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Parcial 1 Flashcards

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1
Q

Most common reason of facing and emergency in the daily practice

A
  • Increase in care for patients with chronic degenerative diseases such as diabetes and hypertension
  • increase in care for patients with heart disease, inmunosupression or transplants
  • longer dental treatments
  • older age in patients
  • use of new medications
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2
Q

Dentistry is a surgical and invasive speciality that is associated with the presence of anxiety, fear and anguisn in the patient. The combination of all these factors can precipitate a situation that could lead to medical emergencies
V o F

A

V

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3
Q

Defined as the quality that cannot be postponed, that does not admit waiting: the obligation of immediate compliance. Therefore, when talking about a medical emergency, we consider any situation of unexpected and sudden health compromise that puts the patients life at risk and that therefore requires immediate medical attention

A

Emergency

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4
Q

It is the non-life-threatening health situation that requires care within a reasonable period of time

A

Urgency

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5
Q

Examples of urgency

A

-Bronchitis
- nauseas and mild indigestion
- rash
- cough
- nasal congestion
- earache or sore throat
- red eye

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6
Q

Examples of emergency

A
  • Severe fractures
  • poisoning
    -burns
  • asthma attack
  • fainting and seizure
  • memory loss
  • vision loss
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7
Q

Three most common emergencies are

A

Syncope
Moderate allergic reaction
Angina pectoris

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8
Q

Hipertension postural mayormente en

A

Personas de la tercera edad y emabarazadas

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9
Q

According to the study the most common time when a medical emergency occurs in the dental office is

A
  • during or immediately after applying local anesthesia (76.9%)
  • dental treatment (15.2%):
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10
Q

The two dental procedures most frecuently associated with the appearance of medical emergency are

A

Extracción (38.9%) and endodontics (26.9%)

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11
Q

Factors that increase the incidence of emergencies

A
  • increase of elderly patients
  • long sessions
  • use of new medications
  • use of new techniques
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12
Q

Factors that decrease the incidence of emergencies

A
  • Clinical history focused on medical emergencies
  • detection and control of anxiety
  • training to handle any eventuality
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13
Q

Prevention can be achieved with a

A

Thorough medical history, a detailed physical examination, a medical check up and direct supervision of the patient

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14
Q

______ contributes the basic of prevention. The dentist must delve deeper into the patients current condition, placing special emphasis on the time of onset, evaluation, medical control, current medication and date of the last evaluation by the doctor

A

Clinical history

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15
Q

_____ has a great legal importance, since all the clinical data that the patient wants to provide will be recorded there. In the event that any condition is denied, and any complications occur, this constitutes a legal medical document that can exempt the dentist from any responsibility

A

Medical history

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16
Q

The recording of vital signs and their clinical correlation is essential, and it is essential to these measurements when the patient arrives at the office and during the surgical procedures
V o F

A

V

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17
Q

In patients with an ongoing illness, whatever it may be, communication with their treating doctor to know their physical condition, as well as their authorization to carry out the dental procedure, will be elements of undoubted value to prevent emergencies
V o F

A

V

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18
Q

It is essential to assess the degree of risk of each patient, so the dentist must be familiar with the risk degree scale of the American Society of Anesthesiologist

A

ASA

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19
Q

EMERGENCIES
The dentist must conduct himself appropriately to control, manage and treat these eventualities, as well as have trained personnel to manage and control them, so having the necessary adaptations to the dental clinic or office is an essential requirement to be able to treat a regular patient. Or in need of special health care
V o F

A

V

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20
Q

EMERGENCIES
The dentist must conduct himself appropriately to control, manage and treat these eventualities, as well as have trained personnel to manage and control them, so having the necessary adaptations to the dental clinic or office is an essential requirement to be able to treat a regular patient. Or in need of special health care
V o F

A

V

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21
Q

MANAGEMENT OF MEDICAL WHAT TO DO

A
  • Mantener la calma y tranquilidad para transmitir seguridad al equipo de trabajo y al paciente
  • estar entrenado para realizar los procedimientos de soporte básico y avanzado: realizar cursos de urgencias médicas, saber hacer RCP
  • conocer el equipo de urgencias: equipo y medicamentos
  • saber cuándo y a quien solicitar ayuda: no siempre se necesita equipo médico de urgencia
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22
Q

General measures for managment possible emergencies in the dental office are:

A
  • early and timely diagnosis of medical emergencies
  • adequate staff preparation
  • Clear therapeutic concepts
  • emergency equipment
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23
Q

It is very important to have a _____ diagnosis of medical emergencies, and this should begin at the _____ that the patient presents

A

Early, First symptom or sign

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24
Q

Early and timely diagnosis of medical emergencies knowledge of the patients previous medical profile will greatly facilitate its recognition and faster response to treatment; the oral health professional must monitor this response minute by minute and make decisions based on its evolution
V o F

A

V

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25
During an emergency three people help
Dentist, assistant and the receptionist
26
Rollos assignment
- Dentist: provides direct emergency care to the patient and make the decision to call 911 - assistant: the most available person, prepare the emergency equipment and assists the dentist - receptionist: call 911 if instructed to do and inmedially hel in the emergency
27
911 Protocol In case of need to call the emergency service, it is very important that the person responsable for doing so know the action protocol. Time is vital and it is advisable to know in advance how to act in the cases V o F
V
28
The following system is proposed (SIR)
1. Situation: provide the exact address of the clinic and indicate the emergency 2. Information: inform how the patient is and the actions that have been initiated 3. Recomendations: transmit the dentist the recomendations that the emergency service provide until the medical help arrives
29
Complete courses that includes medical emergencies and cardiopulmonary resuscitation are essential, as required by the official mexican standard NOM________, for the prevention and control of oral disease, which in it article______, establishes:_________
NOM-013-SSA-2006, 5.9, the stomatologist and auxiliar staff must be trained in the managment of basic cardiopulmonary resuscitation maneuvers.
30
Along with adequate preparation of the dental team, it is strictly necessary to have an emergency ______for the treatment of the most common emergencies in the daily dental consultation, as required by the official Mexican standard NOM_______ to the prevention and control of oral diseases, which in article ____ indicates____
First aid kit, NOM-013-SSA2-2006, 5.9, that the stomatological office should have a first kit that includes what is necessary to control medical emergencies that may occur during the stomat9ogical exercise
31
“The stomatological office should have a first kit that includes what is necessary to control medical emergencies that may occur during the stomatological exercises”
NOM-013-SSA2-2006
32
Three aspects should be taken into consideration before medically treating a medical emergency
1. In the inicial managment of medical emergencies, the administration of drugs is not strictly necesarry 2. The first intention treatment of all medical emergencies includes basic life support 3. When in doubt, it is advisable not to medicate
33
First aid kit components What to do you need?
- medication and implements for the application of medicines - equipment for taking vital signs - advanced life support equipment - respiratory support equipment
34
The first aid kit must be
Organices, complete and visible
35
The medications contained in the first aid kit are an essential part of the managment of emergencies and can be classified as
Critical or primary and non- critical or secondary
36
Use in anaphylaxis, cardiac arrest, unresposive asthma
Epinephrine
37
Use in acute intense angina type pain
Nitroglycerin
38
Use in clinically significant hypotension
Ephedrine
39
Use in epileptic seizures
Lorazepam
40
Use in myocardial infarction
Aspirin
41
Use in allergic reactions
Chlorphenhydramine
42
Use in allergic reactions
Chlorphenhydramine
43
Use in anaphylactic/ bronchospasm
Albuterol
44
Examples of Non critical
Alcohol, ketorolaco, paracetamol
45
Adrenaline
Anaphylaxis Adult: 500 mg repeated at 5 minutes intervals until response Pediatric: -6 years: 150 mg, 6-12 years: 300 mg, +12 years: 500mg. May be repeated at 5 minutes intervals until an adequate response
46
B2 bronchodilator (e.g salbutamol) inhaler
Asthma attack Adults and pediatric: 2 actuations inhaled. Use space device if necessary. Repeat doses may be necessary
47
Glycerayl Trinitrate spray
Angina or suspected heart attack Adults: 2 actuations sublingually. May be repeated Pediatric: non
48
Dispersible aspirin
Suspected heart attack Adult: 300 mg oral (chewed) Pediatric: n/a
49
Glucose (quick acting)
Hypoglycemia (patients COOPERATIVE AND ABLE TO SWALLOS SAFELY) Adults and pediatric: 15-20 mg quick acting (1.5-2 tubes of glucogel, or 4-5 glucotabs)
50
Glucagon
Hypoglycaemia (patient UNABLE TO SWALLOW SAFETY eg. unconscious) Adults: 1 mg IM PEDIATRIC: -8 years (-25kg): 0.5 mg IM, +8 years (+25 kg): 1 mg IM
51
Midazolam cromucosal solution
Prolonged convulsive seizures (-o =5min) or repeated (-= 3 in one hour) Adults: in the buccal route as a single dose of 10 mg Pediatric: -5 years: 5 mg, 5-10 years: 7.5 mg, 10-18 years 10 mg
52
Ephinephrine injection is used to treat______, life-threatening _______ caused by_________ Ephinephrine works by _______________________ Dose_____________ Ephinephrine should be injected ______ as soon as it is suspected that the patient may be expecting a severe allergic reaction Signs include difficulty____________
SEVERE, allergic reactions, (insect bites or stings, foods, medication, latex and other causes Relaxing the muscles in the airways and narrowing the blood vessels 0.3 or 0.5 mL of adrenaline Intramuscularly Breathing, wheezing, hoarseness, swelling, redness of the skin, fast hearatbeat, weak pulse, hypotension, confusion, loss of control of urine or bowel movements, fainting, or loss of consciousness
53
Second round or allergic reactions can occur after the inicial anapahylactic reaction. A second reaction may happen as early as an hour after the first reaction or as long as 72 hours later and can be less severe or more severe
Biphasic anaphylaxis
54
Diphenhydramine competitively anatagonizes the effects of _________, which is why it is used as a treatment for symptoms associated with ______ This medication prevents the ________reaction mediated by _______ but does not prevent its release. It has notable _____ activity and a intense tendency to induce _____ Dose:
Histamine, allergies Allergies, histamine, antimuscarinic, sedation 25 to 50 mg every 4 to 6 hours
55
Sublingual nitroglycerin tablets or sublingual spray are used to treat ______. Nitroglycerin is a _____ that works by _______ This produces______of both _______and_______ in a dose- dependent manner. Dosage:
Episodes of angina Coronary vasodilator, relaxing vascular smooth muscle Dilation, the venous and arterial beds Siblingual nitroglycerin 5mg
56
Nitroglycerin can be in
Sublingual tablets or spray . Cada 5 minutos tomar si no se quita, no más de 3 veces
57
Nitroglycerin tables Duran _____ y spray _____ Si no ________ está mala
6 meses, 2 years. Sting
58
_______ coronary vasodilator indicated in the treatment of angina pectoris and hypertensive crises with precordial pain. In case of emergency ______ mg (_____tablets) sublingually should be given. Therapeutic effects appear _____ minutes after application
Isorbide dinitrate, 5-10, 1-2, 2-5
59
______Selective adrenergic receptor agoinst for beta 2 receptors. In adults in case of bronchospam, _______ inhalation (_____) is taken in a single dose which can be increased to ___ inhalations if necessary. The maximum dose is _______ mcg every ______
Salbutamol 1, 100-114 mcg, 2 200-228, 4-6 hours
60
It is indicated as prophylaxis and treatment of bronquial asthma and bronchospam associated with bronchitis and emphysema
Salbutamol
61
_________5% glucose solution. Solution for ________ indicated in carbohydrate metabolism (hypoglycemia, insulin coma)
Anti hypoglycemic agents, Intravenous infusion
62
Anti hypoglycemic agents: glucose solution
5%
63
_________May help reduce the severity of myocardial infarction and stoke because once absorbed into the bloodstream, aspirin irreversibly inhibits COX-1 in platelet , which decreases their production of thromboxane. This prevents platelet aggregation. If signs of any of these emergencies are observed, it is recommended to chew_____ while waiting for the ambulance
Acetylsalicylic acid/ aspirina, 300 mg aspirin tablets
64
It’s mechanism of action is the inhibition of cyclooxygenase activity and therefore the synthesis of prostaglandins. Despite having antipyretic and anti-inflammatory activity, at analgesics doses the anti-inflammatory effect is less than that of other NSAIDs. In case of acute pain, ______ mg of medication should be administrated _______
Ketorolaco, 30 mg, sublingually
65
______A corticosteroid, works by modifying the body’s immune response and has a potent anti-inflammatory effect with various metabolic reactions. It is useful as _______ and is used in cases of adrenal crisis. The treatment will consist of the administration of ____mg of hydrocortisone intravenously.
Hydrocortisone, second choice medication in anaphylactic shock, 100 mg
66
Are used to awake consciousness after syncope as the release of ammonia gas irritates the membranes of the nose and lungs and therefore triggers a respiratory reflex: the lungs breathe in and out quickly and deeply to cleanse the nasal passages of stinging ammonia. Deep inhalation helps reset breathing patterns, sending more oxygen to the brain as breathing returns to normal.
Ammonia salts
67
AED
Automated external defibrillator
68
Useful for ventilating patients with light, stable air pressure in the airways to keep them open. It can be used with varying oxygen concentrations, as an external oxygen source can be adapted. With good technique, the patient can be ventilated until they recover, or until they arrive at the emergency department, or until they can be intubated.
Bag-valve mask
69
Includes nasal tips and face mask. It is used when we need to use oxygen in different concentrations according to the patients needs
Oxygen application equipment
70
It is applied when the patient cannot be intubated. To apply it, take the laryngeal mask with the right hand and hold the patients occiput with the left hand. The mask is advanced guided by the index finger following the contour of the hard palate until resistance is encountered, where the ballon is inflated with 20 cc. Of air checking its correct placement
Laryngeal mask
71
Indicated for unconscious patients as they prevent the tongue from obstructing the airway.
Oropharyngeal or nasopharyngeal cannulas
72
_______Are recommended for the patient who is not completely unconscious, while _______ are used in patients who are in a coma as they can cause nausea and vomiting
Nasopharyngeal cannulas, oropharyngeal cannulas
73
First aid kit components It will be made up for three basic instruments:
Baumanometer, stethoscope, and thermometer
74
Severe allergic reaction that is rapid in onset and can cause death
Anaphylaxis
75
Causes of anaphylaxis
Common: foods (peanuts, fishm shellfish, milk, egg, etc), insect bites, medications, latex. Rare: nitrous oxide, benzodiazepines, antihistamines Uncommon: local anesthetics
76
Signs and symptoms of anaphylaxis
Occur 15 to 30 minutes after exposure to the allergen. Sometimes symptoms can start after 1 hour - skin rash/ hive - facial redness or sudden paleness - laryngeal edema, bronchospasm accompanied by stidor, wheezing or hoarseness - possible cardiorespiratory - hypotension/ tachycardia
77
Anaphylaxis primary treatment
1. Call 911 2. Place the patient in horizontal position with legs raised (if breathing is adequate) 3. Guarantee the opening of the air route 4. In case of cardiac arrest star CPR 5. In case of danger to vital signs, administer subcutaneous adrenaline - adults: 0-5 ml at concentrations of 1:1000 - 6-12 years: 0-3ml - repeat every 5 min if it does not improve 6. Administer oxygen: 15 lt/min
78
Anaphylaxis secondary treatment
1. Bronchodilator (b2 agonist) albuterol or salbutamol, aerosol inhalation - children 4-8 inhalations; adults, eight shots of albuterol or salbuterol 2. H1 blocker (antihistamine: diphenhydramine) or chlorphenamine 10 to 20 mg IV or IM, IV 1-2 mg/kg (maximum 50mg) or 50 mg orally 3. Supplemental oxygen from 3 to 5
79
Most common errors in anafilaxis
1. Do not use ADRENALINE as your first option 2. Suppose that corticosteroids and antihistamines can replace adrenaline 3. Delay placement of an EV line 4. Trust when there is improvement 5. Do not refer the patient to a more complex healthcare center
80
Is a chronic disease characterized by especial inflammation of the airways that causes narrowing of the airways, decreased flow of air in and out of the lungs
Asmathic crisis
81
Signs and symptoms of asmathic crisis
- difficulty breathing - dyspnea and respiratory wheezing - more than 25 breaths/ minute - accelerated pulse: + 110 minutes - serious signs: cyanosis, decreased pulse or confusion
82
Medical management in asmathic crisis
1. Guarantee the opening of the air route. Place the patient sitting. 2. Give 2 inhalations of bronchidilator (eg. salbutamol) with 100 mg in each inhalation - repeat a second time if there is no response 3. If there is no improvement, call 911 4. Administer oxygen: from 2 to 15 liters/ minute (use saturometer if available) 5. Adrenaline .5 ml in case there is no improvement 6. Repeat bronchodilator inhalations up to a maximum of 10
83
It is defined as an increase in PaO2 and decrease in PaCO2, caused by an increase in the frequency or depth of respirations
Hyperventilation
84
Causes of hyperventilation
This can occur anxiety or panic. Agitation
85
Signs and symptoms of hyperventilation
- slight lightheadness and dizziness - weakness - accelerated - possible chest pain and/or palpitations
86
Medical managment of hyperventilation
1. Reassure the patient 2. Place the patient sitting 3. Use a bag so that the patient can breathe in it and increase the carbon dioxide 4. If there is no improvement, call 911 5. Continue to reassure the patient
87
It is clinically produced paroxysmal chest pain syndrome that is precipitated by stress or exercise and is cured with rest or the use of coronary vasodilators
Angina pectoris
88
Que clases de angina no atender?
3 y 4

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