|
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 2 ml
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
Deriphylline inj
Colloid solution for infusion (e.g. Haemaccel 500 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, unusual sights 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 supine whenever 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 volume pulse) 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 of Ammonia)
Delay dental treatment unless urgent.
If recovery is slow or delayed reconsider diagnosis.
Check blood sugar and, if low, administer IV glucose.
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.
|