Medical emergencies can also occur in kids!

Adverse medical complications may present themselves in the course of dental treatment. Every dental practitioner should have the knowledge and skill for the diagnosis and management of medical emergencies. Although most are not life-threatening, they could occur with potentially serious conditions. To reduce medical emergencies occurring in dental clinic, the dentist should take the thorough history and conduct general examination of the patient. Practising dentists should have previous knowledge of Basic Life Support (BLS) and should be capable of diagnosing the possible cause(s) of emergencies during a dental visit. In fact, present studies suggests that many dentists on graduation do not feel competent in managing medical emergencies, while some feel insecure in doing so. Therefore, advanced training is needed for both undergraduates and post graduates students.

Medical emergencies can also occur in kids!

Most suggestions for treating emergencies in recently published literature are written for adult patients. Since children are not miniature adults, it is necessary to modify the approach. Suggestions for treating emergencies in children have not yet been sufficiently addressed.

Differences between children and adults are reflected in the size and shape of the body along with emotional and cognitive maturity, but differences in physiology, such as the respiratory, cardiovascular, and immune systems, are also important. The pharmacokinetics of drugs in the body of the child must also be taken into account.

Equipment used must be adaptable to the patient’s age, for example there are different sizes of breathing masks and oropharyngeal or endotracheal tubes, which must be properly selected. An oropharyngeal tube should be introduced directly in children, as opposed to the way of applying the tube in adults in which the tube is concavely applied to the palate to reach the soft palate and then rotated by 180° to put it into position. Rotation is not recommended for children because of the delicate structure of their airway, and because of the size of the tongue in relation to the oral cavity. The dosage of medication to be used in emergency situations, as well as the application techniques, are different from those to an adult patient.

Various emergency conditions and their treatment -

1. Ischemic heart disease consists of angina pectoris and myocardial infarction.

Symptoms: sudden retrosternal pain that radiates to the neck, lower jaw, shoulders and arms, this can be manifested as a feeling of tightness and an inability to breathe.

Treatment

1. discontinue dental treatment
2. call an ambulance
3. administer dose of nitroglycerin 0.4 mg in tablets, sublingually

If the pain persists, myocardial infarction must be suspected and the patient should be given 325 mg aspirin, if necessary, administer oxygen, while waiting for an ambulance.

2. Cardiac arrest is the sudden stopping of the heart. It is represented by the lack of pulse, loss of consciousness and aponea. Cardiac arrest in children may be a consequence of respiratory or circulatory failure, although usually the problem is in the respiratory system.

Therapy: if the child is not breathing or has agonal breathing at times, open the airway and apply five breaths of air; before each breath of air the rescuer should take a deep breath and supply air to the victim as soon as possible, so that oxygen in the inhaled air is not derived from his or her own lungs; if the rescuer is sure that the palpable pulse frequency of the patient is greater than 60 ppm, he or she should continue with artificial ventilation until the arrival of qualified assistance; if there is no pulse, he or she should begin with chest compressions, which are performed in children over the lower half of the sternum, avoiding compression to the zyphoid bone. The procedure should consist of 15 external cardiac massages and two breaths of air; this procedure for reviving children with a rhythm of 15:2 applies to children up to puberty, whereas older children and adolescents receive the reviving procedure similarly to adults.

Procedure for external cardiac massage in a small child:

Imagine a line that connects the nipples of a child. Put the following three fingers on the chest: index, third and fourth finger. The index finger should be close to the imaginary line that joins the nipples. Raise the index finger in the air and start massaging by putting pressure on the sternum with the two remaining fingers. If the fourth fingers feel the zyphoid bone, move the little finger towards the imaginary line.

3. Diabetic ketoacidosis can develop in patients with an absolute or relative insulin deficiency, resulting in high hyperglycemia, the accumulation of ketones and the development of metabolic acidosis.

Symptoms: polydipsia, polyphagia, polyuria, weakness, nausea, vomiting, hyperventilation, red face, and the smell of acetone; it can lead to disorders of consciousness.

Treatment: in the first hour, administer saline at a dose of 10–20 ml/kg body weight, and after 2 h of this treatment, include intravenous insulin.

4. Hypoglycemia is a condition of low blood glucose levels. It represents the most common acute complication of diabetes but can also develop in patients who do not have diabetes.

Symptoms: tremor, hunger, palpitations, anxiety, sweating, headache, fatigue, disturbances of consciousness, convulsions and pallor.

Treatment: stop all procedures, place the patient in a comfortable position (usually this means to sit up straight), pay attention to breathing and circulation, give oral carbohydrates (sugar dissolved in water, orange juice, chocolate), with one dose containing 40 g of glucose. Repeat the dose every 10 min until symptoms disappear; if not effective, give 1 mg glucagon intramuscularly or 50 ml of 50% dextrose intravenously over 2–3 minutes.

5. Acute asthma attack is a chronic inflammatory disease of the entire respiratory system in patients with allergic diseases.

Symptoms: dyspnea, chest tightness, audible wheezing or problematic breathing. For physical status, the most significant findings are extended and difficult-expiration, with a marked expiratory whistle.

Treatment: immediate treatment begins with the inhalation of beta-agonists (salbutamol), which will be sufficient if the problem is a mild attack; in severe attacks, administration of epinephrine is indicated at a dose of 0.01 to 0.03 ml/kg of a 1:1000 solution, administered intramuscularly or subcutaneously

6. Syncope is a short-term reversible loss of consciousness and postural tonus, which results from a sudden, transient and diffuse disorder of brain function resulting from a sharp reduction in the delivery of blood to the brain.

Symptoms: the patient shows signs of confusion, breaks into a cold sweat, turns pale and usually says that he or she is not well. Later, pupillary dilation appears, along with increased respiration, disorientation and loss of consciousness; breathing becomes irregular, shallow and may be absent; bradycardia occurs; the blood pressure drops and the pulse is weak.

Therapy: if the patient is placed in the Trendelenburg position, the duration of syncope is short and lasts from a few seconds to a few minutes; the patient is conscious and can be given a sweet drink to prevent hypoglycemia. In patients who are unconscious, it is indicated to give 36–50% glucose solution intravenously or intramuscular glucagon; if the staff are not trained to inject drugs or any medications are not available, it is possible to rub honey or a sweet drink in the buccal fold taking care to avoid aspiration.