Monday, 28 November 2011

HOW TO MANAGE ASTHMATIC PATIENTS IN DENTAL CLINICS & HOSPITALS

TO BE FOLLOWED BY DENTIST BEFORE TREATMENT:-
1.Patients appointment should be late morning or afternoon.
2.Assess severity of ASTHAMATIC condition.
3.Consider antibiotic prophylaxis for immuno-suppressed patients.
4.Consider corticosteriod replacement for adrenally suppressed patients.
5.Avoid using dental materials that may elicit an ASTHMATIC ATTACK ie ,DENTIFRICES ,FISSURE SEALANTS ,METHYL METHA ACRYLATE ,FLOURIDE TRAYS & COTTON ROLLS can trigger asthmatic events.
6.If asthmatic patients does not use a broncodilator ,make sure the emergency kits has both a bronchodilator & oxygen.
TO BE FOLLOWED BY DENTISTS DURING TREATMENT:-
1.Rubber dams should be used cautiously.
2.Use technique to reduce patient stress:

  • Avoid prolonged supine positioning
  • Avoid nitrous oxide in people with severe ASTHMA.
  • Avoid using BARBITURATES.
3.Avoid using LA containing SODIUM METABISULFIDE.
4.Use vasoconstrictor judiciously.
TO BE FOLLOWED BY DENTISTS AFTER TREATMENT:-
1. Be cautious while prescribing NSAID to ASTHMATIC patient.
2.TETRACYCLINE should be used cautiously.
3.Avoid use of ERTHROMYCIN in patients taking THEOPHYLLINE.
4.Avoid use of PHENOBARBITALS in patients taking THEOPHYLLINE.

5.Analgesic of choice for these patients is ACETAMINOPHEN.
WHAT TO DO DURING ACUTE ASTHMATIC ATTACK IN DENTAL CLINIC OR HOSPITAL :-
1. Allow patient to assume a comfortable position & discontinue the dental procedure.
2.Establish & maintain patient airway & administor beta2 agonists VIA inhaler or nebulizer.
3.
Administer oxygen 6-10 liters VIA facemask, nasal hood or cannula.
if no signs of improvement is absorbed & systoms are worsening ,administer EPINEPHRINE subcutaneously (1:1,000 solution ,0.01 milligram/kg of body weight to a maximum dose of 0.3mg)
4.Alert medical emergency service.
5.Maintain a good oxygen level until the patient stops,wheezing /or medical assistance arrives.
6.Begin basic life support A,B,C & D 's activity as needed.
Have a nice day,,,,!

23 comments:

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  8. Goodevening Dr.Kumar ,, thanks for your nice information about managing asmathic patients,,but how to manage asmathic patient under general anasthesia,,in other words if the oatient need dental surgery under anasthesia,what is the precautions i should take and which kind of drugs i should avoid,,and if this patient has cardiac problem like prosthetic valves,,what shall i do ???please answer me as soon as u can coz am facing such a situations,,thanks

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  11. Why do we need to place the patient upright and not in supine??? Any logical and technical reason???

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