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Managing Adult Medical Emergencies in the Dental Office
Cerebrovascular Accident

Course Author(s): Palma A. Freydinger, DDS;Fady F. Faddoul, DDS, MSD

Cerebrovascular Accident

Cerebrovascular accident or stroke (Table 13) is a syndrome associated with the interruption of blood supply to a portion of the brain causing neurologic deficit. Most commonly, a stroke is secondary to an evolving blood clot associated with atherosclerosis that progressively blocks a cerebral artery. Alternatively, it may be due to an embolus that lodged in a cerebral artery obstructing blood flow or result from subarachnoid or intracerebral hemorrhage into brain tissue. Stroke-like symptoms lasting less than 1 hour are termed transient ischemia attacks (TIA).

Table 13. Cerebrovascular Accident.

Prevention:
  • Identify at-risk patient
    • Reduce anxiety
    • Ensure profound local anesthesia
      • Use local anesthetic agents containing a vasoconstrictor congruent with the patient’s functional capacity
Signs and symptoms:
  • Headache, stiffness in the neck
  • Nausea and vomiting
  • Pupils unequal
  • Slurred speech
  • Motor dysfunction
    • Facial drooping
    • Hemiplegia
  • Focal or generalized seizure
  • Altered mentation
Emergency response:
  • Stroke assessment22
    • Place patient in a upright or semi-reclining position
      • Ask patient to smile
        • Normal: both sides of face move equally
        • Abnormal: one side of face does not move at all
      • Ask patient to raise both arms
        • Normal: both arms move equally or not at all
        • Abnormal: one arm drifts compared to the other
      • Ask the patient to repeat “you can’t teach an old dog new tricks”
        • Normal: patient uses correct words with no slurring
        • Abnormal: slurred or inappropriate words or mute
    • If any one of the 3 signs of stroke assessment is abnormal
      • Activate EMS
        • Administer oxygen
          • 2 to 4 L/minute by nasal cannula
        • Monitor vital signs
          • If at any time the patient becomes unresponsive, no normal breathing, and no palpable pulse consider the diagnosis of respiratory and/or cardiac arrest
            • Immediate CPR and defibrillation congruent with current recommendations
Nota bene:
  • Signs of recovery: symptoms subside
  • Signs of deterioration: pruritus, erythema, urticaria worsen; signs of ventilation failure similar to anaphylaxis
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