5. Medical Emergencies: Neuromuscular Flashcards
Unconsciousness -common causes in the dental office • Va s o d e p r e s s o r \_\_\_\_ • Drug administration or ingestion • \_\_\_\_ • Epilepsy • Hypoglycemic reaction
syncope
orthostatic hypotension
Unconsciousness -infrequent causes in the dental office • \_\_\_\_ insufficiency • Allergic reaction • Acute \_\_\_\_ • Cerebrovascular accident • \_\_\_\_ reaction • Hyperventilation
adrenal
MI
hyperglycemic
Mechanisms of unconsciousness • Inadequate delivery of blood or oxygen to the brain – Acute \_\_\_\_ insufficiency – \_\_\_\_ – Va s o d e p r e s s o r syncope
• Direct or reflex effects on the CNS
– ____ accident
– Convulsive episode
adrenal
orthostatic hypotension
cerebrovascular
Mechanisms of unconsciousness • Systemic or local metabolic deficiencies – Drug ingestion or administration – Acute allergic reaction – \_\_\_\_ – \_\_\_\_ – \_\_\_\_
• Psychic mechanisms
– Va s o d e p r e s s o r syncope
– ____
hyperglycemia
hyperventilation
hypoglycemia
hyperventilation
Syn cope
• A sudden transient loss of consciousness without ____ symptoms, followed within
____ (less than 30 minutes) by resumption of ____ usually with the ____ status intact
consciousness
seconds to minutes
consciousness
premorbid
Va sodepressor Syncope
• Atrial bradycardia • Benign faint • Neurogenic syncope • Psychogenic syncope • Simple faint • ____ • Va s o d e p r e s s o r syncope • Va s o v a g a l syncope
swoon
Vasodepressor Syncope Nonpsychogenic Factors • Standing or sitting in an \_\_\_\_ position • Hunger from dieting or a missed meal • \_\_\_\_ • Poor physical condition • Hot, humid, crowded environment • \_\_\_\_ gender • Age between 16 and 35 years
upright
exhaustion
male
Va sodepressor Syncope Psychogenic Factors • Fright • Anxiety • Emotional stress • Receipt of unwelcome news • Pain, especially of a sudden & unexpected nature • Sight of \_\_\_\_ or surgical / dental instruments
blood
Sy ncope – Predisposing Factors • Stress • Impaired physical status • Drug administration or ingestion – \_\_\_\_ – \_\_\_\_ – \_\_\_\_
analgesics
antibiotics
anxiolytics
Pat hophysiology
• Stress precipitating the ____ response
• ____ release
• ____ stimulation – dilation of vascular bed in
skeletal muscle
Why this causes fainting: if you run away, the blood that pulls into your large skeletal muscles
like your legs can cycle and be forced into central circulation and into your brain. However, if
you are frozen there and don’t contract your muscles, your blood vessels are dilated and pulls
at your muscular beds and stay there– less blood to your ____ = FAINT. • This is why more ____ faint– they have more ____. More muscle mass = more
fainting.
- Remember that likely to faint age is ____ years; you almost never see a KID faint.
- If you’re already lying down in ____ position, you will most likely not faint.
fight or flight
catecholamine
beta-2
brain
males
muscles
16-35
supine
Di fferential Diagnosis Syncope
- ____ causes
- Va s c u l a r causes
- ____
- Exposures to toxins & drugs
- ____ problems
- Cardiogenic causes
- Disorders of ____
neurogenic
endocrinopathies
psychogenic
oxygenation
Loss of consciousness
• Leads to loss of muscle ____, including
pharyngeal muscles
• Leads to airway ____
tone
obstructions
Syncope management
- ____
- ____
- ____
airway
breathing
circulation
Airway
• In life support, they teach you to make sure person is not just sleeping.
• When he was an intern in surgery, a medical intern was watching a cardiac monitor, and he saw what he
thought was a ventricular fibrillation and he ran into the patient’s room with a defibrillator and defibrillated
the patient.
• The patient was standing at the sink using an electric toothbrush, and it was an artifact (idk what
this means but he laughs). It hurts like hell to be ____ while you are awake.
• Says to apply the situations in the monitors and simulate to clinic.
• Point is: check if your patient is ____ or sleeping before you do anything.
• You want to open their airway with a jaw ____ or extend their head (if no neck injury).
defibrillated
awake
thrust
Airway Obstruction
• We won’t do this, but if there is a foreign body like they’ve aspirated your crown, you probably shouldn’t
do a ____.
• In the oral surgery clinic, we have these forceps to use.
finger sweep
Oral Airway
• The things that you SHOULD be familiar with: when you do a jaw thrust and chin tilt and you just cant get the airway open, this device is called an ____.
• The right size is the length from the ____ to the angle of the ____.
• This goes in the mouth over the dorsum of the tongue and behind the base of the tongue and acts
as a spacer b/w the posterior pharyngeal wall and base of tongue and keep the tongue open and
forward toward the airway to breathe around that.
• You can imagine that a conscious person would not really like this, b/c of their gag reflex. You should do
it on a conscious person with ____ in airway.
• It goes in like that (points to the left pic) and sits in here with the tongue ____ to that (points to the right
pic).
oral airway
lips
mandible
obstruction
anterior
Nasal Airway
- If you have a conscious person and they’re obstructing and not moving air well, and you’re pretty sure they’re gonna ____ on your oral airway, you can use a NASAL AIRWAY.
- Again, there are multiple sizes, but he only shows us 2. • Right size is from the ____ down to the angle of the ____.
- Goes along the floor of the nose to the soft palate and drops down the base of the tongue. • If you have to insert these, realize that the floor of the nose doesn’t go ____. Don’t angle it up, or else it will hit your brain. Keep it ____ to the floor of the nose.
gag nasal aperture mandible up parallel
Breathing
Assess: Breathing
Ve n t i l a t e , if needed
Mask side goes over your ____ and mouth. Squeeze this and it pushes air into your pulmonary system. The opposite end attaches to an ____ source and now you’re able to deliver more than room air.
nose
oxygen
Breathing
Yo u use it this way. Repeats that the mask goes over the nose and mouth. • Your ____hold the mask down while the other three fingers get under the
inferior border of the ____. • The other hand squeezes the bag to ventilate.
thumb and index finger
mandible
Circulation
Assess: pulse
• To c h e c k a p u l s e , t h e e a s i e s t t h i n g f o r u s i s t o c h e c k t h e ____ p u l s e . • If you wanna feel your own carotid pulse, feel your thyroid cartilage, fall over to the groove anterior to your
____ muscle. Hopefully you’ll feel your carotid bounding underneath there. • That’s usually at the level of your ____ cervical vertebrae, the carotid bifurcation.
• If you have someone that is older and you suspect they have athlerosclerotic heart disease, you don’t
want to mashing on the carotid too firmly or else you will dislodge a ____ and end up w/ a stroke.
carotid
fourth
plaque
Pulses
• Carotid – systolic BP of at least ____ mm Hg
• Femoral - systolic BP of at least ____ mm Hg
• Radial - systolic BP of at least ____ mm Hg
• ____ – check in an infant
60
70
80
brachial
Postural Hypotension
• Disorder of the ____ nervous system in
which syncope occurs when the patient assumes
an upright position
• Fall in the systolic BP of ____ mm Hg or more upon
standing
autonomic
20
Postural Hypotension Predisposing Factors • \_\_\_\_ administration & ingestion • \_\_\_\_ • \_\_\_\_ recumbence & convalescence • Inadequate postural reflex • Pregnancy • Addison’s disease • Ve n o u s defects in legs • Postsympathectomy for hypertension • Physical exhaustion, fatigue, & starvation • Chronic postural hypotension (Shy-Drager)
drug
age
prolonged
Postural Hypotension Management
•____
•____
•____
airway
breathing
circulation
Se izures
• Epilepsy • Convulsion
• Ictus
• ____ – prolonged or repeated seizures
• ____ – Sustained muscle contraction (appears rigid)
• ____ – Intermittent muscular contractions &
relaxation
status epilepticus
tonic
clonic
Seizures
• An occasional, an excessive and a disorderly discharge of nerve tissue • Incidence (30 – 50)/100,000 per year • Altered \_\_\_\_ function – \_\_\_\_, auditory, visual, gustatory, sensory, motor, and mental status changes
visceral
olfactory
