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Med Emergencies Flashcards

(75 cards)

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1
Q

sequence for donning PPE

A
  1. gown
  2. mask/ respirator
  3. goggles or face shield
  4. wash hands
  5. gloves
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2
Q

sequence for doffing PPE

A
  1. gloves
  2. goggles
  3. gown
  4. mask/respirator
  5. wash hands
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3
Q

CPR on adult patient
- compressions vs breaths
- order

A

2 in deep compressions; 100-120 per min
and 1 breath/ 5 seconds

Call for help
911
Get AED
check vitals
Start CPR

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4
Q

CPR on child patient
- compressions vs breaths

A

1 breath every 3-4 sec
30 compressions: 2 breaths (same as adult) but change to 15:2 if 2nd rescuer is helping.

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5
Q

Difference in protocol for child CPR witness to collapse vs no witness

A

witness: Call 911, get AED, then start CPR

no witness: start CPR then activate EMS and get AED if still alone

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6
Q

how many compressions to breaths in CPR

A

30 compressions : 2 breaths
* change to 15:2 if second rescuer.

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7
Q

where to check for pulse during CPR

A

child and adult- carotid a.
infant - brachial a

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8
Q

Physical assessment of medically complex pt includes what

A
  • Vitals (BP and HR)
  • visual inspection (including anxiety level, hygiene, distress, appearance)
  • med questionairre.
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9
Q

2 reasons a med consult is indicated

A

A. to clarify med status
B. to obtain additional info
**NOT asking for permission

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10
Q

4 things a med consult should include

A
  1. explanation for “Reason for Consult”
  2. anticipated dental care
  3. type of anesthesia
  4. Anticipated pre-tx and post-tx meds
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11
Q

MC emergency in the dental office=

describe this

A

Vasovagal syncope 90%

aka neurocardiogenic syncope or vasodepressor syncope

brief loss of consciousness due to cerebral ischemia.

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12
Q

does vasovagal syncope happen to healthy people?
when is best time to treat this?
how quick is recovery?

A

yes
best to treat before loss of consciousness

recovery in sec -min

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13
Q

causes of vasovagal syncope (7)

A

needles
blood
blood drawn
fear of injury
heat exposure
standing for long time
straining (like bowel mvmt)

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14
Q

initial response of vasovagal syncope and compensatory response=

how does this cause fainting?

A

initial - sympathetic
compensatory response = parasympathetiv stimulation of vagus nerve (overcompensation)

BP drops from vagal stim causing blood to pool in extremities.
not enough blood to brain = hypoxia.

–> fainting

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15
Q

pre-syncope signs and symptoms

A

NP PATH:
nausea
perspiration
pale
anxiety
tachycardia to bradycardia
hot flashes

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16
Q

how to manage vasovagal syncope in CONSCIOUS patient

A

reassure patient
Trendelenburg position
monitor vitals and ABCs
give supp O2 if breathing is labored

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17
Q

mgmt of vasovagal syncope if pt is UNCONSCIOUS

A
  1. trendelenburg
  2. ABC (airway, breathing, circulation)
  3. monitor vitals
  4. Spirits of Ammonia or cold compress if pt has not recovered.
  5. Call 911 if pt still out
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18
Q

what is orthostatic syncope/ postural

A

syncope from change in position; vasc system cannot adjust

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19
Q

RFs for postural syncope

A
  • Age >65 bc slow responsiveness of baroreceptors
  • MEDICATIONS: ACE inhibs, B-blockers, Ca channel blockers, antidepressange, relaxants, nitrates
  • alcohol
  • pregnancy
  • long appointments in supine position
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20
Q

Medications that inc risk of orthostatic hypotension

A

Ace inhibs
Ca channel blockers
B blockers
antidepressange
muscle relaxants
nitrates

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21
Q

Fastest recovery period of all emergencies=

A

Postural/orthostatic syncope

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22
Q

Presyncope phase of orthostatic/postural syncope

A

no symptoms (bad)

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23
Q

how to prevent postural/orthostatic syncope

A

raise chair slowly and have pt sit for a few

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24
Q

management for orthostatic/postural syncope when pt recovers normally vs does not recover

A

normal: observe for 30 before discharge

delayed: re-evaluate diagnosis. call 911

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25
if pt does not recover quickly from orthostatic/postural syncope, what diagnoses should be considered
hypoglycemia cardiac arrest CVA or stroke transient ischemia attack
26
hypoglycemia def= most common cause
< 70 mg/dL plasma glucose insulin or oral hypoglycemic agents tx db combined with missing meals.
27
Threshold for diabetes when: - fasting blood sugar = - random plasma glucose= - 2 hr post-parandial glucose= - HbA1c= - Fructosamine test=
126 mg/dL >200 mg/dL WITH symptoms >200 after 75g load HbA1c >6.5% >250 umol
28
should dental tx be deferred if db is not controlled?
Yes - if uncontrolled defer unless emergency
29
**Dr. Shin mentioned: how will HcA1c levels be altered if pt has sickle cell or is pregnant
will get false reading
30
Pre-diabetic levels for A1c, fasting plasma glucose, and oral Gluc tolerance
A1c: 5.7-6.4 Fasting plasma: 100-125 Oral gluc tolerance: 140-199
31
How do blood glucose levels and fructosamine levels compare?
for each 30mg/dL change in blood glucose, about 37.5 umol change in fructosamine and 1% CHANGE IN HBA1C **
32
hypoglycemia signs
shakiness feeling cold/clammy mood changes lack of energy hunger/nausea anxious pale skin fast heartbeat blurred vision restless sleep
33
mild vs moderate vs severe hypoglycemia signs
mild: hunger, nausea, dizzy, headache, lethargic, confusion, restless. BG < 60-65 mod: diaphoretic, tachycardic, anxiety, confused. BG < 50 severe: hypotension, unconscious, seizure. BG < 30
34
when should pt eat meals before dental office
within 2 hrs (balanced with fats and protein)
35
if hypoglycemic pt is conscious, how manage?
* stop procedure * comfy position * ABCs and vitals * ORAL*** glucose * recheck in 15min
36
unconcious pt managment hypoglycemia:
Call 911 Trendelenburg position ABCs (airway and O2) administer IM glucose (deltoid) monitor vitals prepare for emergency transport
37
2 necessary questions for med consult if pt has cardiovascular condition
type of heart problem (verify heart is stable for dental procedures) and if abx prophylaxis is necessary
38
abx prophylaxis for cardiovascular pt is approved when:
- prosthetic cardiac valces - infective endocarditis - cardiac transplant - congenital heart disease - unrepaired cyanotic congenital heart disease - repaired congenital heart defect with residual shunts
39
MC condition that pt take prescription med= what are #'s
hypertension SBP > 130; DBP >80
40
high BP can cause what problems
* enlarged heart * aneurysms in vessels * narrowing and hardening of blood vessels in the kidneys leading to kid failure * rupture of BVs in eyes causing blindness
41
normal pre-hypertensive Stage 1 Stage 2 hypertensive crisis
less than 120/80 120-129/ <80 130-139/ 80-89 >140/ >90 >180/ >120
42
T/F: for hypertensive crisis to be diagnose, pt must experience signs of angina? what to do in this situation?
false refer to ER IMMEDIATELY
43
IUSD cutoff for hypertension
160/100 mmHg **elevated risk of stroke/cerebrovascular incident
44
T.F: decrease hypertensive pts exposure to epi what is bigger threat: exogenous or endogenous epi?
true - limit to 0.04mg = 2.2 carps of 1:100k endogenous spi from adrenal medulla can produce 0.28mg epi/min - yikes **so def use stress relief protocols
45
angina pectoris=
impaired delivery of blood to myocardium *includes CAD, antina, and previous MI **transient ischemia to myocardium progressive narrowing or spasm of coronary arteries
46
Sx of angina pectoris
substernal pain in left shoulder, arm, or mandible, PRESSURE, SQUEEZING OR BURNING , SOB, fatigue, lightheadedness.
47
angina pectoris is relieved by
rest and nitroglycerin
48
mgmt for angina pectoris
terminate tx comfy position call 911 ABCs and vitals give sublingual nitroglycerin **about .4mg - wait 5 min. Repeat if no relief 2-3 times If no relieve with N, give 4 NON-ENTERIC ASPIRIN (81MG EA)
49
T/F: An MI is the same as sudden cardiac arrest
no - MI is diminished O2 (circulation prob) causing injury whereas cardiac arrest is electrical issue causing erratic heartbeat or stop is persistent angina pectoris that is NOT responsive to nitroglycerin over 15min pd (3 doses)
50
how long to defer dental tx after cardiac insult (MI)
6 months
51
time after cardiac insult and re-infarction rate: < 4mo 4-6mo > 6mo
30% 15% < 5%
52
T/F: Pt has a pulse with MI.
True. (no pulse or breathing with cardiac arrest)
53
Tx for cardiac arrest
call 911 CPR and AED
54
how long for anaphylaxis to occur
seconds to minutes - a type 1 hypersensitivity rxn
55
Immunoglobulin that initially responds in anaphylaxis vs re-exposure
initially IgE just gets produced @ re-expsoure, IgE binds mast cells causing histamine & other mediators to be released = anaphylaxis
56
signs and Sx of anaphylaxis
ITCHY angioedema cough, dyspnea, WHEEZING, difficulty to BREATHE flush, hypOtensive, seizure unconsciousness
57
medication for anaphylaxis give medicine before calling 911, or 911 first?
IM Epi - adult 0.3mg - child 0.15mg 911 first
58
T/F: Not all allergic reactions are anaphylaxis what is medicine for allergic rxn (cutaneous)
true diphenhydramine (benadryl 25-50mg qid)
59
Seizure can be caused by:
TBI, stroke, tumor, infection, CVD, medication non-compliance ...
60
seizures typically last how long
< 5 min
61
what seizure medications have gingival hyperplasia risk
Dilantin/ phenytoin
62
prodromal phase of seizure is called:
Aura phase - visual and auditory disturbances momentarily before siezure starts - blank stare or crying out
63
arching of back during a seizure is called
opisthotonos (clonic phase)
64
T/F: during seizure, pt should not be restrained
true. only guide extremities and stabilize to protect from injury
65
if possible, put seizing pt in what position
supine
66
Time the siezure: mgmt for < or > 5 min
< 5 min: discharge pt once stable. > 5 min: call 911
67
diagnostic tests to obtain it pt has: 1. liver disorder 2. plavix, aspirin, other nsaids 3. thrombocytopenia 4. anticoags: warfarin, pradaxa, Xarelto/Eliquis 5. Heparin
1. PT, aPTT, INR 2. bleeding time or platelt function test 3. CBC 4. warfarin INR; others no test needed 5. aPTT
68
CBC with differential test reports what info
RBC and WBC count platelet count hemoglobin and hematocrit
69
bleedig time test gives what info
how fast stop bleeding (normal is 3-10 min)
70
prothrombin time test provides what info
EXTRINSIC pathway of coagulation (10-14 sec normal)
71
aPTT tells what info
response to heparin (normal is 25-45sec)
72
INR gives what info
used with PT to assess EXTRINSIC cascade
73
INR test is used only for:
warfarin or liver disease. *** pt on warfarin MUST have updated INR within 2 days of appt
74
normal INR result= should pt discontinue medicine for dental procedure?
2-3 for patients on warfarin do not discontinue as risk of stroke/MI is greater
75
contraindications to dental tx:
bleeding time > 10 min platelet ct less than 150k aPTT > 45 sec PT > 15 sec IN > 3.0

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