Asysin2leads Posted October 8, 2008 Posted October 8, 2008 If you told us what type of PEA he was in, it might be helpful. The not feeling well all day is almost a sure sign of an AMI... actually, to be more specific, cardiogenic shock and pump failure brought on by a prolonged AMI. The dentist might be off the hook for this one.
towheadedmule Posted October 8, 2008 Posted October 8, 2008 what about Ludwig's Angina? Surely the dentist would have seen it, but then again?
zzyzx Posted October 9, 2008 Author Posted October 9, 2008 He was in PEA at a rate of around 70 before going asystole. No conscious sedation; just local anesthetic.
Doczilla Posted October 9, 2008 Posted October 9, 2008 Injection of lido/epi into a vein could potentially cause arrhythmia due to the epi, but it would take a lot (the epi is at a concentration of 1:100,000, so 1cc would be .01mg). Theoretically it could cause cerebral vasospasm if injected into the carotid, which lies not too far from the infralveolar nerve. A large overdose of lidocaine could cause seizures, though it would take quite a bit more than the dentist would usually inject into the mouth. If the dentist was using bupivicaine (Marcaine) instead of lidocaine for longer anesthetic effect, accidental injection of it into an artery or vein is instantly cardiotoxic and can cause cardiac arrest. We don't generally see this with dental procedures, but with regional anesthesia, since larger amounts are used. Or it might just be bad luck. 'zilla
zzyzx Posted October 9, 2008 Author Posted October 9, 2008 I'll post the answer in a few days...just want to give a few more people a chance to see this scenario.
ambodriver Posted October 9, 2008 Posted October 9, 2008 Cardiopumonary arrest. I second that, Doctor.
zzyzx Posted October 10, 2008 Author Posted October 10, 2008 This was a strange call. I didn't expect to be running a full arrest on a 35 y/o after being called for what was supposed to have been a seizure. Nobody in the office even realized this poor guy had coded. After the call, I was thinking that maybe he'd had a brain aneurysm, long QT syndrome, or something weird like that. I couldn't think of any complications from a routine dental procedure that could've killed him. I followed up a few weeks later and found that he'd died of an AAA. His belly was maybe a little distended, but not like another patient I'd seen who also died of an AAA. Anyway, sad case. He was even younger than me. Congenital defect? Marfan syndrome? I also felt sorry for the dental assistant who, at the time, must've been wondering if he'd done something terribly wrong.
HellsBells Posted October 10, 2008 Posted October 10, 2008 Where was the dentist when this was all going down? Surely he must have realized the man was dead?
Arizonaffcep Posted October 11, 2008 Posted October 11, 2008 It's called tunnel vision...and it gets a little narrow!
firedoc5 Posted October 11, 2008 Posted October 11, 2008 They oral surgeon that done my wisdom teeth became an ACLS Instructor. We taught a few classes together. He had stories of things going wrong in the dentist's chair. Of course he never had any kind of incidents. But his office was well prepared. He probably had more equipment than some small ER's had.
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