortably SSN perform BLS Then we should start definite management using Beta blockers So the drug related emergency is what we have next that is overdose That is an overdose is when a person ingest or takes more than normal of recommended or prescribed amount of drug It can be accidental or intentional So in a dental practice the most common overdose H is by local anesthesia So the most common symptoms confusion Toctinus blurred speech muscle twitching facial trimmer headache tinnitus drowsiness disorientation elevated blood pressure heart rate respiratory rate if uncontrolled There will be generalized tonic cloning seizures and generalized CNS carbopathy So we can manage it by administer BLS basic life support then hundred percent oxygen and anti-convulsants Then allow recovery to occur in case of continuation of symptoms. We need to immediately transfer to a better medical facility So that is about overdose and we have allergy problem That is another medical image Allergy is nothing but a hypersensitive state of skin and various mucosa acquired through the exposure to a particular allergen then the reexposure to which produces a increased Immersion capacity to react. So occurring via expression of IG The NFL axis is a common one So NFL axis We have discussed in detail You can see here In previous videos. So here in allergy normal allergy, we have red itchy watery eyes sneezing congestion and runny nose And sore throat postnatal drip and cough So we can manage it by reassuring the patient. Sometimes we need to initiate the BLS then administer and T histamine okay and T histamine Typhine hydramine that is 50 mg or epinephrine That is a point one two point Three ML one is two thousand IM Then we need to monitor the vitals regularly. So that is all about Various medical emergencies in dental practice. We have discussed in detail about most of the conditions So it was classified in the beginning based on certain general category such as the loss of consciousness and respiratory emergencies seizures Cardiovascular emergencies and drug-related emergencies so in Unconsciousness we have Syncope hypotension and hypoglycema then seizure respiratory emergency. We have airway obstruction and asthma cardiovascular emergency MI and antenna pectolis and drug-related emergency that we have overdose reactions and allergies So medical emergency management we need to start from the preventive side Prevention is always better than cure So we need to be prepared always any patient as a potential medical emergency patient So we need to take a proper history So history taking the first part and Properly recognizing the problem as a second one and effective management as a third one So we need to have all the facilities In our clinic or wherever we are practicing And we need to have thorough knowledge By seeing the symptoms we need to Identify the Diagnosis or identify the problem Okay, and we need to learn BLS that is very much essential basic life support So that's all for now regarding the medical emergencies. So I'll come up with a new topic in oral surgery. Thank you