Instructions

TASK
Acute clinical cases that affect the well-being and safety of the patients we are treating can appear
in the dental clinic and we must be clear about how we should act to solve them.
You are asked for an action sheet for each of the 4 clinical cases we present to you.
We propose the following tab as a guide to make your own, although each student can do it as
he thinks is most convenient. However, all must meet the following criteria:
• Brevity.
• Order. Clear steps anyone can follow.
• Practice. It should be easy to use and useful.
Clinical Cases:
1. 78-year-old patient with a history of hypertension and diuretic treatment, who becomes dizzy
after rising from the armchair after a simple procedure.
2. Patient of 78 years with a history of hypertension and treatment with diuretics, who after getting
up from the armchair after a simple procedure presents headache, dizziness and a small state of
confusion.
3. Patient of 22 years, male, who when sitting on the armchair and before starting with clinic of
skin pallor, sweating of hands and face, dizziness and nausea.
4. 45-year-old patient obese and partially sedated as it is very anxious. During the procedure
begins suddenly with clinic of strators, cough and shortness of breathing.
Guide Case:
A 19-year-old male patient attended for possible caries in the first upper left premolar (24). As we
approach his mouth to examine this piece, he begins with a picture of paleness, sweating, and
reports tinnitus and blurred vision. It ends with a partial loss of consciousness.
Differential Diagnosis:
Lipotimia. Most likely, by age and sex.
· Vagal reaction: Is it accompanied by bradycardia? You have to take his pulse.
· Anxiety crisis with hyperventilation: Do you breathe fast, very often?
· Allergic reaction: Is it accompanied by any other signs: skin rash, respiratory distress,
hypotension, arrhythmias, ...?.
Attitude:
1. Discontinue care and remove all material from the patient's mouth, release tight clothing.
2. Stimulate the patient to assess the degree of consciousness. Do not stop actively talking to the
patient.
3. Quickly place the patient in the Trendelemburg position (supine position with the feet slightly
elevated above the head (15-20º)). If not possible, at least knock him down.
4. Provide the air passage, bringing the head back and check if the patient is breathing.
5. Assess carotid pulse to assess bradycardia. It should be done for a short time, because the
pressure of the carotid causes a vagal stimulus that would prolong and / or aggravate the syncope.
6. Recovery is almost always spontaneous in 2 or 3 minutes. In the event that recovery is not
immediate, request emergency medical help and while administering oxygen at 3-4 L / min),
controlling breathing, pulse and blood pressure.
7. If atropine is available, intramuscular 0.5 mg should be administered, which is the
pharmacological treatment of choice.
8. Do not start the procedure until the patient is recovered. Sometimes it is convenient to leave
him in the waiting room with a companion, and even suspend the intervention. In no case should
the patient be forced to sit up if he is not well and must be accompanied during ambulation to
avoid falls.