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Managing Adult Medical Emergencies in the Dental Office
Hyperventilation

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

Hyperventilation

Hyperventilation (Table 7) is characterized by anxiety-related dyspnea and tachypnea. Cerebral hypoxia leads to prolonged inspiration (i.e., deep sighs), which result in low CO2 concentration and elevated arterial pH (respiratory alkalosis). Hyperventilation syndrome is common in young women. Predisposing factors include pain, and personal and environmental stress. Other causes include cardiopulmonary disease (e.g., cardiogenic shock, COPD, pulmonary edema), and central nervous system stimulants (e.g., drugs, cola, coffee, tea).

Table 7. Hyperventilation.

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:
  • Frequent (>20 breaths/min), prolonged sighing inspiration
  • Dyspnea
    • Sometimes so severe that the patient feels like suffocating
  • Light-headedness and dizziness
  • Paresthesia
    • Burning or prickling feeling of the face and extremities
  • Tonic muscle spasm
  • Tetani can occur because with severe respiratory alkalosis
  • Tightness, pain in the chest
  • Syncope
Emergency response:
  • Place patient in an upright or semi-reclining position
    • Instruct the patient to take in a shallow breath and hold it as long as possible
      • Repeat this sequence 6 to 10 times
    • Alternatively, have patient rebreed expired air from a paper bag – DO NOT ADMINISTER OXYGEN
  • If patient is not responding
    • Activate EMS
      • Monitor vital signs
        • If at any time the patient becomes unresponsive, no normal breathing, and no palpable pulse consider the diagnosis of cardiac arrest
          • Immediate CPR and defibrillation congruent with current recommendations
Nota bene:
  • Signs of recovering: breathing returns to normal
  • Signs of deterioration: vital signs unstable
  • Anxiety, often precipitated by personal or environmental stress, is the most common predisposing factor associated with hyperventilation, these patients respond well to pre-operative sedation
  • Hypoxia, associated with cardiopulmonary disease, may also cause hyperventilation. Patients who relate a history of hyperventilation secondary to a medical condition (other than anxiety) should not receive pre-operative sedation
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