Managing a Myocardial Infarction Emergency

Dr. PJ Murphy, Clinical Assistant Professor, UBC

Given the increased prevalence of conditions such as metabolic syndrome in North America in recent years, the proportion of patients with serious cardiovascular risk profiles has risen significantly. With this elevated risk, the chances of a medical emergency at the dental office have also increased.

In this episode if CDA Oasis Live, Dr. PJ Murphy, Assistant Clinical Professor at UBC, talks to Dr. John O’Keefe about managing a myocardial infarction emergency at the dental office.

Here are the key takeaways from the conversation:

Recognition

• Recognition is key to the management of a myocardial infarction emergency.
• Stable angina will typically present in the same way every time. As soon as that stable angina deviates from its normal presentation, the patient is at risk of a myocardial infarction emergency and you should call 911 immediately.

Taking Action

• When stable angina presents, give the patient their usual dose of nitroglycerine. If the pain persists, then it is not stable angina.
• Call 911
• Take patient vitals, making sure BP is above 90 over 60
• Check patient has not taken Viagra or Sildalis recently
• Give second dose of nitroglycerine 5 mins after the first
• Hook patient up to oxygen, 10L per min
• If angina does not settle, give patient 4 x 81mg tablets of aspirin
• Locate automated defibrillator
• Switch oxygen mask for ambu bag in case patient loses consciousness before medics arrive
• Epinephrine – can be given IV or by intraosseous injection if necessary

Presentation

• Typically men will have a classic presentation – chest pain that radiates down left or both arms, towards the mandible and/or into the back
• 30% of women will not have this typical presentation and their symptoms will be less severe
• Patients over the age of 75 can also have an atypical presentation

Preparation & Planning

• Nothing in a text book will prepare you for a myocardial infarction at the office. What can help is if the staff at the office practice and rehearse scenarios.
• Provincial regulatory boards recommend practicing medical emergencies in the office twice yearly with the entire staff. Each staff member should have a different responsibility.
• Crash kit – important that one staff member is responsible for checking the crash kit on a monthly basis to make sure there are no expired medications.

We hope you find the conversation useful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.

Until next time!
CDA Oasis Team