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Oral surgery > 16. Behavior in emergency situations in the maxillofacial and oral surgery. > Flashcards

16. Behavior in emergency situations in the maxillofacial and oral surgery. Flashcards

1
Q

Syncope, and its main characteristics

A
  • Transient loss of consciousness and postural tone=>
  • Spontaneous recovery without neurological deficit
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2
Q

Most common cause of unconsciousness in a dental office setting

A

Vasovagal syncope

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3
Q

Psychogenic and non-psychogenic causes of vasovagal syncope

A
  1. Psychogenic=>
    * Fright
    * Anxiety
  2. Non-psychogenic=>
    * Prolonged standing and dehydration
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4
Q

What surgeon should consider when a patient experiences syncope

A
  • Usually a benign, self-limiting event=>
  • Rule out other more serious etiologies of unconsciousness
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5
Q

Cardiac causes of syncope

A

Obstructive outflow diseases such as aortic stenosis

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6
Q

Neurogenic causes of syncope

A

Seizures, transient ischemic attack, migraines

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7
Q

How orthostatic hypotension can lead to syncope

A
  • Patients with depleted intravascular volume=>
  • Side effect of drugs=> antidepressants and antihypertensives
  • Patients with autonomic instability=>
  • Diabetes mellitus
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8
Q

Hypoglycemia relation to syncope

A

Rare cause of syncope

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9
Q

Patients in which vasovagal or vasodepressor syncope generally the etiology

A

Young, healthy patients

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10
Q

Stages of syncope and the symptoms

A
  1. Presyncopal Stage:
    * Blood pressure and heart rate drop
  2. Syncope Stage:
    * Irregular breathing
    * Pulse thready, blood pressure can drop to extremely low levels
    * Unconsciousness can last from seconds to several minutes after placement in the supine position
  3. Postsyncope Stage:
    * Rapid recovery
    * Pallor, nausea, disorientation may persist
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11
Q

Management steps for syncope in an emergency situation

A
  • Stop the procedure immediately
  • Trendelenburg position and administer oxygen
  • If unconsciousness =>,basic life support protocol: call for help, assess airway, breathing, and circulation
  • Chin lift or jaw thrust to open the airway.
  • If breathing and circulation present=> crush an ampule of ammonia under the patient’s nose to hasten recovery
  • Call emergency medical services if unconsciousness lasts beyond 10-15 minutes.

Failure to lay the syncopal patient flat can result in brain damage or death.

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12
Q

Most frequent triggers for asthma

A
  • Viral or bacterial respiratory infections
  • Exposure to cold, allergens, irritants=>
  • Smoke, and exercise
  • Emotional distress and medications=>
  • Aspirin, NSAIDs
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13
Q

How oral and maxillofacial surgeon prepares for an asthmatic emergency

A
  • Careful history and conducting a physical examination=>
  • Extent of the patient’s asthma
  • Baseline peak flow rate
  • Usage of inhaled agents
  • History of emergency care or intubation
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14
Q

Measures that can help prevent asthma attacks during dental procedures

A
  • Reduce emotional distress in fearful patients.
  • Anesthetic drugs such as opioids and barbiturates cautiously=> as they can induce bronchospasm=>
  • Histamine release
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15
Q

How a typical asthma attack presents

A
  • Chest congestion or tightness
  • Nonproductive cough
  • Inspiratory and expiratory wheezing
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16
Q

Signs of a severe asthma attack

A
  • Increased dyspnea
  • Use of accessory respiratory muscles
  • Hypoxia is a late sign=>
  • Immediate treatment.
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17
Q

Steps taken if a patient is suspected of having an asthma attack during a surgical procedure

A
  • Stop the surgical procedure immediately
  • Administer oxygen and a beta-2 agonist like albuterol via a metered dose inhaler (MDI).
  • No response to bronchodilators=>
  • Medical emergency (status asthmaticus) and alert EMS
  • Subcutaneous epinephrine and parenteral glucocorticoids for severe attacks
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18
Q

Recommended dosage for albuterol during an asthma attack

A
  • Six puffs of albuterol MDI (90 µg/puff)
  • Can be repeated every 20 minutes as needed
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19
Q

Status asthmaticus, and how it is managed

A
  • Severe asthma attack that does not respond to bronchodilators
  • Requires immediate EMS intervention=>
  • Subcutaneous epinephrine and parenteral glucocorticoids
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20
Q

How epinephrine administered during a severe asthma attack

A
  • Subcutaneously at a dose of 0.3 ml of 1:1000 dilution
  • Every 20-30 minutes for up to three doses
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21
Q

Role of glucocorticoids in managing severe asthma attacks

A
  • Relieve airway inflammation
  • Benefits after 3-6 hours, early
  • 125 mg of methylprednisolone
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22
Q

Complications that can occur in diabetic patients in the surgical office setting

A
  • Hypoglycemia
  • Diabetic ketoacidosis
  • Hyperosmolar non-ketotic coma
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23
Q

Why hypoglycemia particularly concerning in the outpatient setting

A
  • Acute condition requiring immediate attention=>
  • Severe complications
24
Q

How hypoglycemia defined in adults and children

A
  • Blood glucose levels less than 50 mg/dl in adults
  • Less than 40 mg/dl in children
25
Q

Relationship between intensive glucose control therapy and hypoglycemia in diabetes management

A
  • Helps prevent microvascular complications of diabetes mellitus=>
  • But increases the incidence of symptomatic hypoglycemia
26
Q

Normal physiological response to hypoglycemia

A
  • CNS response=> release of glucagon, cortisol, and epinephrine=>
  • Increase glycogenolysis and gluconeogenesis
  • Inhibit insulin-dependent glucose uptake
  • Process can be disrupted by drugs or disease states=> impaired recovery from hypoglycemia

The brain relies on a continuous glucose supply as it cannot store glucose.

27
Q

How diabetes and certain medications impair the body’s response to hypoglycemia

A
  • E.g exogenous insulin and beta-blockers can impair the counter-regulatory response to hypoglycemia=>
  • Reduce the body’s ability to recover from low blood glucose levels
28
Q

Why diabetic patients undergoing surgery at increased risk for hypoglycemia

A
  • Patients to fast (NPO status), necessitating adjustments in insulin or oral hypoglycemic doses
  • Surgeries can alter eating habits=>
  • Increased risk of hypoglycemia
29
Q

Initial symptoms of hypoglycemia

A
  • Sweating, anxiety, palpitations
  • Hunger, and tremor=>
  • Blood glucose levels below 60 mg/dl
  • Mild cognitive dysfunction around 50-55 mg/dl.
30
Q

How hypoglycemia affects older patients compared to younger patients

A
  • More likely to experience cognitive impairment
  • Less likely to exhibit other warning symptoms of hypoglycemia
31
Q

Severe symptoms that can occur with progressive hypoglycemia

A
  • Severe neurologic symptoms include lethargy and obtundation at 45-50 mg/dl
  • Coma can occur at 30 mg/dl
  • Convulsions and death below 20 mg/dl
32
Q

Initial steps taken to manage hypoglycemia in a surgical office setting

A
  • Obtain an initial blood glucose level to document hypoglycemia
  • Do not delay glucose administration if clinical suspicion is high
33
Q

Appropriate treatment for a conscious patient experiencing hypoglycemia

A
  • Oral glucose via glucose=>
  • Tablets, fluids, candy, or food
  • Reasonable initial dose is 20 g of glucose
34
Q

Done if patient is unable or unwilling to take oral glucose

A
  • Intravenous dextrose=>
  • Initial dose of 25 g
  • Unconscious patients,=> dextrose while managing airway, breathing, and circulation
35
Q

Glucagon used in managing hypoglycemia, and its limitations

A
  • Administered intravenously (1 mg doses),
  • Subcutaneously
  • Intramuscularly (1-2 mg)
  • Effective except in cases of hypoglycemia secondary to ethanol due to depleted glycogen stores
36
Q

What clinicians should be aware of regarding the treatment of hypoglycemia with glucose or glucagon

A
  • Raise plasma glucose concentrations only transiently
  • Monitoring of the patient’s glucose concentration and clinical status essential after treatment
37
Q

Monitoring required for a conscious patient who only needed oral carbohydrates to treat hypoglycemia

A
  • One hour before allowing them to leave the office=>
  • To ensure stable blood glucose levels and recovery
38
Q

Monitoring required for an initially unresponsive patient treated for hypoglycemia

A
  • Monitor vital signs and blood glucose levels at least every five minutes=>
  • Until medical assistance arrive
39
Q

Why offices that provide medications, especially parenteral ones, should be prepared for anaphylaxis

A
  • Life-threatening medical emergency occuring unexpectedly
40
Q

Anaphylaxis and how does it occurs

A
  • Type I hypersensitivity reaction=> antigen binds to IgE antibodies on mast cells and basophils=>
  • Systemic release of immunologic mediators
41
Q

Common clinical presentations of anaphylaxis

A
  • Urticaria (hives) and/or angioedema (swelling)
  • Respiratory compromise and cardiovascular collapse=>
  • Usual causes of death in anaphylaxis
42
Q

Common causes of anaphylaxis in a surgical practice

A
  • Drugs such as penicillin and aspirin
  • Exposure to latex
43
Q

Conditions that must be differentiated from anaphylaxis

A
  • Vasodepressor syncope
  • Local anesthetic overdose
  • Panic attack, cardiac arrest, foreign body aspiration
44
Q

How initial signs and symptoms of anaphylaxis be managed

A
  • Procedure stopped immediately
  • Airway, breathing, circulation, and consciousness level assessed,
  • Epinephrine should be administered without delay
45
Q

Role of epinephrine in managing anaphylaxis, and how it should be administered

A
  • Intramuscularly or subcutaneously at a 1:1000 dilution (0.2–0.5 ml in adults or 0.01 mg/kg in children)
  • Injected into the lateral thigh, upper arm, or sublingually=.
  • Dose repeatable every 5 minutes as needed
46
Q

Position patient placed in during anaphylaxis and why

A
  • Trendelenburg position (lying flat with feet elevated)
  • Maximize cerebral blood flow
47
Q

Additional treatments that should be considered after initial epinephrine administration in anaphylaxis

A
  • Antihistamines (such as diphenhydramine) intramuscularly or intravenously at 1–2 mg/kg (up to 50 mg).
  • Albuterol for bronchospasm
  • Corticosteroids (such as hydrocortisone prevent recurrent or protracted anaphylaxis
48
Q

Why its important for all patients with anaphylaxis to be taken to an emergency department

A

Can recur

49
Q

Seizures

A
  • Excessive activation of neurons=>
  • Abnormal neurological functioning
50
Q

Two main classifications of seizures

A
  • Partial=>
  • Simple partial (consciousness maintained) and complex partial (consciousness lost)
  • Generalized seizures=>
  • Involve activity in both cerebral hemispheres
  • Absence, myoclonic, and tonic-clonic (grand mal) seizures
51
Q

Differentiates primary from secondary seizures

A
  • Primary seizures =>no known etiology
  • Secondary seizures=> injury or illness affecting CNS
52
Q

How a seizure managed in a medical office setting

A
  • Confirm it is a seizure and not syncope
  • Patient should be reclined to a supine position to minimize injury
  • Basic life support initiated=>
  • Airway is clear and administering oxygen
  • Objects should be moved away
  • Pulse should be checked to rule out cerebral hypoxia

Tonic-clonic seizures last less than 2 minutes and do not require anticonvulsants, but postictal monitoring and support are crucial

53
Q

Status epilepticus and why is it considered a true medical emergency

A
  • Seizures lasting longer than 5–10 minutes
  • or frequent seizures without a return to baseline between ictal states=>
  • Significant morbidity and mortality
54
Q

Initial treatment steps taken for a patient experiencing status epilepticus

A
  • Call EMS immediately
  • Basic life support, and secure intravenous access.
  • Ampule of 50% dextrose IV to rule out hypoglycemia
  • First-line treatment=> benzodiazepines- lorazepam (0.02–0.03 mg/kg IV),
55
Q

Second-line treatment options if benzodiazepines do not terminate a seizure

A
  • Phenytoin (20 mg/kg IV infusion at 25–50 mg/min)
  • Phosphenytoin (15–20 mg/kg IV infusion at 100–150 mg/min) intramuscularly
  • Monitor vital signs closely due to potential hypotensive effects

Oral surgery (106 decks)

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