Transcript Medical Emergencies

Medical Emergencies in the Dental Office
Presented by: Dane Smith, DDS
A
B
C
• Airway
• Breathing
• Circulation
• Drugs
D
Prevention
• Assessing your patient
• Using a medical history
Patient History Form
A
B
C
Airway
Breathing
D
Nitrogen, CO2, etc.
20% O2
Atmospheric Pressure
Airway
Lungs
Arteries
Veins
Tissues
H2O/CO2
Carbon-based molecules
Mitochondria
ATP - ADP
O2
A
B
C
Circulation
D
Tissue
Liver
Kidneys
Lungs
Out of Body
LOCAL
ANESTHETICS
Used in your Office Mg/Carpule Carpules for 100lb patient Maximum Carpules
Clinical manifestations of local-anesthetic overdose
Signs
Symptoms
Low to Moderate overdose levels
Confusion
Headache
Talkativeness
Light headedness
Apprehension
Dizziness
Excitedness
Blurred Vision, unable to focus
Slurred speech
Ringing in ears
Generalized Stutter
Numbness of tongue & perioral tissues
Muscular twitching and tremor of the face
Flushed or chilled feeling
And extremities
Drowsiness
Nystagmus
Disorientation
Elevated blood pressure
Loss of consciousness
Elevated heart rate
Elevated respiratory rate
Moderate to High overdose levels
Generalized tonic-clonic seizure, followed by:
Generalized CNS depression
Depressed blood pressure, heart rate and respiratory rate
Tissue
Liver
Kidneys
Lungs
Out of Body
Miligrams of local anesthetic per cartridge (1.81 ml)
commonly used in dentistry
%
Total
Concentration = mg/ml x 1.8 ml = mg/cartridge
0.4
4
7.2
0.5
5
9
1
10
18
1.5
15
27
2
20
36
3
30
54
4
40
72
Maximal recommended doses of commonly used local anesthetics
From S. Malamed
Patient
Weight
(lb)
Lidocaine
2% with/without
Vasoconstrictor;
2.0 mg/lb
Up to 300 mg max
Mg
No. of
cartridges
Carbocaine
Mepivacaine
2% or 3% with or
without
vasoconstrictor
2.0 mg/lb
Up to 300 mg max
Mg
No. of
cartridges
2%
20
40
1.1
40
80
2.2
60
120
80
40
Citanest
Prilocaine
4% with/without
Vasoconstrictor
2.7 mg/lb
Up to 400 mg max
Mg
No. of
cartridges
Septocaine
Articaine (for adults)
4% with
Vasoconstrictor;
3.2 mg/lb
Up to 500 mg max
Mg
No. of
cartridges
Septocaine
Articaine (for kids)
4%
Vasoconstrictor;
2.3 mg/lb
Up to 500 mg max
Mg
No. of
Cartridges
3%
1.1 0.8
54
0.75
64
0.9
80
2.2 1.5
108
3.3
120
3.3 2.0
160
4.4
160
100
200
5.5
120
240
140
46
0.6
1.5
128
1.8
92
1.3
162
2.25
192
2.7
138
1.9
4.4 3.0
216
3.0
256
3.6
184
2.5
200
5.5 3.5
270
3.75
320
4.4
230
3.0
6.5
240
6.5 4.0
324
4.5
384
5.33
280
7.5
280
7.5 5.0
378
5.0
448
6.2
160
300
8.0
300
8.0 5.5
400
5.5
500
7.0
180
300
8.0
300
8.0 5.5
400
5.5
500
7.0
200
300
8.0
300
8.0 5.5
400
5.5
500
7.0
Marcaine
.5% w
1:200,000 epi
90 mg max
M
g
No. of
Cartridges
Package Insert
Lidocaine
2% w/ 1:100,000
epi
3.2 mg/lb
500 mg max
Carbocaine
3% w/
vasoconstrictor
3.0 mg/lb
400 mg max
Citamest
4% w/1:200,000
epi
4.0 mg/lb
600 mg max
Septaocaine
4% w, 1:100,000
epi
Children/Adults
3.2 mg/lb
100 lbs
320 mg = 8.8c
36 mg/c
100 lbs
300 mg = 5.5c
54 mg/c
100 lbs
400 mg = 5.5c
72 mg/c
100 lbs
320 mg = 4.7c
68 mg/c
Marcaine
.5% w
1:200,000
90 mg max
Maricaine .5%
9 mg/c
Dane’s Rule
100 lbs
10 = 5c
2
100 lbs
10 = 3.3c
3
* c= carpules
100 lbs
10 = 2.5c
4
100 lbs
10 = 2.5c
4
9 mg /10 lbs
Of body wt
Not to exceed
10 c
Comparables for 100lbs
Malamed
Lidocaine 2%
Carbocaine 3%
Citanest 4%
Septocaine 4%
Marcaine .5%
w 1/100,000 epi
W vasoconstrictor
w 1/200,000 epi
w 1/100,000 epi
For kids
w 1/200,000 epi
100lbs
5.5 c
100lbs
3.5c
Max
5.3c
100lbs
3.75c
Max
5.5c
100lbs
3.0c
5.5c
7.4c
5.5c
8.3c
4.7c
Max
8.3c
Max
7.0c
Insert
8.8c
Dane’s Rule
5c
13.8c
3.3c
2.5c
2.5c
6.9c
9mg/1lbs
1c/10lbs
10c max
Effects of vasoconstrictor (epinephrine 1 : 200,000) on
peak local anesthetic level in blood
From S. Malamed
Peak Level (ug/ml
Local
Anesthetic
Dose
(mg)
without
with
vasoconstrictor vasoconstrictor
Mepivacaine
500
4.7
3.0
Lidocaine
400
4.3
3.0
Prilocaine
400
2.8
2.6
Etidocaine
300
1.4
1.3
Vasoconstrictor commonly employed in dentistry
From S. Malamed
Agent
Epinephrine
Available
concentrations
Maximal
dose
1 : 50,000
Healthy adult .2 mg
1 : 100,000
Cardiac patient 0.04 mg
1 : 200,000
Local Anesthetic
agents used with
Lidocaine 2%
Articaine 4%
Lidocaine 2%
Articaine 4%
Prilocaine 4%
Levonordefrin
1 : 20,000
Healthy adult 1.00 mg
Mepivacaine 2%
Cardiac patient 0.2 mg
Procaine 2% with
propoxycaine 0.4%
Levarterenol
(Levophed)
1 : 30,000
Healthy adult 0.34 mg
Cardiac patient 0.14 mg
Procaine 2% with
propoxycaine 0.4%
Dilutions of vasoconstrictor used in dentistry
From S. Malamed
Dilution
Drug
available
1:1000
Epinephrine
mg/ml
mg per
cartridge (1.8 ml)
maximum no. of cartridges
used for healthy patient (H)
and for cardiac patient (C)
1.0
Not Applicable
Not available in local anesthetic cartridges
0.1
Not Applicable
Not available in local anesthetic cartridges
(emergency kit)
1:10,000
Epinephrine
(emergency kit)
1:20,000
Levonordefrin
0.5
0.09
10 (H), 2 (C)
1:30,000
Levarterenol
0.034
0.06
5(H), 2 (C)
1:50,000
Epinephrine
0.02
0.036
5(H), 2 (C)
1:100,000
Epinephrine
0.01
0.018
10 (H), 2 (C)
1:200,000
Epinephrine
0.005
0.009
20 (H), 4 (C)
A
B
C
DRUGS
D
Dose
.125 mg
.3 mg
Epinephrine
Beta 2
Beta 1
Alpha
Lungs
Heart
Bronchodilation
Oxygen Availability
Arteries
1.
Heart Rate
Blood Pressure
2.
Contractility
Vascular Resistance
3.
Centralized Perfusion
Peripheral Vascular Constriction
4.
Counteracts effects of histamine
Pain
Non-Narcotics
Narcotics
Acetaminophen
Codeine
Ibuprophen
Hydrocodiene (vicodin)
Aspirin
Potential Medical Concerns
Nitrous Oxide
Oxycodone (percodon)
Potential Medical Concerns
Potential Medical Concerns
1. Side effects
1. Side effects
1. Side effects
2. Drug interactions
2. Drug interactions
2. Drug interactions
Antibiotics
Tetracyclines
Penicillins
Biaxin
Clindamycins
Erythromycins
Cephalosporins
1. Dosage & Frequency
2. Potential Medical
Concerns
3. Side Effects
4. Drug Interactions
THE END