EMERGENCY DRUGS AND MEDICAL EMERGENCIES

EE

AIM:

• To raise awareness of Emergency Drugs used in dentistry and when to use them.

• To highlight common medications in dentistry and why they are prescribed.

OBJECTIVES:

• Learners will be able to identify all Emergency Drugs found in standard Emergency Drugs Kit and when they should be used.

• Learners will be familiar with common prescribed medications , why they are prescribed and the effects on the oral cavity.

TASK

• In pairs list all the Emergency Drugs that you think you would find in a Dental Emergency Drugs Kit.

EMERGENCY DRUGS CONTENTS

• Adrenaline Mininjet injection• Adrenaline Epipen • Glucagon 1mg kit• Salbutamol Inhaler 100mcg• Aspirin tablets 75mg• Transmucosal midazolam 10mg• Glucogel dextrose gel 10g

ANAPHYLACTIC SHOCK

Adrenaline for anaphylaxis (1:1000)

• Adrenaline Injection minijet 1mg in 1ml• Adult (over 12yrs) : 0.5ml• 6-12yrs: 0.3ml

• Inject slowly under the skin or in the muscle, repeat injections to be given into a different site.

ANAPHYLACTIC SHOCK

Epipen

• Under 6yrs : 0.15ml

• To be given intramuscularly

HYPOGLYCAEMIC

Glucagon

• To be given intramuscular, subcutaneous or intravenous

• Adult and child over 8 yrs – 1mg

• Child under 8 yrs – 0.5mg

HYPOGLYCAEMIC

GLUCOGEL DEXTROSE GEL

10 g of glucose in a 25g tube (single dose)

1) Twist off cap and squeeze the required amount inside the cheek.

2) Gently massage the cheek to aid absorption.3) Alternatively, squeeze required amount into

the mouth and swallow.

MYOCARDIAL INFARCTION & ANGINA

ASPIRIN

• Aspirin - dispersible tablets 75mg

• Adult 300mg (dispersed in water or chewed)

MYOCARDIAL INFARCTION & ANGINA

Glyceryl Trinitrate (GTN)

• Aerosol spray 400 micrograms/ metered dose

• Adult : 1-2 sprays sublingually, repeat as required.

ASTHMA ATTACK

Salbutamol

• Inhaler 100mcg• By aerosol inhalation via large volume spacer (and close fitting face mask if child is under 3)

Adult and child : 4-10 puffs each inhaled separately.

EPILEPSY

Transmucosal midazolam

• Buccal administration repeated once if necessary.

• Adult and children over 10 yrs : 10mg (1ml)• 5-10yrs : 7.5mg (0.75ml) Follow instructions on the carton and squirt

about half of the prescribed dose between lower gum and cheek on one side of the mouth – repeat on other side. If difficult administer the whole dose into one side.

TASK

• Describe the Dental Nurse’s roll in dealing with Emergency Drugs in an emergency.

• Explain the safe handling and storage of Emergency Drugs in dental practice.

OTHER ASSISTANCE AIDS

• Portable oxygen

• Defibrilator –AED(automated electrical device)

Duties of reception staff

• Ensure all patients details are to hand• Call 999 and request ambulance• The operator will ask questions ie: age/sex/

signs/symptoms, treatment given.• Give clear instructions of address, postcode, tel

number.• Ensure patients in waiting area are informed

that an emergency has taken place ant they may have to wait or offer another appt.

TASK

• In groups describe the Signs & Symptoms of the following conditions. Explain how you would deal with each situation in dental practice and any Emergency drugs which would be administered.

• As a group present back your scenario to the rest of the group.

TASK CONT....

• FAINT (VASOVAGAL ATTACK)• ASTHMA• EPILEPSY• ANGINA• ANAPHYLAXIS

COMMON DRUGS PATIENTS MAY BE TAKING

• ASTHMA

• Ventolin• Becotide• Salbultamol• Turbutaline

• Heart Conditions• Aspirin• Glyceral Trinitrate (GTN)• Digoxin

Angina• Nifedipine (Adalat)

• Epilepsy

• Epilim• Phenatoin( Epanutin)

• Gastric Reflux

• Gaviscon• Peptac• Omeprazole

Acid Reflux Tooth erosion

• Diabetic

• Diet• Insulin injection• Metformin tablets

What drugs effect treatment planning?

• Aspirin• Warfarin Hyperplasia• Nifedipine- Control Angina• Ciclosporin- Prevent transplant rejection• Phenytoin (Epanutin)- Control Epilepsy

Gingival hyperplasia

Xerostomia

• Sjogrens Disease• Beta Blockers• Antipressants

Herpes Virus• Varicella zoster virus (chicken pox)• Herpes zoster virus ( shingles)

Lifestyle Factors

• DMF• Regurgitation• Vomiting• Liver disease• Malnourishment• Bulimia• Parkinsons• Stroke

Osteoporosis

Patients taking any Bisphosphonate drugsAlendronic Acid, daily/ once a weekZoledronate- Injection form once yearly Will require referral to hospital for difficult

extractions.Osteoblasts vs Osteoclasts

Osteoporosis

• Exposed bone in the maxilla or mandible• A disruption of the resorption and remodeling cycle of bone• Poor blood supply to affected area• “Non-healing” extraction socket or exposedjawbone with localized swelling and discharge

Osteonecrosis

• Predisposing factors• – Age• – Radiation therapy to the jaw region• – Medications i.e. steroids• – Underlying dental problems• – Tooth removal or local factors i.e. dental

implants or fillings• – Thin, friable mucosa

Cross section

Sedation Methods

• Oral sedation temazepam or diazepam tablet form• Inhalation sedation controlled nitrous oxide and oxygen mask• Intravenous sedation into the vein- midazolam reversal drug used flumazonil- 3 available

Glossitis

• What is it?• What are the causes?

QUESTIONS & EVALUATION