Dental Emergencies & Records (Review: Outcome 7) Flashcards
Medical Emergencies
A condition or circumstance that requires immediate action for a person who has been injured or has suddenly become ill
- You must be prepared to respond immediately
- Your knowledge and skills could mean the difference between life and death
How to prevent a medical emergency from occuring?
Key to prevent a medical emergency is:
- have an open communication about patient’s health
- ensure medical history is updated at every appointment
Most emergencies that occur in the dental office are caused by?
Combined stress of a person’s daily life and the apprehension of going to the dentist
How to prepare for a medical emergency?
- Successful management of medical emergencies in the dental office requires preparedness, prompt recognition, and effective treatment
- Ongoing observation of the patient is an important part of emergency preparedness
- Signs and symptoms
- Every member of the dental team must be current in Cardiopulmonary resuscitation (CPR), /Heimlich maneuver/chest thrusts, ability to assess and record vital signs accurately
Symptom
What the patient is telling you about how he/she feels or what he/she is experiencing
- ex. “I feel dizzy,” “I’m having trouble breathing,” or “my arm hurts”
Signs
What you observe in a patient
- ex. change in skin colour or increase in respiratory rate
Roles in a medical emergency
When an emergency occurs in dental office, it is most effectively managed when each member of dental team executes their responsibilities efficiently. Each member of team assigned specific responsibilities
- Comforting the patient
- Monitoring the patient’s vital signs
- Retrieving the emergency kit
- Bringing the oxygen tank
- Calling emergency services
- Responding to the needs of other patients in the office
Emergency Kit
- A standardized emergency kit is organized and equipped with emergency supplies
- Routine maintenance for the emergency equipment and supplies should be assigned to a staff member who will oversee making sure that the equipment is in working condition and the drugs have not expired
- These checks can be done weekly or daily, depending on office policies
Basic equipment
- Emergency drug kit
- Automated external defibrillator (AED)
- Pocket mask
- Blood pressure device
- Portable oxygen tank (color-coded green) with attachments for face mask and bag mask
- Reserve oxygen tank
Common drugs in an emergency kit
1) Oxygen
- Use: respiratory distress
- Route: inhaled
2) Ammonia inhalant
- Brand/common name: Spirits of ammonia
- Use: fainting
- Route: inhaled
3) Epinephrine (Adult = 0.3mg, Pediatric = 0.15mg)
- Brand/Common name: Autoinjector, EpiPen
- Use: Allergic reaction
- Route: IM, IV, subcutaneous
4) Diphenhydramine
- Brand/common name: Benadryl
- Use: Allergic reaction
- Route: IV, deep IM
5) Nitroglycerin (tablet/spray)
- Brand/common name: Nitrostat
- Use: Angina
- Route: Sublingually
6) Albuterol
- Brand/common name: Ventolin
- Use: Bronchospasm with asthma
- Route: Inhaled
7) Aspirin
- Brand/common name: Bayer
- Use: Myocardial infarction
- Route: Orally
8) Oral glucose (gel/orange juice concentrate)
- Brand/common name: glucose
- Use: hypoglycemia
- Route: orally
Ammonia inhalant
- Brand/common name: Spirits of ammonia
- Use: fainting
- Route: inhaled
Epinephrine
(Adult = 0.3mg, Pediatric = 0.15mg)
- Brand/Common name: Autoinjector, EpiPen
- Use: Allergic reaction
- Route: IM, IV, subcutaneous
Diphenhydramine
- Brand/common name: Benadryl
- Use: Allergic reaction
- Route: IV, deep IM
*IV = intravenous
*IM = intramuscular
Nitroglycerin
(tablet/spray)
- Brand/common name: Nitrostat
- Use: Angina
- Route: Sublingually
Albuterol
- Brand/common name: Ventolin
- Use: Bronchospasm with asthma
- Route: Inhaled
Aspirin
- Brand/common name: Bayer
- Use: Myocardial infarction
- Route: Orally
Oral glucose
(gel/orange juice concentrate)
- Brand/common name: glucose
- Use: hypoglycemia
- Route: orally
Oxygen
- The most frequently used “drug” in medical emergency
- The ideal agent for resuscitation of a patient who is unconscious, but still breathing
- If patient is not breathing, air must be administered through rescue breathing or similar emergency measures
- A portable unit with tanks of oxygen may be stored where it can be moved quickly into a treatment room if needed
*ONLY an RDH and DDS can administer oxygen
- RDA can only assist the operator with preparing the equipment
Who can administer oxygen in a medical emergency?
Only RDH and DDS can administer oxygen
- RDA can only assist the operator with preparing the equipment
Oxygen System
- Oxygen tank
- Gauge regulator
- Tubing
- Delivery systems: cannula, face mask
Oxygen Cylinder characteristics
- Always green in color
- Made of steel or aluminum
- Available in different sizes
Regulator
Controls the flow of oxygen out of a tank
Tubing
- Used for connecting the oxygen tank at the gauge regulator to the face mask
- Allows delivery of oxygen to the patient
Oxygen Delivery Systems
2 ways:
- Nasal cannula
- Face mask
Postural Hypotension
Also referred to as orthostatic hypotension
- a level of altered consciousness that may lead to loss of consciousness
- results from insufficient blood flow to the brain and may occur in a patient immediately after a sudden change in positioning
Syncope
Caused by an imbalance in the distribution of blood to the brain and to the larger vessels within the body
- this reduced blood flow to the brain causes the patient to lose consciousness
What are the psychological factors that can contribute to syncope?
- Stress
- Apprehension
- Fear
- Sight of blood or sight of a certain instrument
What are the physiological factors that can contribute to syncope?
- Remaining in one position for a long time
- Being in a confined environment
- Skipping meal or being hungry
- Experiencing fatigue or exhaustion
- The patient may complain of symptoms and the signs may be noticed for several minutes before the patient loses consciousness
Prevention for syncope
If patient tells you they feel like they may faint:
- seat them in a supine position
- lie them down and elevate patient’s legs
Syncope Management
- Place patient in supine position with feet elevated slightly
- If patient does not respond, call EMS: 911, loosen any constrictive clothing and begin basic life support as required
- Provide supplemental oxygen as required
- nasal cannula
- nonrebreather mask - Be prepared for vomiting
- if vomiting occurs turn the patient onto their side to protect their airway - Provide additional treatment as required if other injuries occurred as a result of syncopal episode
List a few cardiovascular emergencies
1) Angina Pectoris
- chest pain caused by insufficient blood supply or oxygen to the heart
- can be aggravated by exercise, tension, cold weather or large meal
2) Myocardial Infarction (Heart attack)
- the muscles of the heart are damaged because of an insufficient oxygen supply
Angina
- Chest pain caused by insufficient blood supply or oxygen to the heart
- Can be aggravated by exercise, tension, cold weather, or a large meal
- Patient feels severe chest pain
- Sensation of severe constriction or pressure on chest
- Signs and symptoms are similar to myocardial infarction (heart attack)
- Pain usually lasts 3-8 minutes
When an attack strikes, it is important to remember that the patient could be having a heart attack - Pain relieved or eased promptly by administration of a commonly prescribed drug, nitroglycerin
Signs and Symptoms of Angina
- Chest pain (most common)
- Diaphoresis (sweating)
- Nausea
- Pallor (pale)
- Apprehension (anxiety, fear)
- Levine sign (holding a clenched fist over chest)
- Elevated pulse
- Elevated blood pressure
Angina - Management
- Stop dental treatment
- Place the patient in a semi-supine or upright position
- Circulation, airway, and breathing should be assessed and monitored
- Assist patients with administration of nitroglycerin (vital signs must be taken prior to and after each nitroglycerin administration. NEVER give nitroglycerin if systolic bp is below 90mmHg or 30mmHg below baseline or in patients who are extremely bradycardic (less than 50 bpm) or tachycardic (over 100 bpm)
Myocardial Infarction
Commonly referred to as a heart attack
- muscles of the heart are damaged because of an insufficient oxygen supply
- if this damage is severe enough, the patient will die; however prompt medical treatment can limit damage to the heart
- any unexplained chest pain should be treated as a potential acute myocardial infarction
Signs and Symptoms of Myocardial Infarction
- Chest pain
- Respiratory
- Behavioural
- Pale, cool, diaphoretic skin
- Nausea, vomiting
- Weakness/lightheaded
- Syncope
Myocardial Infarction - Management
- Call EMS: 911
- Stop all patient activity and place the patient in a position of comfort (semi or high fowlers)
- Loosen restrictive clothing, especially around the neck and chest
- Assess vitals
- If patient has a history of angina, assist patients with the administration of nitroglycerin.
- if no history of angina, nitroglycerin from emergency kit should be administered - Administer high flow oxygen via nonrebreather
- Administration of aspirin should be initiated as soon as the symptoms of acute myocardial infarction are identified
- If the patient goes into full cardiac arrest, CPR should begin immediately
Allergic Reactions
- Can come on suddenly and can easily become life-threatening
- If symptoms do not subside after initial treatment with antihistamines, call ambulance so that more extensive treatment can be rendered as the patient is transported to the hospital emergency dept.
- A severe allergic reaction is referred to as anaphylaxis or anaphylactic shock
What is severe allergic reaction referred to as?
Anaphylaxis or anaphylactic shock
Signs and Symptoms of Allergic Reactions
- Itching
- Hives
- Swelling of lips, tongue, throat
- Shortness of breath
- Wheezing
- Heart arrhythmia
- Sudden drop in blood pressure
- Loss of consciousness
Allergic Reactions - Emergency response
- Monitor and record vital signs
- Administer antihistamine
- Observe patient for worsening of symptoms
- If symptoms continue, call 911
- Prepare to administer epinephrine
- Administer oxygen as needed
- Prepare to provide basic life support
How can airway obstructions be prevented?
- Ligatures
- Rubber dam
- High volume evacuation
- Patient positioning (upright) - impressions, fluoride trays
Hyperventilation
The patient takes in too much oxygen
- Stress and anxiety can trigger some patients to begin taking rapid respirations or to hyperventilate
Signs and Symptoms of Hyperventilation
- Rapid, shallow breathing
- Light-headedness
- Tightness in chest
- Rapid heartbeat
- Feeling of heaving a lump in the throat
- Panic-stricken appearance
Hyperventilation - Emergency Response
- Reposition patient for comfort
- Calm the patient
- Coach patient to take long and slow breaths
- Assure the patient
- Instruct the patient to breathe into cupped hands
Asthma
A respiratory disorder characterized by the narrowing of the upper airway
Two factors contribute to this narrowing:
1. The bronchial tubes constrict during an allergic-type reaction, severe emotional stress, or presence of infection
2. The mucosa that lines the airway may also become inflamed
- The constriction and inflammation lead to difficulty breathing, coughing, and wheezing
Signs and Symptoms of Asthma
- Coughing
- Wheezing
- Increased anxiety
- Pallor
- Cyanosis (bluish skin around the nails or lips)
- Increased pulse rate
Asthma - Emergency Response
- Position patient upright
- Have patient self-medicate with rescue inhaler or backup inhaler
- Administer oxygen as needed
- Assess and record vital signs
- Call 911 if breathing does not improve after administering medication
Cerebrovascular Accident (Stroke)
When blood vessels that carry oxygen to the brain are blocked significantly
- depending on the location of the damage in the brain, a stroke could present as mild or transient loss of concentration, loss of gross or fine motor coordination, loss of speech or vision, or other neurological manifestations
- Key factor in treating a suspected stroke is to transport the patient as quickly as possible to a hospital’s emergency dept.
Signs and Symptoms of Cerebrovascular Accident (Stroke)
- Paralysis
- Difficulty speaking
- Visual impairment
- Seizure
- Difficulty swallowing
- Severe headache
- Unconsciousness
Cerebrovascular Accident (Stroke) - Emergency Response
- Call 911
- Monitor and record vital signs
- Prepare to initiate basic life support if patient becomes unconscious
Seizures
- Patients who have seizure disorders are commonly controlled through medication
- A change in routine, diet, or stress can trigger a seizure anywhere, anytime
- Grand mal seizure = characterized by a temporary loss of consciousness accompanied by uncontrollable muscular contractions and relaxation
- If a patient experiences even a mild seizure in the dental office, under no circumstances should he/she be allowed to drive home
Grand Mal Seizure
Characterized by a temporary loss of consciousness accompanied by uncontrollable muscular contractions and relaxation
Signs and Symptoms of Seizures
- Experience of an aura or a peculiar smell, taste, sound or vision
- Unconsciousness
- Uncontrolled muscle contractions
- Rapid heart rate
- Increased body temperature
Seizures - Emergency Response
- Call 911
- Place the patient on his/her side.
- this currently recommended to prevent aspiration in case the patient vomits - Keep patient from harm by removing items in the mouth or close by that could injure patient during seizure
- Protect patient from self-injury during muscle contractions
- Be prepared to administer anticonvulsant medication
- Monitor and record vital signs
- Be prepared to perform basic life support
Hypoglycemia
Low blood sugar
- Alterations in medication dosage, diet, exercise, and stress levels could have a significant impact on the likelihood of a diabetic patient having a serious drop in blood sugar during a dental appointment
Signs and Symptoms of Hypoglycemia
- Sudden mood change
- Hunger
- Trembling
- Slurring of speech
- Increased perspiration
- Increased anxiety
- Possible loss of consciousness
Hypoglycemia - Emergency Response
- If patient is conscious, ask if there were any changes in medication or meals today
- Administer a concentrated form of carbohydrate if patient is conscious
- e.g. sugar, icing, or orange juice - If patient is unconscious, administer IM injection of dextrose from emergency kit
- Call 911 if patient does not respond
- Do not let patient drive home
Hyperglycemia
High blood sugar
- Patients with diabetes also may experience dangerous spikes in blood sugar
- As with hypoglycemia, these elevation can be precipitated by alterations in medication, diet, exercise, and stress levels
Signs and Symptoms of Hyperglycemia
- Excessive urination
- Excessive thirst
- Acetone (fruity) breath
- Rapid pulse
- Lower blood pressure
Hyperglycemia - Emergency Response
- Ask patient when he/she last ate and whether he/she has taken prescribed insulin
- Retrieve insulin if available
- if able, ask patient to self-administer the insulin - If insulin is unavailable or patient does not respond, call 911
- Be prepared to provide basic life support if patient becomes unconscious
