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Management of pediatric emergencies in the dental office.
by Daniel Ravel DDS, FAAPD
Medical emergencies can occur anywhere, even a dental office.
Although pediatric emergencies are uncommon during a dental appointment, they may be life-threatening when they do happen.
Emergencies may be due to a variety of causes, including: a child's pre-existing medical condition, an airway obstruction caused by a dental material, or problems related to a sedation procedure.
BELOW ARE SOME TREATMENT PROTOCOLS FOR PEDIATRIC EMERGENCIES:
Airway obstruction:
For conscious child - perform the Heimlich maneuver.
For unconscious child - suction the mouth, open the airway and attempt to ventilate, give up to 5 abdominal thrusts, repeat these steps if necessary, call EMS (emergency medical services) after 1 minute of attempting to clear the obstruction. Consider needle cricothyrotomy.
Laryngospasm: Initiate BLS - ensuring airway breathing and circulation, call EMS, give positive pressure oxygen x 30 seconds, give anectine if necessary - preceeded by 0.02 mg/kg of atropine, and intubate after giving the neuromuscular blocking agent (anectine).Visualize the vocal cords with a straight #2 blade, and use a size 4.5 ET tube in many cases.
Bronchospasm: Bronchial dilator spray (Albuterol), BLS, pos. pressure oxygen, epinephrine 1:1,000 SQ at 0.01 ml/kg, call EMS.
Emesis and aspiration: Turn patient to side, suction, BLS, EMS, pos. pressure oxygen.
Respiratory depression: (Below 15 breaths/min) BLS, EMS, pos. press oxygen, Narcan (naloxone).
Respiratory arrest: (With pulse) BLS, EMS, pos. pressure oxygen, monitors, start IV.
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