All Emergencies - Basic life support principles:

1. Maintain an airway
2. Assess breathing
3. Monitor circulation

Request patients with a history of asthma bring their own bronchodilator aerosol medication to every dental appointment.
Preferred bronchodilator for the emergency kit is albuterol. Unlike epinephrine, albuterol does not stimulate the cardiovascular system.

Signs & Symptoms:

1. Patient has difficulty breathing
2. Patient is conscious

Management:

1. Terminate dental treatment.
2. Place patient in upright position.
3. A-B-C Airway, Breathing, Circulation - Basic life support, as indicated.
4. Monitor BP, heart rate & rhythm every 5 minutes.
5. Differential diagnosis:
   • Hyperventilation - negative health history, rapid breathing, light-headed, acute anxiety, tingling fingers, toes.
   • Acute Asthma attack - wheezing, anxious, sweating, face flush (See below)
   • Heart failure - feels like they are suffocating, may be cyanotic, may cough up frothy, blood tinged sputum

Acute Asthmatic Attack

Management of bronchospasm:

1. Position the patient comfortably - usually the patient will prefer to sit up.
2. A wheezing patient is maintaining their own airway, albeit partially obstructed. Blood pressure is usually elevated, while pulse is at base line or slightly elevated.
3. If available, administer a bronchodilator - pt's first; if no help, use one from emerg. kit.
4. EMS should be called if bronchodilator is not available, or if no history of asthma, or if patient requests it, or if the episode continues after one or two doses of the bronchodilator (= status asthmaticus).
5. Oxygen may be administered, but is not as critical as the bronchodilator.
   If the episode continues or if the patient's lips or nail beds become cyanotic, oxygen must be administered.
6. Administer 0.3 mg epinephrine sub-cutaneous, IM or IV, except in cardiac patients
7. Once the actue episode is over, treatment can resume if the patient and dentist are comfortable. Modify future treatment to prevent a recurrence.
8. Patient may leave the dental office on their own if the dentist feels that recovery is complete.

Medications for Asthma/Respiratory Distress:

Bronchodilator spray
I.V. Epinephrineor Aminophylline
Albuterol
Epinephrine
Aminophylline

Respiratory Depression - click here