Flashcards in Final Exam Deck (21):
What steps can be taken to avoid overdose?
-Review patient's medical history to determine the biotransformation capability
-It is recommended to use the minimal effective dose
-Total dose administered is too large (calculate MRD based on patient's weight before administering)
-Consider age of the patient and physical status
-Use a vasoconstrictor unless it is contraindicated
-Limit area of use of topical
*Know dental anatomy
*Aspirate in two planes
*Use a 25- or 27- gauge needle
*Administer drug slowly
What are signs of cardiovascular toxicity?
-shortness of breath
What should you know about epinephrine overdose?
-Occurs when higher concentrations are administered
-Patients with cardiovascular disease are much more susceptible to an epi overdose
-The lowest possible effective dose should always be used when administering local anesthetics with epi to all patients, whether healthy or medically compromised
-MRD for a healthy patient is 0.2mg
-MRD for cardiovascularly involved patient is 0.04mg
Know the actions and differences of topical anesthetics. (Especially Benzocaine)
Benzocaine: amide; is one of the more common and widely used; rapid onset; 20%
Lidocaine: ester; 2% or 5%; 2-10 minutes;
What is the recommended treatment of allergic reactions?
For serious allergic reaction: epinephrine
For the most severe allergic reaction: Methylprednisolone
Commonly used ester topical anesthetics that can contribute to an allergic reaction
benzocaine and tetracaine
The most important measure that the dental hygienist can complete to prevent an allergic reaction
the preanesthetic patient assessment
Delayed allergic reactions:
Skin Allergy: erythema, hives, itching (*administer antihistamine*)
Respiration Allergy: bronchospasm, wheezing, flushing, tachycardia, etc. (*terminiate procedure, administer epinephrine, position patient semi-erect, administer antihistamine, provide basic life support if needed*)
Laryngeal Edema Allergy: obstruction of airway, respiratory distress, loss of consciousness, etc. *(terminate procedure, position patient supine, administer epinephrine, administer oxygen, transfer patient to hospital*)
Immediate allergic reactions:
Skin Allergy: itching, flushing, feeling of hair standing on end (*terminate procedure, supine position and legs elevated, administer epinephrine and oxygen, transport patient to hospital*)
Gastrointestinal Allergy: abdominal cramps, nausea, vomitting, diarrhea (*same as management of anaphylaxis related to skin*)
Respiratory Allergy: tightness or chest pain, cough or wheeze, laryngeal edema (*same as management of anaphylaxis related to skin*)
Cardiovascular Allergy: pallor, light headed, palpitations, hypotension, unconsciousness (*same as management of anaphylaxis related to skin*)
Know what and how to document about anesthesia in patient's charts
-Record in RED
-Medical status of patient or contraindications
-Any refusal of treatment by the patient and a brief statement documenting the discussion of risks associated with treatment refusal
-Patient's MRD, the drug used and concentration, vasoconstrictor used if any, the amount administered in milligrams, the gauge and type of needle, the injections administered, the time of anesthetic administered, and any patient reactions
-Any unexpected occurence or reactions
-Postpone instructions given to patient
How long do you leave topical on?
Leave in place for 1-2 minutes
What do you do if you notice a developing hematoma?
First sign of swelling, apply pressure directly to the area for a minimum of 2 minutes. Apply ice to the region to reduce swelling. Communicate to the patient that soreness and limited movement of their jaw may occur. Inform patient no serious complications are associated with hematomas. Do not dismiss patient until bleeding has stopped. Follow up as indicated.
What happens if you deposit in the parotid gland?
When you deposit in the parotid gland, you are overinserting the needle. When this happens, transient facial paralysis can be caused during the IA block.
The dental hygienist should do the following to PREVENT litigation:
-Maintain proper licensure
-Take responsibility for lifelong learning
-Never exceed the scope of dental hygiene practice
-Obtain informed consent
-Make appropriate referrals
-Maintain patient privacy
-Do not experiment on a patient with new local anes.
-Administer the appropriate volume
-Never abruptly stop treatment or abandon patient
-Keep patient informed
-Document and keep accurate records
-Obtain professional liability insurance
Open and effective communication between the dental hygienist and the patient is an important risk management tool
dental hygienist-patient communication
The dental hygienist should have an open discussion with his or her employer regarding the potential liabilities for dental hygienists and prevention categories
dental hygienist-employer communication
The dental hygienist should strive to use all protocols to prevent the injury from occurring
if an injury occurs, the dental hygienist should strive to contain the injury
The dental hygienist should strive to return the patient to a functional state and prevent future injuries
Defined by the Centers for Disease Control and Prevention as a percutaneous injury or contact of mucous membrane or nonintact skin with blood, saliva, tissue, or other body fluids that are potentially infectious