Lecture 1

Question 1

These increase the incidence of medical emergencies in dental offices

Answer 1

• Geriatric population seeking dental care
• Number of patients taking medications
• Number of medications taken per patient
• Length of dental appts
• Administrations of drugs by dentists

Question 2

Amount of emergencies that occur in dental offices in 10 years

Answer 2

In 10 years, on average there are about 7.5 emergencies that occur in a dental office. 1/3 of them are life-threatening so prevention is key.

Question 3

Most common med emergencies experienced at the dental office

Answer 3

1. Syncope
2. Mild allergic reaction
3. Angina pectoris
4. Orthostatic hypotension
5. Seizures
6. Asthmatic attack (bronchospasm)
7. Hyperventilation
8. Epinephrine reaction
9. Hypoglycemia
10. Cardiac arrest
11. Anaphylactic reaction
12. Myocardial infarction

Question 4

Occurrence of systemic complications

Answer 4

• Before tx:
◦ 1.5%
• During and after local anesthetic
◦ 54.9%
• During tx:
◦ 22.0%
• After tx:
◦ 15.2%
• After leaving dental office:
◦ 5.5%

Question 5

Keys to prevention of medical emergencies

Answer 5

Medical history and vital signs

Question 6

Components of medical history

Answer 6

• Medical history: must be complete and accurate
◦ Chief complaint
◦ Medication
◦ Medical conditions past and present
◦ Allergies
◦ Review of system?
◦ Hx of surgeries
◦ Social hx

Question 7

Components of vital signs

Answer 7

BP
Pulse
Temp
Respiration

Question 8

Be alert as a clinician, if a patient notes a medical condition, know how that condition could turn into a med emergency. Give examples

Answer 8

‣ Patient has
• Heart conditions: be alert to MI, congestive heart failure or CVA
• Asthma: be alert to possible asthma attack
• Has history of CVA (stroke) frequent headaches and dizziness: be alert to a possible CVA
• Epilepsy: be alert to seizure
• Thyroid problems: be alert to myxedema coma or thyroid storm
• Diabetes: hypoglycemia and diabetic coma
• Corticosteroid use: adrenal insufficiency
• Allergies: allergic reaction
• Bleeding disorders: bruising, hemorrhages, hemophilia

Question 9

What is blood pressure?

Answer 9

The force exerting by the blood against the vessel walls

Question 10

Systolic blood pressure

Answer 10

The pressure in the vessels during ventricular contraction

Question 11

Diastolic blood pressure

Answer 11

The pressure in the vessels during ventricular relaxation

Question 12

Blood pressure categories

Answer 12

Question 13

Factors affecting blood pressure

Answer 13

‣ Things that affect BP
• Blood viscousity
• Blood volume
• Vessel resistance
• Age: elders and arteroschlerosis caused higher BP
• Gender: higher in men and post menopausal women
• Stimulants: coffee and nicotine (vasoconstrictors)
• Exercise: consistent exercise lowers BP and BP higher immediately after exercise

Question 14

What is pulse?

Answer 14

Speed and force of patient’s heartbeat

Question 15

Common areas taken for pulse

Answer 15

radial, brachial, femoral, carotid
• Use radial for baseline reading in case of emergency

Question 16

Abnormal pulse categories

Answer 16

‣ Tachycardia (greater than 100 bpm)
• Body is trying to increase oxygen to tissues
• Occurs due to
◦ Fever
◦ Exercise
◦ Nervous excitement
◦ Medications
◦ Stimulant drugs
◦ Disease states (CHF, hemorrhage and shock)
‣ bradycardia (less than 60 bpm)
• Occurs due to
◦ Iightheadedness
◦ Dizziness
◦ Chest pain
◦ Syncope
◦ Circulatory collapse
• Treat with atropine
‣ arrhythmia (irregular)

Question 17

Normal pulse

Answer 17

Question 18

What is respiration?

Answer 18

The process by which oxygen and carbon dioxide are exchanged in the body; involuntary

Question 19

Abnormal respiration

Answer 19

‣ Tachypnea: greater than 20
• Hyperventilation
‣ Bradypnea: less than 12
• Syncope
‣ Dyspnea: difficulty breathing
• Usually associated with heart or lung disease
‣ Apnea: absence of breaths
‣ Orthopnea: shortness of breath while laying back (recumbent)

Question 20

Normal respiration

Answer 20

Question 21

‣ Things that affect/influence respiration

Answer 21

• Age: age increases-> lung capacity increases= lower RR; aging=lung less elastic RR increases
• Medications: Narcs decrease RR, sympathomimetics dilate briochioles and improve RR
• Stress or exercise: increases strength and depth of breathing
• Altitude: less oxygen with high altitude= increased RR
• Males have larger lung capacity=lower RR
• Posture: slumped or stooped= more difficult to exchange o2

Question 22

What is temperature?

Answer 22

A measure of heat associated with metabolism in the body

Question 23

Normal temperature

Answer 23

Question 24

Abnormal temperature

Answer 24

‣ Pyrexia (fever)
• Etilogy:
◦ infection
◦ Neurological disease
◦ Malignancy
◦ Congestive heart failure
◦ Trauma
◦ Drugs
• Delirium or convulsions may happen with high fever
‣ Hypothermia (below 95 F)
• Etilogy:
◦ medications
◦ Malnutrition
◦ Illness
◦ Trauma

Question 25

ASA classification

Answer 25

ASA Classification Origin: American Society of Anesthesiologists created system in 1941 Purpose: assess patient’s health and risk for complications before surgery and after anesthesia Dental clinicians also uses this classification to assess patient’s level of health and their risk for complications/ medical emergencies ASA 1 and 2 safe to treat in practice with none or minimal modifications to tx ASA 3 and 4 higher risk for med emergencies so will require substantial modifications in their management and tx; may need referral to hospital setting. Elective tx shouldn’t be done on an ASA 4

Question 26

All ASA classifications

Answer 26

ASA 1 • Normal healthy patient, no psychiatric, organic and physiologic disturbances ASA 2 Mild systemic disease or risk for systemic disease • Tobacco smoker without COPD • Obese • Pregnant • Infant • Well controlled mild disease • Type 2 diabetes without systemic effect Social drinker ASA 3 • Severe systemic disease that causes limitations • Controlled severe systemic disease • Multiplied well controlled systemic diseases (more than one body system) • Well controlled type 1 diabetes • Controlled heart failure • Stable angina • Poorly controlled HTN • Morbid obesity • Chronic renal failure • MI greater than 6 months without residual signs or symptoms • Poorly controlled asthma • No immediate danger of death ASA 4 • Severe systemic disease that is a constant threat to life • May have shortness of breath or distress at rest • MI within last 6 months • Unstable angina • Symptomatic heart failure • COPD • Hepatorenal failure