NO2 Sedation’s Emergencies: Airway Obstruction

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In this article, we tackle one of the most common dental emergencies during NO2 sedation, Airway obstruction. We explain the symptoms and different methods of management. 

NO2 Sedation Most common Dental Emergencies

One of the most common dental emergencies during N2O sedation is airway obstruction.

Airway Obstruction:

  • Altered or lost of breathing sounds.
  • Breath-holding.
  • Paradoxical breathing.
  • Wheezing
  • The universal sign of choking ( Hands at the throat).
  • Coughing and/or choking

Airway Obstruction management

1st Level: the patient is conscious

For Adults: Encourage Coughing if possible and reposition the airway.

For Children: First, check for any visible/reachable foreign object in the mouth and check for breathing. Place the child over your lap with his head down, then give 4-5 back blows. Recheck the mouth for the foreign object and retrieve it, then check for breathing, repeat.


2nd Level: the Heimlich maneuver (Abdominal thrust)

Step 1 (Back Blow): Administer five blows to the back by hitting the palm of your hand against the area between the shoulder blades. If Step 1 does not fix the problem, move on to

Step 2 (Abdominal Thrust): Perform five abdominal thrusts by first placing your fist around someone’s stomach with your thumb against the middle of the abdomen — above the navel. Then, wrap your other hand around the fist and thrust upward. If the object is still stuck, repeat the process starting with Step 1.

The navel (clinically known as the umbilicus, colloquially known as the belly button) is a protruding, flat, or hollowed area on the abdomen at the attachment site of the umbilical cord. All placental mammals including humans have a navel.

Step 3 (CPR): If the victim falls unconscious, start performing chest compressions with rescue breaths. First, lift the chin and tilt the head to open the airway. Pinch the nose shut. Make a complete seal over the person’s mouth and blow air for about 1 second. Perform 30 chest compressions, pushing hard and fast in the middle of the chest. Look for and remove objects in the airway. If breaths don’t make the chest rise, repeat the process. You should also consider calling your emergency number.


3rd Level: Surgical Intervention 

Emergency cricothyrotomy

The patient lies supine with the neck extended. Then the larynx is grasped with one hand while a blade is used to incise the skin, subcutaneous tissue, and cricothyroid membrane precisely in the midline, accessing the trachea. Finally, A hollow tube is used to keep the airway open.

Tracheostomy

This method is a more complex procedure because the trachea rings are very close together, and part of at least one ring usually must be removed to allow tube placement. Tracheostomy is preferably done in an operating room by a surgeon. In emergencies, the procedure has a higher rate of complications than cricothyrotomy and offers no advantage. However, it is the preferred procedure for patients requiring long-term ventilation.


References:

  • https://www.msdmanuals.com/professional/critical-care-medicine/respiratory-arrest/surgical-airway
  • https://ca.finance.yahoo.com/news/heres-see-someone-choking-food-170916512.html
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About Author

MohsenSaeedOzaibi, A Dentist, Dental Manager at Emirates Jordanind Medical Center, Founder of OziDent.com. Graduated in 2009 with a Bachelor's Degree in Dental Science from Misr International University. A veteran in digital dental content publishing and marketing.

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