Medical Emergencies in the dental office Flashcards Preview

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Flashcards in Medical Emergencies in the dental office Deck (31)
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1

Emergency

An unforeseen combination of circumstances that call for immediate action. Low frequency high impact events

2

Minor: Simple faint

Elevate feet and monitor if they come back

3

Intermediate emergency

O2 + Repositioning - start CPR

4

Major emergency

Call 911, referral to MD or ER. Ex: Diabetes, infection, hypertension - too high BP

5

Prevention of medical emergencies

Vital signs to be taken - BP (120/80), Heart rate & rhythm (60-110), Respiratory rate (16-18 breaths), height, weight

6

Determining medical risks

Medical history questionnaire, physical eval, dialogue history, medical consultation, ASA classification

7

ASA physical status classifications

1 - healthy patient, no systemic disease
2 - mild systemic disease
3 - severe systemic disease limiting activity
4 - incapacitating systemic disease that is a constant threat to life
Do not see anyone below a 4
5 - Moribund patient not expected to survive 24 hours with/out an operation
6 - brain dead, organ harvest for donation
E: "Emergency operation" added to patients physical status classification

8

Levels of consciousness

Awake
Altered - pre-syncope, TIA, slurred words
Unconscious - syncope, orthostatic hypotension
Seizures - hyperventilation, syncope, epilepsy

9

Airway - breathing

Obstruction, hyperventilation, asthma, COPD, emphysema

10

Management of cardiac emergencies

Given the increase in human life expectancy resulting from improvement in medical care, dental practitioners are now more likely to encounter cardiovascular emergencies in an outpatient setting

11

Cardiovascular

Angina - chest pain, Hypo/Hypertension, dysrhythmia - bradycardia, tachycardia, myocardial infarction, cardiac arrest

12

Drug related emergencies

Overdose: local anesthetics, sedatives
Reaction to drugs: allergy (rash, itching, airway)

13

Goals of physical evaluation

ability to psychologically tolerate stress
ability to physically tolerate treatment
is treatment modification indicated
is psychosedation indicated
which sedation technique is indicated
any contraindication to premedication used

14

Recognition of anxiety

increased BP and pulse
trembling
diaphoresis
restlessness
hyperventilation
dilated pupils

15

Stress reduction protocol

oral sedation - pm and am
intraoperative sedation - IV or N2O
Effective pain control - local anesthesia
Am appointment
Time factor - short appts
Hot and humid weather
Post-op Rc prn
Post-op phone call

16

Treatment modifications

Intra-op oxygen
Sedation - oral, N2O, IV
Patient position - can they withstand?
Antibiotic premedication
cardiac pacemaker or defibrillator
anticoagulant

17

Fainting

Vasodepressor syncope

18

Syncope

is considered a transient loss of consciousness due to hypoerfusion of the brain and is characterized by rapid onset and spontaneous resolution
Can be caused by pallor, nausea, sweating, bradycardia, and rapid fall in BP - > when below a critical level, results in loss of consciousness due to generalized cerebral ischemia
Usually evoked by emotional stress associated with fear or pain

19

Orthostatic hypotension

A decrease in systolic BP or 20mmHG or a decrease in diastolic BP of 10 mmHG within 3 mins of standing when compared with baseline BP
Increased with age

20

Psychogenic factors

Fright or anxiety, pain, emotional stress, sight of blood, sight of dental instruments, unwelcome news

21

Non-psychogenic factors

upright or standing position, hungers exhaustion, poor physical condition, hot, humid, crowded environment, male sex, age btw 16-35

22

Vasovagal syncope

sudden, rapid drop in heart rate and BP which leads to fainting. Most common cause of syncope - about 32%. most patients experience their first episode as a teenager or adolescent

23

syncope manifestations

warmth, loss of color, sweating, feels bad, nausea, BP at baseline, tachycardia

24

syncope episodes

usually triggered by a sudden, temporary drop in blood flow to the brain, which leads to loss of consciousness and muscle control
the person then falls down or over, which allows blood flow to return to the brain
returning blood flow allows the person to regain consciousness

25

late syncope manifestations

yawning, difficult breathing, pupillary dilation, cold hands and feet, dizziness, loss of consciousness, hypotension and bradycardia

26

Treatment syncope

position patient - horizontal
airway and breathing
circulation - vital signs
oxygen
cool compress on wrist & forehead
aromatic spirits of ammonia
loosen clothing
reassurance

27

Hyperventilation - prevention

medical history
physical exam
recognize signs of anxiety
stress reduction protocol

28

Hyperventilation

to breathe at an abnormally rapid rate, so increasing the rate of loss of CO2
rate of removal of CO2 from the blood is increased
as the partial pressure of CO2 in the blood decreases, respiratory alkalosis ensues

29

Hyperventilation - symptoms

tightness in chest - suffocation
rapid respiration - rapid pulse
light headedness - apprehension
Lump in throat - precordial pain
Might think their having a heart attack

30

Hyperventilation: signs and symptoms

rapid and shallow breathing, confusion, dizziness, cold hands, carpal-pedal spasms; can lead to seizures, tingling or numbness of hands or lips, carpopedal spasm, patients are usually btw 15-40, color good