Management of Common Medical Emergencies Flashcards
(82 cards)
1
Q
Factors that Increase the Likelihood of Emergencies
A
- Increased number of medically
compromised individuals seeking care - Medical advances in drug therapy
- Longer appointments
- Increased use of drugs in oral healthcare
settings
2
Q
Prevention
A
- Comprehensive health history and risk
assessment - Treatment Modification
- Documentation
3
Q
Health Assessment
A
Vital Signs
3
Q
Health History
A
- Past and present health status
- Problems a patient might not be aware of
- List of medications names and dosages
4
Q
What are common signs of anxiety in dental patients?
A
*Sweating
*Increased blood pressure and heart rate
*Restlessness
*Nervous conversation
*History of cancelled appointments
*Only seeking ER care.
5
Q
What are some effective stress reduction strategies for anxious dental patients?
A
*Building rapport
*Clear communication
*Minimizing wait time
*Scheduling short morning appointments
*Pain control
*Providing follow-up care.
6
Q
Physical Status Classification
A
American Society of Anesthesiologists (ASA)
6
Q
ASA I
A
(green): normal health
7
Q
ASA II
A
(yellow): mild disease/extreme anxiety
8
Q
ASA III
A
(yellow): severe disease
9
Q
ASA IV
A
(red): disease threatens life
10
Q
ASA V
A
(red): near death
11
Q
ASA VI
A
(red): moribund
12
Q
How should dental personnel be prepared for emergencies?
A
Trained to recognize and assist in emergencies.
13
Q
What training should dental personnel have for emergency situations?
A
- BLS, CPR, AED
- Drills
14
Q
What is the role of the emergency kit in the dental office?
A
Should be readily available and include necessary supplies to manage emergencies and summon EMS, directing them to the scene.
15
Q
What are the contents of the Emergency Kit
A
- Epinephrine
- Histamine blocker
- Nitroglycerin
- Bronchodilator
- Oral glucose
- Aspirin
- Pulse oximeter
16
Q
What are common causes of unconsciousness in dental patients?
A
Vasovagal syncope and orthostatic hypotension.
17
Q
What are common respiratory distress emergencies in dentistry?
A
Hyperventilation, asthma, and allergy/anaphylactic reactions.
17
Q
What are common causes of altered consciousness in dental patients?
A
Hypoglycemia and seizures.
18
Q
What are the signs of chest pain emergencies in dentistry?
A
Angina pectoris and acute myocardial infarction.
19
Q
What is vasovagal syncope?
A
“Simple fainting,” a sudden, temporary loss of consciousness with a maintained pulse.
20
Q
How does vasovagal syncope typically present?
A
The patient experiences a sudden loss of consciousness, but their pulse remains steady.
21
Q
What are the signs and symptoms of syncope?
A
Pallor, light-headedness, and sweating.
22
How should you treat syncope in the dental office?
*Lay the patient supine
*Elevate their lower extremities
*Monitor vital signs.
23
Should ammonia ampules be used to treat syncope?
They are unnecessary
24
What should you do if syncope symptoms do not resolve?
Call 911 for emergency medical assistance.
25
How can you identify a patient at risk for syncope?
Patients prone to anxiety or those using anti-anxiety medications are at higher risk.
26
How should you position a patient to prevent syncope during treatment?
Keep the patient supine, especially during anesthesia administration.
27
What should you avoid to prevent syncope in patients?
Do not allow patients to change posture rapidly, especially elderly patients.
28
When is syncope not just "syncope"?
When the cause is more serious, such as a stroke, acute cardiovascular event, drug overdose, or hypo/hyperglycemia.
29
Other causes of altered consciousness:
– Vasovagal reaction
– Stroke
– Acute cardiovascular
event
– Self-induced drug
overdose
– Hypo- or
hyperglycemia
30
What typically precipitates hyperventilation?
Fear or anxiety.
31
What happens during hyperventilation?
There is an excessive loss of carbon dioxide and inspiration of too much oxygen.
32
What can happen if hyperventilation is not treated promptly?
It may lead to syncope.
33
What are the signs and symptoms of hyperventilation?
– Air hunger, apprehension
– Rapid respiratory rate
– Circumoral, hand, and foot numbness or
tingling
– Carpopedal spasm
– syncope
34
How should you treat hyperventilation?
Make the patient aware of their rapid breathing
Coach them to take slower breaths
Calm and reassure them.
35
What should you do if a hyperventilation attack cannot be broken?
Call 911.
36
Prevention of Hyperventilation: Stress reduction
- Medical Risk
- Morning clinic
- Vital signs
- Pain Control
- Short sessions
- Follow ups
37
What is the most common cause of respiratory distress among dental patients?
Asthma
38
What happens during an asthma attack?
There is constriction of bronchial and bronchiolar muscles and excessive secretion of viscous mucus.
39
What are the signs and symptoms of asthma?
– Wheezing
- Chest tightness
– Stridor
- Coughing
- Dyspnea
- Cyanosis
40
How should you treat an asthma attack?
- Position the patient in a tripod position
- Administer one puff of an inhaler
- Repeat in five minutes if needed.
41
What should you do if there is no improvement in five minutes after treating asthma?
Call 911.
42
How can you prevent asthma attacks?
- Determine the severity of the illness
- Medications prescribed
- Frequency and severity of attacks, and known triggers.
43
What can be done to reduce the risk of an asthma attack?
- Remove allergens
- Follow a stress-reduction protocol
- Consult with a medical professional.
44
What is hypoglycemia?
Low blood glucose levels, often caused by taking insulin without eating properly or taking too much insulin.
45
Type I diabetes
The body does not produce adequate amounts of insulin.
46
Type II Diabetes
Impaired glucose
47
What are signs of hypoglycemia?
- Altered mental status
- Diaphoresis (sweating)
- Tachycardia
- Cold, clammy skin
- Weakness, and lack of coordination.
48
What can happen if hypoglycemia persists?
The patient may experience seizures and slip into a coma.
49
How do you manage hypoglycemia in a conscious patient?
Give fruit juice or regular soda.
50
How do you manage hypoglycemia in an unconscious patient?
- Administer glucose gel, glucagon IM, or 50% dextrose IV.
- Call 911 and provide basic life support.
51
How can you prevent hypoglycemia in a patient?
Ensure blood sugar levels are controlled (80-100 mg/dl).
52
What should a patient do before a dental appointment to prevent hypoglycemia?
Eat a meal after taking anti-diabetic medication.
53
What causes an allergic reaction?
An antigen/antibody reaction to a substance the patient has been previously sensitized to.
54
How can allergic reactions manifest?
Symptoms may be confined to a single organ or become generalized.
55
What are the signs of a mild allergic reaction?
Flushed skin, swelling, rash (delayed response).
56
How should an allergic reaction be treated?
- Place the patient in a supine position and maintain the airway.
- Administer Benadryl, steroids, or Epinephrine (EPIPEN).
- Call 911 if necessary.
56
What is the single leading cause of death in the U.S.
Cardiac Arrest/Myocardial Infarction
56
What are the signs of a severe allergic reaction?
Respiratory distress, rapid onset, hypotension (anaphylaxis).
57
How can allergic reactions be prevented in the dental office?
- Review medical history for known allergies.
- Assess the severity of the allergy.
- Confirm the patient's treatment plan for managing allergies.
58
Cardiac Arrest/Myocardial Infarction
* Supply of oxygenated blood to myocardium is reduced
* Myocardial cells become necrotic
59
What are common signs of cardiac arrest/myocardial infarction?
* Squeezing sensation in the chest
* Pain radiating to arms, neck, back, or jaw
* Difficulty breathing
* Perspiration and difficulty breathing
* Nausea
* Feeling of impending doom
60
What is the first step in managing a Myocardial Infarction?
Terminate treatment.
61
How should the patient be positioned during an Myocardial Infarction?
Position the patient comfortably, ideally in an upright position.
62
What does MONA stand for in the treatment of Myocardial Infarction?
- Morphine (IM/IV)
- Oxygen
- Nitroglycerin
- Aspirin (325 mg, chewed)
63
What if morphine is not available during an Myocardial Infarction?
Administer a 50:50 ratio of nitrous oxide and oxygen.
64
How many doses of nitroglycerin can be given during an Myocardial Infarction?
3 doses within 10 minutes.
65
What should be done if the patient is not responding to nitroglycerin?
Provide CPR and defibrillation if necessary.
66
Why should dentists label the initial date when nitroglycerin is opened?
To track the expiration and ensure the medication is within its effective date.
67
How should MI prevention be managed in dental settings?
Delay elective treatment until after 6 months post-MI
68
What is necessary before proceeding with dental treatment for a patient with a history of MI?
Request medical clearance from the physician
69
What blood pressure conditions should be avoided during dental treatment?
No treatment if blood pressure is excessively high
70
Aspiration
Object enters the bronchi or lungs.
71
Ingestion
Object enters the esophagus and GI tract.
72
What are common dental objects that can be aspirated or ingested?
- Extracted teeth
- Crowns and bridges
- Implant instruments, endodontic instruments
- Cotton rolls
73
Signs and Symptoms of Aspiration and/or Ingestion
* Coughing
* Airway Obstruction
74
What position should a patient be placed in to manage aspiration/ingestion?
Upright position to encourage a productive cough.
75
What imaging is used to manage aspiration or ingestion?
- Flat plate X-ray of the abdomen
- Chest X-ray
76
What is the management for aspiration of an object?
Bronchoscopy to remove the object.
77
What is the management for ingestion of an object?
Strain stools and xrays films in 3-4 days.
