Angina or an Acute Coronary Syndrome
Ensure that patients with a history of angina bring their medication (e.g. glyceryl trinitrate spray or tablets) when presenting for dental treatment, and have it in a readily accessible place.
Management
If chest pain occurs in a patient with a history of angina:
Stop dental treatment
Measure blood pressure, heart rate and pulse oximetry
Assess consciousness by talking to the patient.
To relieve symptoms, use glyceryl trinitrate. Ask the patient to sit down (because of the possibility of hypotension), then give:
Glyceryl trinitrate spray 400 micrograms sublingually, repeat every five minutes if pain persists, up to a total of 3 doses if tolerated. |
OR
Glyceryl trinitrate tablet 300 micrograms to 600 micrograms sublingually, repeat every 5 minutes if pain persists, up to a total of 3 doses if tolerated. |
If the patient recovers, do not proceed with dental treatment; refer for medical evaluation even if the patient appears well.
If pain persists for more than 10 minutes despite taking two doses of glyceryl trinitrate, give a third dose and manage as for severe or new chest pain.
If chest pain is severe or new:
Call 000
For patients with a history of angina, give glyceryl trinitrate as above
For all patients, give:
Aspirin 300mg orally, chewed or dissolved before swallowing |
Measure blood pressure, heart rate and pulse oximetry.
Start supplemental oxygen if SaO2 is less than 90% and titrate to SaO2 90 - 96% if possible.
Provide reassurance until assistance arrives.
If the patient loses consciousness, start basic life support. Use an automated external defibrillator if available.
Cardiac Arrest
In cardiac arrest, the patient suddenly loses consciousness, has no pulse and is not breathing.
Management of Cardiac arrest
If cardiac arrest occurs:
Stop dental treatment
Call 000
Start basic life support, including CPR. Use an automated external defibrillator if available.
Maintain treatment until the patient regains consciousness or assistance arrives.
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