Dental clinics of North America
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Respiratory emergencies are among the most common problems encountered in dental practice and are potentially among the most devastating. Therefore, they must be recognized rapidly and treated promptly. This article focuses on the clinically significant pathophysiology of respiratory emergencies, such that the practitioner can effectively identify the patients with a risk of developing a respiratory crisis and use this information to help provide rapid, effective therapy. Simple protocols are presented for the treatment of the most common respiratory emergencies.
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Fortunately, the incidence of pediatric cardiopulmonary arrest is extremely low in the outpatient dental office setting. Because most cardiopulmonary arrests in children result from a progressive deterioration in respiratory function, outcome critically depends on rapid diagnosis and evaluation of the adequacy of ventilation and the pediatric airway. This holds true for any pediatric medical emergency. ⋯ Whatever the nature of the medical emergency, caring for a child under these circumstances is challenging. Pediatric Advanced Life Support (PALS) and continual review of the American Heart Association guidelines should be considered by those specializing in the treatment of infants and children. This training will not only bolster practitioner confidence, but enable prompt, effective response for any pediatric medical emergency.
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Allergic and pseudoallergic reactions can be associated with all drug classes used in dental practice. A thorough medical history is essential to avoid challenging a patient with an agent for which they have proven intolerance. Despite this precaution, the dentist must be prepared to manage an immediate reaction, should it occur. ⋯ The duration of action for epinephrine is relatively brief (10 to 30 minutes), and dosages may need to be repeated if symptoms recur. Following stabilization, patients who have experienced anaphylactoid reactions should be transported by EMS to the closest emergency room for definitive management. A treatment algorithm summarizing management of allergic reactions is presented in Figure 1.
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The majority of diabetic medical emergencies can be prevented by proper preoperative instructions. New or emergency patients unable to receive such instructions are at higher risk, occasionally necessitating the prudent use of various agents to treat hypoglycemia. The signs and symptoms of hypoglycemia and hyperglycemia are reviewed, allowing one to make an educated differential diagnosis of the altered physiological state. Finally, some conditions are not preventable or treatable in the dental office, with notification of the emergency medical system being the indicated treatment choice.