Symposia

90th AAOMS ANNUAL MEETING, SCIENTIFIC SESSIONS ANDEXHIBITION IN CONJUNCTION WITH THE CHINESE SOCIETYOF ORAL AND MAXILLOFACIAL SURGEONSSeptember 16–20, 2008, Seattle, WA

SYMPOSIUM ON PHARMACOLOGY AND USE OF EMERGENCYAGENTSThursday, September 18, 2008, 7:30 am–9:30 am

Pharmacology of New and ExistingEmergency AgentsKaren Baker, RPH, MS, Iowa City, IA

No abstract provided.

Emergency Protocols in the Adult PatientDaniel L. Orr II, DDS, PhD, JD, MD, Las Vegas, NV

No abstract provided.

Emergency Protocols in the PediatricPatientAndrew Herlich, DMD, MD, Pittsburgh, PA

Preparation for emergent care in the office-based en-vironment requires standard evidence-based protocolsand regular practice to prevent adverse outcomes. Pedi-atric patients require pediatric specific drug doses andmost importantly, pediatric specific equipment. Adultequipment cannot and should not be adapted to pediat-ric patients. Useful protocols have been published by theAmerican Heart Association as part of the AdvancedPediatric Life Support published in Circulation in 2005.

Airway equipment should include appropriate sizedbag-mask-valve assemblies, oral and nasopharyngeal air-ways, as well as endotracheal tubes and laryngeal maskairways or other supraglottic devices such as the KingAirway. Rigid stylets may be quite helpful in the properplacement of endotracheal tubes especially during emer-gent situations. They are also quite helpful for practitio-ners who do not manage pediatric airways on a regularbasis. Difficulty in ventilation requires the practitioner toremember the displaced or obstructed endotrachealtube, pneumothorax or equipment failure aka DOPE.

Cardiac equipment must also be pediatric appropriate.Blood pressure cuffs, EKG, pulse oximetry, and defibril-lators/AEDs must also comply with pediatric standards.

Vascular access may be established by a variety of

means including standard intravenous cannulae, butter-fly needles, and rarely, intraosseous needles. Intravenousfluids and medications must be administered in appro-priate doses and devices. Intravenous administration setsshould be either buretrol or minidrips as opposed to theadult administration sets.

Routine resuscitation medications should be availableand readily prepared in pediatric doses. Small syringes willassist in this process. Routine drugs including cardiac lido-caine, atropine, epinephrine, diphenhydramine are neces-sary for successful outcomes. For reversal of sedation andanalgesia, flumazenil and naloxone must be closely avail-able. If anaphylaxis presents in the child, steroids and H2blockers should be available and administered rapidly.Other protocols will be discussed during the conference.

Reference

American Heart Association: Part 12: Pediatric Advanced Life Sup-port. Circulation 2005; 112: IV 167-187

Establishment and Maintenance of anUp-to-Date Emergency CartRichard C. Robert, DDS, MS, San Francisco, CA

In every oral and maxillofacial surgery office the careproviders must be ready for a medical or anestheticemergency that could happen on any day, at any time.However, when many new employees begin working inan oral and maxillofacial surgery office, they have limitedmedical background.

Death or serious injury always turns a bright light onthe oral surgery office, particularly when it involvesdelivering conscious sedation or general anesthesia.Claims of substandard care often focus on deficits inresuscitation due to poor planning and ineffective ordelayed implementation. This program will review theconsequences of being unprepared for an office emer-gency and how to prevent these deficiencies.

Even though resuscitating a patient is not a routineevent, the administrators of sedation and general anes-thesia must maintain the tools and data to use in the

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