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PEDO (Spring) > 8. Medical Emergencies > Flashcards

8. Medical Emergencies Flashcards

1
Q

T/F All drugs (LA, antibiotics, sedatives, etc( have the potential to produce acute, life-threatening reactions

A

t- either through allergy or toxicity (OD)

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2
Q

The main roles of the dentist in emergency situations are

A
  • Prevention most important aspect in dealing with medical emergencies
  • Stabilize the patient until EMS transfer
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3
Q

Medical emergencies can be prevented how

A
  • medical history and physical exam
  • Medical consult (when indicated)
  • Patient monitoring
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4
Q

Medical history is typically obtained how

A

questionnaire

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5
Q

Physical exam includes

A
  • Baseline vitals (BP, Pulse, Respiration)
  • Head and neck exam
  • Observation of general appearance
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6
Q

What information is requested for a medical consult

A
  • Ask if the patient is in optimal condition for the planned procedure
  • You are not asking for medical clearance
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7
Q

Level of monitoring depends on what factors

A
  • Procedure
  • Underlying medical condition of the patient
  • Behavior guidance technique used
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8
Q

What level of monitoring is required for healthy patients treated with LA or minimal sedation

A
  • General appearance of the patient
  • Level of consciousness
  • Level of comfort
  • Muscle tone
  • Color of skin/mucosa
  • Respiratory pattern
  • *This should always be monitored in every patient)
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9
Q

Administration of LA in large doses can result in

A

CNS depression (esp. when combined with sedatives)

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10
Q

When the intent is minimal sedation for adults the appropriate inital dose of one enteral drug is

A

no more than the max reccomended doe (MRD) that can be perscribed for unmonitored home use

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11
Q

T/F Pre-op sedatives in kids under 12 prior to arrival at the office is not recommened

A

t- risk of respiratory obstruction

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12
Q

MRD means

A

max recommended dose (FDA) for a drug

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13
Q

Describe incremental dosing

A

administration of multiple doses of a drug until desired effect is achieved but does not exceed the MRD

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14
Q

Describe supplemental dosing

A

A single additional dose of the initial dose of the drug (may be needed for prolonged procedures). Supplemental dose shouldn’t exceed 1/2 the initial dose and shouldn’t be given until the clinical half-life of the drug has passed. The total aggregate dose can’t exceed 1.5x the MRD on the day for treatment

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15
Q

Why is there a narrower margin of safety in kid v.s adults

A

-Smaller degrees of respiration and CV reserve

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16
Q

What two variables are measured with a pulse oximeter

A
  • Pulse (Heart rate)

- Oxygen saturation (SaO2 or SpO2)

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17
Q

How is Oxygenation measured with a pulse ox

A
  • Light absorptive characteristics of hemo globin
    • Red= Deoxy hemoglobin
    • Infrared= Oxygenated hemoglobin
  • Blood flow in arteries
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18
Q

What are the consequences if the pule ox is too tight or too loose around the finger

A

Too tight
-Constricts circulation

Too loose

  • Fall off
  • Let other light in
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19
Q

Paediatric probes are used for .

A

infants <1 y.o

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20
Q

Is a paediatric probe is not available and the patient is 6 months old what can be used as a pulse ox

A
  • Adult pulse ox on the large toe or thumb

- Ear probe (can be used on the cheek)

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21
Q

The earlobe is susceptible to _ which is why you should do what before the application of an ear probe

A

vasoconstriction due to cold or hypovolaemia… rub the ear

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22
Q

What can prevent an accurate reading by a pulse ox

A

Nail polish

  • Colour can absorb light emitter by the pulse ox.
  • Can turn the finger sideways

Henna

  • Unable to measure SpO2 (blocks signal due to pigment)
  • Can detect a pulse

Bright light

  • Direct
  • interferes with the light detector

Movement

  • Can give erractic pulse waveform
  • Issue with shivering which is common in recovery (not common in theatre)

Perfusion
-If blood flow to the finger changes (i.e result of peripheral vasoconstriction from cold or hypovolaemia) it can be seen on the monitor

Carbon Monoxide poisoning

  • Patients involved in fires, inhaled smoke
  • Significant amounts of Hb bond to CO (can’t detect this) and SpO2 is exaggerates as a result
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23
Q

What is the clinically acceptable level of SpO2

A

95-100%

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24
Q

Capnography measures

A
  • End-tidal CO2 (EtCO2)
  • Monitors ventilation
  • Monitor expired CO2
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25
Q

Advantage of capnography over pulse ox

A

Pulse ox is not real time but capnography is therefor changes in ventilation are detected before detectable changes in hemoglobin oxygen saturation

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26
Q

Know this

A

Capnography uses infrared spectrometry to provide instantaneous and continuous record of CO2 con.

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27
Q

The two variables measured by capnography are

A
  • Respiration rate

- End-tidal CO2 conc.

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28
Q

Describe the four different phases of a capnograph

A 
Phase I= Inspiratory blaseline 
Phase II= Expiratory upstroke 
-Large and rapid increase in CO2 conc. 
Phase III=Expiratory Plateau 
-Mostly dead space air to mostly alveolar air 
Phase IV= Expieratory downstroke 
-Rapid decline in CO2 conc. 
-Return to phase I (inspiratory baseline)
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29
Q

What is the angle between phase II and III… phase III and IV

A

II and III= alpha

III and IV= beta

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30
Q

The lines that form the beta angle meet at a point that represents

A

end-tidal CO2

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31
Q

Capnography looks like what if they patient isn’t breathing or has an obstructed airway

A

flat baseline

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32
Q

Percordial/pretracheal stethoscope allows the dentist to hear

A

lung and heart sounds

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33
Q

Describe the difference in the data given by capnography and pulse ox verses percordial stethoscope (quanitative v.s qualitative)

A

capnograph and pulse ox= quanitative

percordial stehoscope= qualitative

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34
Q

Snoring heard on percordial stetoscope means

A

airway blockage by tongue/tissues

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35
Q

Gurgling noises indicate

A

fluids in throut (suction to prevent aspiration/vomiting)

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36
Q

Wheezing means

A

bronchospasm

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37
Q

Obstruction sounds mean

A

poor patient position

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38
Q

No breath sounds mean

A
  • Complete laryngospasm
  • Complete bronchospasm
  • Complete obstruction
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39
Q

What happens to heart rate, BP and respiration rate as you increase in age

A
  • HR decreases
  • BP increases
  • Respiration rate decreases
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40
Q

The most commonly seen pediatric emergencies involve

A

loss of patent airway and respiratory depression and hypoxemia

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41
Q

The primary goal of BLS is

A

establish and maintain proper respiratory function

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42
Q

What is the primary emergency drug

A

oxygen

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43
Q

What is the minimum sized oxygen tank an office should have and why

A

E because the oxygen needs to be delivered minimally at 90% oxygen at a rate of 10 L/min for at least 1 hr

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44
Q

Delivery of O2 to a spontaneously breathing patient can be through

A
  • Nasal cannula
  • facemask
  • Non-rebreather facemask
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45
Q

Which delivers the highest conc. of O2 to a breathing patient

  • Nasal cannula
  • facemask
  • Non-rebreather facemask
A

non-rebreather facemask

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46
Q

What are the different methods of delivering O2 to a patient who isn’t breathing

A

Postive pressure ventilation

  • Mouth-to-mouth
  • Mouth-to-mask
  • Bag-valve- mask (amboo bag)
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47
Q

Which delivers a higher conc. of O2 mouth to mask or bag-valve-mask

A

amboo bag (100 % v.s 16%)

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48
Q

Child rescue breathing = _breaths per minute requiring 1 breath every _ seconds

A

12-20 breaths/min

3-5 sec

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49
Q

Adult rescue breathing = _breaths per minute requiring 1 breath every _ seconds

A

10-12 breaths/min

5-6 sec

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50
Q

What is required for bag-valve-mask ventilation

A
  • tight mask fit

- open airway

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51
Q

Exhalation is (active/passive) with the amboo bag

A

passive

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52
Q

How does a oropharyngeal or nasopharyngeal airway help open an obstructed airway

A

keeps tongue forward

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53
Q

Why can’t u use a naso/oropharyngeal airway in a concious patient

A

induces gagging and vomitting

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54
Q

OPA (oropharyneal airway) is measured from what two points

A

corner of mouth to angle of jaw

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55
Q

NPA is measured how

A

from the nose to the ear?

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56
Q

What is the ideal suction to use during sedation and high

A

high volume suction (Yankauer)can suction mouth and pharynx without damaging tissues

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57
Q

Most medical emergencies in dental office (do/don’t) require use of drugs

A

don’t

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58
Q

Where are the two common sites for IM injections

A

deltoid and vastus lateralis (anterolateral portion of the thigh)

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59
Q

T/F IM injection can’t be done through patient clothes

A

F IT CAN

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60
Q

DURING IM INJECTION NEEDLE IS HELD AT _ DEGREE ANGLE

A

90

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61
Q

What are the two landmarks for the vastuslateralis injection

A
  • Greater trochanter of the femur
  • Lateral femoral condyle
  • Inject in the middle third at the anterior lateral aspect
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62
Q

What is the second most important emergency drug

A

epinephrine

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63
Q

Epinephrine is used in what emergency situations

A
  • Anaphylaxis
  • Asthma (doesn’t respond to albuterol)
  • Cardiac arrest
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64
Q

T/F Epi is only administered if a patient is experiencing a medical emergency

A

t

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65
Q

Actions of Epi

A
  • Sympathomimetic
  • Stimulates both alpha and beta receptors
  • Increases heart beat
  • Increases BP
  • Relaxes bronchial smooth muscle
  • Anti-histamine
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66
Q

Epi is supplied in two different concentrations what are they

A
  • 1:1000 (1mg/mL) in 1 mL ampule

- 1:10,000 (0.1 mg/mL) in 10 mL syringe

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67
Q

What is the conc. of epinephrine in a dose of adult and child epiPen

A 
Adult= 0.3 mg 
Child= 0.15 mg
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68
Q

EpiPen is injected where

A

anterolateral aspect of the thigh ONLY

69
Q

Max dose for child and adult of Epinephrine

A

Child
-0.01 mg/kg up to 0.3mg/dose

Adult
-0.3 mg/dose

70
Q

T/F If you administer epiPen and after 5 mins and the patient isn’t responding you can’t give more epinephrine because you are at the max dose

A

f- give again

71
Q

Side effects of epi

A
  • HTN
  • Tachycardia
  • Cardiac arryhthmia
  • Chest pain
  • Anxiety
  • Headache
72
Q

Albuterol is also called

A

proventil or ventolin

73
Q

When is albuterol used

A

acute asthmatic attack (bronchospasm)

74
Q

Albuterol is a _ receptor agonist

A

beta 2 adrenergic

75
Q

Dose of albuterol

A

2 puffs wach simultaneously with a deep inspiration (repeat as needed)

76
Q

Side effects of albuterol

A

tachycardia and anxiety

77
Q

When is nitroglycerin used

A

-Chest pain (stable or unstable angina pectoralis ir evolving MI)

78
Q

Nitroglycerin is a vaso(dilator/constrictor) and smooth muscle _

A

dilator and relaxant

79
Q

How is nitroglycerin supplied

A

sublingually either in spray or tablets

80
Q

Dose of nitroglycerin

A
  • 1 spray or 1 tab (0.4mg) every 5 mins
  • or until chest pain subsides
  • or systolic BP is below 100 mm Hg
  • Max is 3 sprays**
81
Q

Side effects of nitroglycerin

A
  • Hypotension

- Headache

82
Q

When should aspirin be used as emergency medicine in the dental office

A

-Suspected MI (use chewable tabs- work faster)

83
Q

MOA of aspirin

A

inhibits thromboxane synthetase

-Antiplatelet agent

84
Q

Dose of aspirin

A

325 mg

85
Q

Side effects of aspirin

A

dyspepsia (indigestion)

86
Q

When is diphenhydramine used

A
  • Allergic reactions of slower onset or less severity

- Adjunct to epi in severe allergy

87
Q

Action of diphenhydramine

A

-Histamine H1 receptor antagonist that blocks the response of H1 to histamine

88
Q

How is diphenhydramine supplied

A

50 mg in a 1 mL (or 1 cc) vial (IM)

-Thus in 1 cc there is 52 mg of benadryl

89
Q

Dosage of diphenhydramine

A

1-2 mg/kg IM (up to 50 mg)

90
Q

Side effects of benadryl

A

sedation and xerostomia

91
Q

Midazolam is used as an emergency medicine for

A

sustained grand mal seizures

92
Q

Dose for versed for grand mal seizure is

A
  • (kids) 0.15 mg/kg IM to max of 10 mg for initial dose
  • (Adult) over 50 kg– admin. 10 mg
  • May give supplemental doses is seizure isn’t resolved in 5-10 mins
93
Q

Side effects of versed

A
  • sedation

- depression

94
Q

Commercially available glucose is not significantly absorbed when? But is signigicantly absorbed when?

A

Not when applied in oral vestibules but ARE effective when swallowed

95
Q

Ammonia inhalants are used when

A

arouse patient unconcious secondary to suspected syncope

96
Q

Corticosteroids can be used for what emergency

A
  • acute adrenal insufficiency

- adjunct in allergy management

97
Q

Examples of corticosteroids for use are

A
  • Methylprednisolone (solu-medrol)

- Hydrocortisone (solu-Cortef)

98
Q

what is another name for Flumazenil

A

Romazicon

99
Q

Flumazenil should be given (IM/IV) Narcan?

A

IV… IM or IV

100
Q

What are the things you should look for in an unconcious patient

A
  • position
  • circulation (pulse)
  • airway
  • Breathing
  • Definitive therapy
101
Q

If there is no pulse and the patient is unconscious, what should you do

A

30 chest compressions (one rescuer) at a rate of 100/minute and give 2 breaths and repeat

102
Q

If an unconscious patient has a pulse what should you do

A

open airway and determine if they are breathing

103
Q

If there is no pulse and the patient is unconscious, and there are 2 rescuers, what should you do

A

15 chest compressions at a rate of 100/minute with 2 breaths

104
Q

If the patient lost conciousness or hypotension how should they be positioned

A
  • lay flat on back with feet raised slightly above the heart
  • Minimizes work of heart, increases pooled blood from extremities to vital organs (i.e brain)
105
Q

How should a patient who is conscious and involved in respiratory distress or chest pain be positioned

A

-Sitting or semi-reclined

106
Q

Compression depths for adults, children and infants

A
  • Adults- at least 2 inches (5 cm)
  • Children At least 1/4 AP diameter (~2 inches)
  • Infants At least 1.4 AP diameter (1.5 inches or 4 cm)
107
Q

Compression rate for adults, children and infants

A

all are at least 100/min

108
Q

T/F the chest should completely recoil between compressions

A

t

109
Q

Interruptions should be limited to

A

<10 seconds

110
Q

How do you open the patient’s airway

A

head tilt- chin lift

111
Q

What is the compression-to-ventilation ration for adults, children and infants for 1 and 2 rescuers

A
  • Adult= 30: 2 (1 or 2 rescuers)
  • Child= 30:2 (1 rescuer) 15:2 (2 rescuers)
  • Infant= 30:2 (1 rescuer) 15:2 (2 rescuers)
112
Q

T/F compressions should continue before and after defibrilation shock

A

t

113
Q

Treatment for mild or delayed allergic reaction

A

Diphenhydramine

  • Child= 10-25 mg qid
  • Adult- 25-50 mg quid
114
Q

Treatment for sudden onset anaphylaxis

A
  • Oxygen and epinephrine

- 0.01 mg/kg every 5 min until recovery or help arrives

115
Q

Treatment for acute asthmatic attack

A
  • Sit patient upright
  • Oxygen
  • Albuterol
  • Epi if unresponsive to albuterol (0.01 mg/kg every 15 min as needed)
116
Q

Treatment for LA toxicity

A
  • Oxygen
  • CPR if needed
  • Call emergency
117
Q

Treatment for LA reaction to vasoconstrictor

A
  • Oxygen
  • CPR
  • Call for emergency help
118
Q

Treatment for overdose (benzo)

A
  • Flumazenil (0.01-0.02 mg/kg) max= 0.2 mg. May repear at 1 min intervals tnot to exceed cumulative dose of 0.05mg/kg or 1 mg, whichever is lower
  • Oxygen
  • CPR if needed
119
Q

Treatment for narcotic overdose

A
  • CPR if needed
  • O2
  • Naloxone (0.1 mg/kg up to 2 mg) may be repeated to maintain reversal
120
Q

Treatment for a seizure

A
  • Recline and position to prevent injury
  • Open airway
  • Give benzo (midazolam or diazepam)
    • Child up to 5 yrs (0.2-0.5mg every 2-5 min with max at 5 mg)
    • Child 5 yrs and up 1 mg every 2-5 min with max 10 mg
121
Q

Treatment for syncope

A
  • Reline with feet up
  • Ammonial inhales
  • O2
  • Cold towel on back of neck
122
Q

What is the most common cause of loss of conciousness in the dental office

A

syncope

123
Q

Syncope is (more/less) common in kids compared to young adults

A

less

124
Q

What typically triggers syncope

A

-maladaptive stress (triggered by anxiety)

125
Q

What are the early signs and symptoms of syncope (or presyncope)

A
  • Dizzy or light headed

- May lose normal skin color in face and lips

126
Q

T/F is pre-syncope is recognized early enough syncope can be prevented

A

t

127
Q

Management of pre-syncope

A
  • Position patient supine, lowering head and raising legs above head
  • Should increase BP and promote an increase in cerebral blood flow
128
Q

Administration of O2 is appropriate for any emergency visit involving

A

a decrease in brain perfusion

129
Q

Consequences of syncope

A
  • Decrease in heart rate and BP
  • Decrease in blood flow to brain and loss of conciousness
  • Breathing becomes irregular, pupils dilate and convulsive movements may be noted
  • Muscles relax and airway may become obstructed
130
Q

Any unconscious patient should receive

A

BLS

131
Q

Failure to open airway and maintain ventilation in syncope patient usually leads to

A

convulsive movements subsequent to cerebral hypoxemia

132
Q

Loss of conciousness from syncope usually resolved quickly is

A

placed in supone with legs elevated

133
Q

Although conciousness may be regained quickly after syncopy recovery of _ and _ can be slow

A

HR and BP

134
Q

When should you seek medical assistance for a syncope patient

A

if recovery is delayed beyond 5 mins or is incomplete after 15-20 mins

135
Q

When is drug therapy indicated for syncope… what is the drug of choice and why

A

it isn’t unless HR and BP remain depressed after positioning
-The drug of choice to increase HR and cardiac output is atropine

136
Q

T/F There is no increased risk of repeat syncope after the episode

A

F- there is (patient should be escorted home)

137
Q

An allergic reaction is a type _ hypersensitivity reaction

A

I

138
Q

Primary agents in the dental office that elicit allergic reactions are

A
  • penicillins
  • ester type LA (topical LA)
  • Sulfite antioxidants in LA containing vasoconstrictors
139
Q

Anaphylaxis is primarily mediated by the release of _ from what cells

A

histamine… mast cells

140
Q

The body systems primarily involved in clinical allergic reactions are

A
  • skin Most common
  • respiratory system (2nd most common)
  • CVS
141
Q

Histamine results in

A
  • inflammation

- vascular effects (vasodilation)

142
Q

The more rapid the allergic reaction onset the (more/less) severe

A

more

143
Q

Edema in the face and neck as a result of an allergic reaction is dangerous because

A

airway obstruction

144
Q

What is the primary respiratory issue involved with anaphylaxis

A

bronchial smooth muscle constriction –> respiratory distress caused by airway obstruction

145
Q

Principle recognizable sign of allergic reaction is…. which is caused by

A

wheezing (due to bronchoconstriction)

146
Q

Smooth muscle contraction caused by allergic reactions can lead to what GI issues

A

abdominal cramps

  • nausea
  • vomiting
147
Q

What are the CVS effects of an allergic reaction

A
  • hypotension
  • vasodilitation (result of histamine)
  • Reflex tachycardia
  • Arrhythmia
  • Eventually…. cardiac arrest
148
Q

What is the max initial IM dose of Epi

A

0.3 mg

149
Q

You can administer _ number of ampules of 1:1000 epi

A

1

150
Q

If the patient weights 65 lbs or less which epi-pen is used

A

jr

151
Q

Why is epi used for allergic reactions

A

it counteracts most of the effects of histamine

  • Bronchodilitation
  • Increases BP
  • Counters skin rash and urticaria
152
Q

Epinephrine is not as effective at reducing what effect of histamine

A

edema

153
Q

Oxygen should always be administered when

A

respiratory symptoms are present

154
Q

Supplemental treatment for severe allergic reactions include

A

-corticosteroid and anti-histamines

155
Q

Max dose of diphenhydramine is

A

50 mg

156
Q

What are the four phases of grand mal seizures

A
  • prodromal
  • aura
  • convulsive
  • postictal
157
Q

Describe the prodromal phase of grand mal seizures

A
  • subtle changes that may occur over minutes to hrs.

- not ususally clinically evident to DDS or pt

158
Q

Describe the aura phase of grand mal seizures

A
  • neurologic experience pt goes through immediately before the seizure
  • Related to trigger areas of the brain in which the seizure activity begins
  • Consist of a taste, smell, hallucination, motor activity or other symptoms
  • often the same for the patient
159
Q

The ictal phase is also called the

A

convulsive phase

160
Q

Describe the convulsive stage of grand mal seizures

A
  • loss of conciousness
  • Tonic clonic movements
  • Epileptic cry
  • Clonic phase ususally lasts 1-3 minutes
161
Q

Describe tonic clonic movements

A 
Tonic= rigid skeletal muscle contractions 
Clonic= rapid jerking of extremities
162
Q

What causes the epileptic cry

A

tonic phase where the chest wall muscle contract and air is expelled through the larynx producing a vocalization called the epileptic cry

163
Q

Describe the postictal phase of grand mal seizures

A
  • Clonic phase ends
  • Muscle relax and movement stops
  • Significant CNS depression–> may lead to respiratory depression
164
Q

Patient has amnesia beginning at what phase and ending at what phase during the grand mal seizure

A

prodromal phase throughout entire seizure

165
Q

Describe management of seizures

A
  • Gentle restraint (prevent self-injury)

- Ensure adequate ventilation, supportive care in postictal phase (especially airway management)

166
Q

T/F Single seizures often require drug therapy

A

F- many are self-limiting

167
Q

What is status epilepticus

A
  • Ictal phase lasts longer than 5 minutes

- OR if the seizutes continue to develop with little time between them

168
Q

Status epilepticus can be life threatening because uncontrolled muscle contraction can result in

A
  • Hyperthermia
  • Increased O2 consumption
  • Tachycardia
  • Hypertension
  • Impaired ventilation
  • Cardiac arrhythmias
169
Q

Treamtnet of status epilepticus

A
  • Midazolam or diazepam (IV perfered but can do IM if access isn’t available
  • 0.15mg/kg IM to max of 10 mg for initial dose
  • Ensure airway patency after administration
  • Activate EMS

PEDO (Spring) (9 decks)

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