Dental treatment such as tooth extraction is an invasive therapy which could damage the tissues and cause systemic complication. There are 9 medical compromises in dental practice, which are:
- Syncope (vasovagal syncope)
- Lidocaine toxic reaction
- Angina pectoris
- Stroke (cerebral vascular accident)
- Epilepsy attack (epileptic seizure/ fit)
- Asthma (asthmatic attack)
- Infarct myocardium
- Shock anaphylactic
The percentage of compromises is 90% from syncope and 10% from the rest. As a dentist, syncope might be the most medical compromise to deal with. It is important to understand how to treat this condition. The quick and exact action is needed to maintain respiration (ventilation) and heart rate until the patient get definitive treatment. Thus, Basic Life Support is considered as everybody’s competence, not just paramedic like doctor, dentist, nurse, but also non paramedic like housewife.
The general procedure consists of assessment in AIRWAY, BREATHING, CIRCULATION, and DISSABILITY, which is shortening as A-B-C-D. This assessment is important because it will help determining the emergency type and intervention could be done exactly. There are two things to keep in mind:
(1) ABCD assessment and intervention does not stand alone. If there is an airway problem, then we need to do breathing intervention. And if there is a breathing problem, then we need to do circulation intervention, and so fort.
(2) It has to be done in a series and recur. For example: when doing “C” aspect assessment, “A” and “B” evaluation also must be done.
Assessment results are:
- Free airway => no obstruction
- Blocked airway => half obstruction
- Clogged up airway => total obstruction
The airway obstruction occurs when skeletal muscle tonus decreasing. So, patient with unconscious condition need to be observed carefully. It can be helped by doing this action as follow:
- Clean the oral cavity from foreign thing, for example denture
- Suck saliva which accumulated in orofaring using suction apparatus
- Do chin lift or jaw thrust in order to avoid tongue to drop to the posterior area
Chin lift is done to the patient with half conscious. Jaw thrust is done to total unconscious patient, because if the patient is conscious, he will be nervous as this technique press the angulus mandibula.
If the patient is unconscious, the breathing assessment needs to be done as follow:
- Look => up and down movement of patient thorax
- Listen => breathing voice
- Feel => patient gasp by putting ear and cheek near enough to ensure while the breathing is adequate or not.
The normal frequency is 12-16 times/ minute. If it is more than 25 times/ minute, it shows a respiratory distress. While if it less than 8 times/ minute, it is said that as bradypneu (breath depression).
Unconscious patient who experiencing conscious lost/ reduction needs to be given pure oxygen (O2 100%) with flow 6-8 liter/ minute through face mask. This oxygen also needs to be moistened in order to avoid stimulation respiration gland secretion and causing blocked respiration way.
The circulation parameter is:
- Pulse : pulse rate, strength, rhythm
- Blood pressure
The mean artery pressure could be measured by adding 1/3 diastole and 2/3 systole. Those are influenced by two factors, which are: (1) cardiac output (heart rate x stroke volume) and (2) blood vessel (vascular resistance). For example: a patient who experiences anaphylactic shock => venous return decreasing, but the blood volume is constant.
The normal pulse is about 70 times/ minute. if the pulse is more than 90 times/ minute and weak, then the pulse is less than 80mmHg. If the pulse (radial artery) is not palpated and weak, trying palpated the carotid artery. It the carotid artery is able to be palpated, the systolic pressure is 60mmHg, and does the intervention immediately to repair the cerebral blood flow. Don’t forget to put the patient in supine position or shock position.
D. DISSABILITY (Neurologic Disturbance)
The assessment consists of:
- level of consciousness: decreasing or lost
- conscious disorsder
- Motoric system