Laura M. is a 19-year-old female who presents for root canal treatment of tooth #19. The patient appears anxious and reports to have a history of asthma. Following the administration of local anesthesia, the patient begins to wheeze and complains of shortness of breath. You note she is taking shallower breaths and is breathing rapidly.
She now begins to cough, becoming more anxious and confused.
How would you proceed?
- Position patient upright
- Give patient 100% oxygen from nasal cannula.
- Have her use her Albuterol inhaler.
Albuterol allows for bronchodilation in addition to decreasing mucous secretion. If the patient does not improve, call 911 emergency services.
Then administer Epinephrine 0.3mg subcutaneous every 10-15 minutes (up to 3 times).
A contributing factor to this patient’ s asthmatic attack was induced by stress. Stress is able to create a strong physiologic reaction that precipitates asthma symptoms. Intense emotions can induce smooth muscle contractions and in those with asthma be a catalyst to an attack.
As dentists we know the dental chair can be one of the most s tre ss ful experi ences . The dent al team should attempt to make the experience as calm and as relaxing as possible. This begins from the initial patient phone call, to the patient’s very first visit to the office. All the team members should be warm, friendly, and comforting. The dentist should also be a team leader contributing to the patients experience by explaining the procedure and reassuring the patient. In this case, it is important to have your patient have their rescue inhaler with them at all times and to take 2 puffs prior to procedure to help open the airway.
Asthma is a reversible chronic inflammatory disease of the airway. During an attack the lung’ s airways are obstructed by the smooth muscles. An acute attack is first treated with Albuterol, which allows for relaxation of these smooth muscles to help open up the airway and allow for proper ventilation. Epinephrine is another method to help the airways to open if the patient is not recovering with the albuterol. These attacks are always best avoided by having the patient keep calm and relaxed prior to treatment. If a patient seems stressed before treatment it can be helpful to have patients prophylactically inhale albuterol (2 puffs) prior to help maintain an open airway.