Medical Emergency Preparedness

Question 1

5 Most Common Medical Emergencies in the Dental Office listed from most common to least

Answer 1

1. Vasovagal Syncope
2. Mild Allergic Reaction
3. Angina Pectoris/Myocardial Infarction
4. Postural Hypotension/Orthostatic Hypotension
5. (Seizures, Bronchospasm(asthma attack), hyperventilation/panic attack, epinepherin reaction, diabetic emergencies/hypoglycemia, chocking and aspiration

Question 2

4 Ways to Prevent a Medical Emergency

Answer 2

• Complete a thorough Medical History
• Obtaining Vital Signs and Physical Exam
• Recognizing Signs and Symptoms of anxious patient/increased risk for ME
• Effectively use stress reducation techniques accordingly

Question 3

Stress Induced Emergencies

Answer 3

1. Syncope
2. Hyperventilation
3. Acute cardiovascular emergencies
4. Bronchospam
5. Seizure

Question 4

Drug Induced Emergencies

Answer 4

• Hypoglycemia (not eating when taking diabetes medication)
• Hypotension (BP medication dose too large)
• Overdose of local anesthetics
• Allergy of local anesthetics

Question 5

<120/<80

What are the tx modifcations

Answer 5

None

Question 6

Elevated 120/120-129/<80

What are the tx modications

Answer 6

Inform patient medical referral (if warrented)
Elective dental tx is appropriate
Consider shorter appt

Question 7

Stage 1 Hypertension
Systolic 130-139/<80-89
What are the tx modications

Answer 7

Inform pt medical consult advisable.

Selective dental care (prophy, restorative, nonsurgical tx) is appropriate with proper modifications to tx

Question 8

Stage 2 Hypertension
>140/>90
What are the tx modications

Answer 8

Inform patient medical consult advisable

selective dental care (Prophy, restorative, nonsurgical tx) is appropriate with proper modifications to tx

Question 9

Pacific Dental Hygiene Clinic Cut Off
>equal to 160/ > equal to 100
What are the tx modications

Answer 9

Inform patient
Immediate referral to medical provider and medical clearance needed prior to next appointment.
No elective dental tx
retake bloop pressure 5 minutes

Question 10

A1C: Patients should maintain _ % or less HbA1C with well controlled diabetes or __ %in elderly patients with well controlled diabetes

Answer 10

7

7.5

Question 11

If the patient has not been diagnosed with diabetes and the blood glucose is at or above __ mg/dl we will delay tx and refer to the physican

Answer 11

200

Question 12

Blood glucose limit up to ___ mg/dl if the patient has a current A1C at 7% or below

Answer 12

250

Question 13

Any patient with a blood glucose of ___ mg/dl or higher receives an immediate referral to a physician and all tx is delayed until a med clearance is received

Answer 13

300

Question 14

Etiology of Dental Anxiety

Answer 14

• Previous negative or traumatic experience (childhood)
• Signs of needle or drill
• Sounds of drill or screaming
• Smell of eugenol/clove (dental materials/products /anesthetics
• Sensation of high frequency vibrations
• Fear of pain
• Fear of blood
• Fear of being ridiculed/judgment
• Fear of unknown
• Fear of choking and or gagging
• Lack of control in the dental chair

Question 15

Physical responses of a anxious patient

Answer 15

• Muscle Tightness- Hands gripping or grasping arm rests
• Sweating (hands, forehead, upper lip)
• Frequent urination
• Stiff posture
• Pulsation in carotid and temporal arteries
• Clearing throat
• Restlesness

Question 16

Behavioral and emotional responses in a Anxious Patient

Answer 16

• Hyperactive
• Walking/Talking faster
• Seems to be in a hurry
• Irritated
• Panicky
• Poor memory/confusion
• Stumbling over words
• Outburst of emotions
• Sitting on edge of chair/leaning forward
• Inattentiveness
• Lack of eye contact

Question 17

Stress Reduction Techniques

Answer 17

• Communication skills, rapport, trust building
• Office can be made calm and unthreatening through soft
music, avoiding bright lights, cooler environment with blankets
• Minimal to no wait time and morning appointments
• Aromatherapy- pleasant inhalation of ambient odors such as
essential oils (lavandar has been shown to increase blood flow and reduce cortisol levels)
• Visual stimulation through movies or videos
• Te l l -show-do

Question 18

interpersonal cognitive process (clinician- patient) when a patient’s dental phobia is calmed by the behaviors, attitudes, and communicative stance of the clinician.

Answer 18

Latrosedation

Question 19

Preparation

Emergency Team Structure

Answer 19

Person 1: Ask person 2 by name to alert and get dentist, clinic instructor and front office NOW
Ask Person 3 by name retrieve oxygen and emergency cart NOW. Position patient accordinly.

Person 2:
Retrieves the dental emergency team. Assists person 1 with patient (vitals, oxygen, records events)

Person 3:
Retrieves medical er supplies
Assists person 1 and 2 with patient (vitals, oxgyen, records events)

Question 20

Basic Plan of Action

Answer 20

1. Get Help (Remain Calm & Stay with the Patient)

2. Position

Question 21

Basic Plan of Action

Answer 21

1. Get Help (Remain Calm & Stay with the Patient)
2. Position the patient apprpriately based on their conditon
3. Provide basic life support as needed/monitor vital signs: CAB
4. Activate EMS if directed to by the clinical instructor/denist and campus public safety
   - Dial 9 then 911
   - Dial x7207 or 9 then 503-352-7207
5. Additional management
   - continually observe, monitor vital signs, and evaluate for any signs of recovery or deterioartion
6. Documentation
   - record appropriate information in the patient record
   - Faculty will complete an incident report form in axium personal planner
7. De-briefing
   - The director of clinical education will schedule a debriefing meeting with 24-72 hours

Question 22

CAB

Answer 22

Compressions- 30
Airway
Breathing- 2

Question 23

Oxygen used for all emergency except

Answer 23

hyperventalation

Question 24

Epinephrine (Injectable)

Answer 24

Anaphylaxis (allergic reaction)

• Counteracts major physiological events in anaphalaxis
• Reduces hypotension, bronchospasm, laryngeal edema prevents additonal release of histamine and other chemical mediators

Question 25

Epinephrine (Injectable)

Answer 25

Anaphylaxis (allergic reaction) - Counteracts major physiological events in anaphalaxis - Reduces hypotension, bronchospasm, laryngeal edema prevents additonal release of histamine and other chemical mediators -

Question 26

``` Epinephrine (Injectable) § Rapid onset and short duration § Adult dosage - concentration for intramuscular injections § Pediatric dosage - ```

Answer 26

.3 mg of 1:1,000 .15 mg of 1:1,000

Question 27

Epinephrine (Injectable)

Answer 27

Severe Asthma attack | - Should not use with ischemic heart disease or severe hypertension

Question 28

Nitroglycerin

Answer 28

Angina pectoris MI or CHF • Va s o d i l a t o r - dilates coronary blood vessels • Rapid onset • Ta b l e t a n d s p r a y f o r m § Ta b l e t s b e c o m e i m p o t e n t i f exposed to light or air § Shelf life reduced to 12 weeks § Spray shelf life usually 2 years

Question 29

Nitroglycerine • Administer ___ or onto the tongue • Administer at 5 minute intervals – up to 3 doses • Should not administer if systolic BP _____ or patient has taken ED drugs within 24 hours- sudden decrease in blood pressure • If regular dosage doesn’t resolve symptoms, activate EMS and assume MI

Answer 29

sublingually | BP < 90 mmHg

Question 30

Diphenhydramine (Benadryl) or Chlorpheniramine (non injectable forms)

Answer 30

• Mild, slow onset, non-life threatening allergic reactions § Oral histamine blocker § Chlorpheneramine – 10 mg or § Diphenhydramine 25 – 50 mg

Question 31

Diphenhydramine or Chlorpheniramine (injectable forms) • Intramuscular histamine blocker • ____ allergic reaction (urticaria, pertussis) with some respiratory symptoms • Diphenhydramine 25 – 50 mg or Chlorpheneramine 10 – 20 mg • Pediatric dose is 1 mg/kg of body weight and should not exceed adult dose (lbs./2.2=kg) Note: Chlorpheniramine does not cause as much drowsiness

Answer 31

moderate

Question 32

Albuterol

Answer 32

``` • Asthma attack or bronchospasm • Inhaler • Bronchodilator- dilation of bronchioles with minimal cardiovascular effects • Quick onset – peak effect 30 to 60 minutes • Long duration of action 4 to 6 hours • Adult dose 2 sprays • Pediatric dose 1 spray • Can repeat dose if necessary ```

Question 33

Aspirin

Answer 33

• Reduces overall mortality from MI • Inhibitor of platelet aggregation-prevents progression of cardiac ischemia to cardiac injury or cardiac tissue death • Recommended dose 162 mg – 325 mg: 2 - 4 baby aspirin (81 mg each) • Check medical history for allergy

Question 34

Retrieving broken instrument tips

Answer 34

Perioretriever

Question 35

Magill Forceps

Answer 35

Retrieving object from airway

Question 36

Hypertensive Urgency/Crisis

Answer 36

``` • Extremely high blood pressure reading, BP undiagnosed or poorly controlled- 180/120 • Immediately take patient to ER for further eval • Symptoms • Headache (moderate to severe) • Anxiety • Shortness of breath • Tinnitus • Edema • Epistaxis ```

Question 37

****Hypertensive Urgency/Crisis

Answer 37

``` • Extremely high blood pressure reading, BP undiagnosed or poorly controlled- 180/120 • Immediately take patient to ER for further eval • Symptoms • Headache (moderate to severe) • Anxiety • Shortness of breath • Tinnitus • Edema • Epistaxis ```

Question 38

Symptoms of Hypertensive Urgency Crisis

Answer 38

* Headache (moderate to severe) * Anxiety * Shortness of breath * Tinnitus * Edema * Epistaxis

Question 39

Hypertensive Emergency

Answer 39

• Extremely high BP with target end organ damage • Symptoms – similar to MI or CVA – difficult to determine exact emergency • Sudden increase in BP greater than 180/110 often as high as 220/140 • Dyspnea • Chest pain • Dysarthria- difficulty speaking • Weakness • Altered consciousness • Visual loss • Seizures • Nausea and vomiting

Question 40

Tx of a Hypertensive Emergency

Answer 40

- Treat end organ damage (i.e. MI or CVA) If hypertensive emergency - Otherwise retake BP - Seat patient upright - Contact EMS - Monitor BP every five mintues - Administer 4-6 L O2 if patient complains of Dyspnea

Question 41

• Abnormal condition in which BP is not adequate to oxygenate body tissues • Usually reduction in baseline systolic or diastolic BP of 15–20 mmHg* • Often caused by medications (antihypertensive) or postural/orthostatic hypotension • Can lead to shock

Answer 41

Hypotension

Question 42

Hypotension Treatment

Answer 42

Tr e a t m e n t • Position supine with feet raised. • Assess airway. • Administer O2 4–6 liters/minute. • Monitor vital signs. • If no improvement, contact EMS.