1.Faint.
2.Hypoglycaemia.
3.Cardiac Arrest.
4.Epilepsy.
5.Corticosteroid Insufficiency.
6.Asthma.
7.Myocardial Infarction.
8.Anaphylaxis.
9.Hysteria
10.Haemorrhage.
1.FAINT:
Clinical Features:
- moist, cold skin
- pallor
- dizziness, weakness, nausea
- weak, slow pulse.
Management:
- power patient’s head
- loosen clothing
- glucose drink may be useful.
- consider other causes if recovery not rapid
2.HYPOGLYCAEMIA:
Clinical Features:
- moist, warm skin
- dizziness and disorientation
- full, rapid pulse.
Management
- lay patient flat
- glucose orally or glucagon IM
- summon medical assistance.
3.CARDIAC ARREST:
Clinical Features:
- loss of consciousness
- absence of arterial pulses
- no breathing
Management:
- summon medical assistance
- lay patient on hard, flat surface
- give cardio-pulmonary resuscitation.
4.EPILEPSY:
Clinical Features:
- loss of consciousness
- repetitive jerking movements
- occasional incontinence and vomiting.
Management:
- lay patient in the head injury position
- maintain airway
- if not recovered after five minutes, give 10mg diazepam Intravenously (if possible) or Intramuscularly.
5.CORTICOSTEROID INSUFFICIENCY:
Clinical Features:
- usually in patients on long-term corticosteroid therapy and up to two years after its withdrawal.
- loss of consciousness
- weak, rapid pulse
- falling blood pressure.
- pallor
Management:
- lay patient flat
- 200mg hydrocortisone succinate Intravenously
- oxygen
- summon medical assistance.
6.ASTHMA:
Clinical Features:
- paroxysmal wheezing
- dyspnoea
Management:
- patients should use their normal bronchdilator
- oxygen and hydrocortisone succinate 200mg IV may be required.
- do not lay flat.
- assistance (medical) if not improved
7.MYOCARDIAL INFARCTION:
Clinical Features:
- sever retro-sternal pain
- breathlessness or vomiting
- loss of consciousness
- weak, irregular pulse.
Management:
- summon medical assistance
- DO NOT lay patient flat. This may increase breathlessness
- Entonox to relieve pain and anxiety.
8.ANAPHYLAXIS:
Clinical Features:
- loss of consciousness
- cold, clammy skin
- oedema/urticaria
- falling BP
- weak, rapid pulse
- pallor
Management:
- lay patient flat
- raise legs
- summon medical assistance
- 1ml 1:1000 adrenaline IM
- 200mg hydrocortisone succinate IV
- oxygen.
9.HYSTERIA:
Clinical Features:
- anxiety
- hyperventilation
- disturbed consciousness
- tetany or paraesthesia
Management:
- reassure after excluding other causes.
10.HAEMORRHAGE:
Causes:
- usually locally after traumatic extraction
- occasionally haemorrhagic disorder
Management
- reassure patient
- clean mouth and locate source
- place pack, leave for 15 minutes under pressure
- inquire into family history/medical history
- suture socket under LA
- if bleeding is uncontrollable, refer to hospital.
11.ANGINA:
Clinical Features:
- severe chest pains, radiating down left arm
- pulse regular.
Management:
- one or two tablets of Glyceryl Trinitrate 0.5mg to place under the tongue
- repeat if needed.
First Aid treatment in the dental surgery should aim at improving the patient’s condition or at least preventing it becoming worse without causing any harm.
MINIMUM REQUIREMENTS:
Equipment:
- portable high volume suction
- lung inflation apparatus e.g. Ambu bag
- oral airways
Drugs:
- Oxygen
- Adrenaline 1:1000
- Hydrocortisone 200mg
- Chlorpheniramine 10mg
- Dextrose tablets or Glucose drink
- Ductrose 50% in 50ml or Glucagon
- Glyceryl Trinitrate 0.5mg
- Diaxpam 10mg
TRAINING:
- Attend regular (e.g. annual) training classes with ALL practice staff.
- Have regular training exercises in the practice.
- Maintain all equipment at all times and have readily available.