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EMERGENCY IN A DENTAL CLINIC

Ideally the following equipments and drugs should be present in a dental clinic:

Pulse Oximeter

Portable defibrillator (incorporating ECG print-out

Portable oxygen delivery system

Ambu bag (self-inflating with valve and mask)

Oro-pharyngeal airways (sizes 1, 2 and 3)

Cricothyroid puncture needles

High volume aspiration with suction catheters and Yankauer sucker

Disposable syringes (2, 5, 10 and 20 ml sizes)

Needles (19, 21 and 23 gauge) and butterflies

Tourniquet, sphygmomanometer and stethoscope

Venous access cannulae (venflons 16 and 22 gauge)

IV infusion sets/ Microdrip sets

BM sticks (for rapid assessment of blood sugar levels)

EMERGENCY DRUGS

Oxygen

Adrenaline injection (1:1000 or lmg/1 ml)

Hydrocortisone injection

Anti-histamine injection (e.g. chlorpheniramine tablets 4 mg, injection 10 mg/ml) Avil 2ml

Diazepam ( 5 mg/ml)

Glucose (10% solution) for injection, and powder for oral use

Glucagon injection (ideally) 1 mg

Atropine injection (100 fig/mi)

Aminophylline amp

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Deriphylline inj

Colloid solution for infusion (e.g. Haemaccel500 ml).

Gelfoam, Hemolock

Tab sorbitrate 20 Mg for sublingual use

Tab. Nifedipine (sublingual)

Ringer's Lactate- 5% Dextrose- Normal saline

FAINTING

Dentistry predisposes to fainting (syncope or vaso-vagal episode) due to fear, pain, unusualsights and smells, anxiety, fatigue and fasting. It is the commonest cause of loss of

consciousness in dental practice. It is common in young men. Treat patients supinewhenever possible.

Symptoms and signs

Light-headed feeling (often with nausea) warm, sweaty

feeling Pallor * skin cool and moist to touch bradycardia (with a thready, low volumepulse) loss of consciousness and collapse with resultant rapid, full pulse.

Differential diagnosis

Hypoglycaemia steroid insufficiency drug reaction Cerebrovascular accident myocardial infarction heart block or other causes of bradycardia early epileptic seizure.

Management

Place patient in a semi recumbent postion

Increase ventilation (ask pt. to take deep breaths)

Determine bradycardia by taking pulse at major vessel.

Loosen clothing and open windows.

Establish verbal encouragement of patient and administer glucose orally.

If patient continues to go to drowsy state make him smell/inhale aromatic salt (spirit ofAmmonia)

Delay dental treatment unless urgent.

If recovery is slow or delayed reconsider diagnosis.

Check blood sugar and, if low, administer IV glucose.

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If bradycardia persists, give atropine IV incremental

doses of 100 micro mili|g.

Maintain airway and administer oxygen. If hypotensive, consider steroid insufficiency

administer IV hydrocortisone. Seek urgent medical attention.