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Oral surgery > Emergencies > Flashcards

Emergencies Flashcards

1
Q

Drugs and substances that may produce allergic reactions

A
  • Local anaesthetics
  • Antibiotics
  • Analgesics
  • Anxiolytic drugs
  • Dental materials
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2
Q

Most common preservative in local anaesthetics that causes allergy

A

Paraben

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3
Q

Most common antibiotic producing allergic reaction

A

-Penicillin

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4
Q

Most common analgesics responsible for allergic reactions

A
  • Codeine(narcotics)
  • Aspirin (acetylsalicylic acid)-urticaria to anaphylactic shock
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5
Q

Anxiolytic drugs that commonly cause allergy

A

-Barbiturates (mild-urticaria)

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6
Q

Dental materials that commonly cause allergy

A

-Acrylic resins
-Antiseptics
-Radiograph processing solutions
-Gloves
(Mild-stomatitis and skin urticaria)

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7
Q

Classification of allergic reactions

A
  • Type I- Anaphylaxis
  • Type II- cytotoxic hypersensitivity
  • Type III- Immune complex mediated hypersensitivity
  • Type IV-Cell mediated or delayed type hypersensitivity
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8
Q

Types of allergic reactions

A
  • Anapylaxis
  • Urticaria
  • Quinckes Edema
  • Allergic Asthma
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9
Q

Precautionary measures for allergy

A
  • Questions about type of allergy
  • Referral for allergy testing
  • Prepared to deal with allergic reaction with drugs(adrenaline, hydrocortisone, antihistamines and oxygen)
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10
Q

Anaphylaxis

A
  • Acute respiratory and circulatory collapse
  • Hoarseness of voice, anxiety, wheezing, irregular heart rate
  • Fatal within 5-10 mins
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11
Q

Anaphylaxis treatment

A
  • Termination of treatment-patient put in Trendelenburg position
  • Adrenalin(0.3-0.5ml) giving i.v or i.m
  • Control of vitals
  • Hypotension treatment wit NaCl(i.v)
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12
Q

Anaphylactic shock treatment

A
  • Adrenalin(0.5ml 0.1%) diluted in NaCl(o.9%) i.v
  • Urbason (1-3mg/kg i.v)
  • Salbutamol (5mg iv)
  • Droperidol(for throes)
  • CPR
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13
Q

Urticaria

A
  • Most common reaction
  • Vesicles due to histamine and serotonin→ increased permeability of vascular structures
  • Vesicles induce pruritis and burning sensation on skin→ limited or spread over body
  • Severe reaction→fall in blood volume→ anaphylaxis
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14
Q

Urticaria treatment

A
  • Termination of treatment-patient in Trendelenburg position
  • Adrenaline (0.3ml 0.1%) s.c, i.m or i.v
  • Allergosan(1% 2ml) i.v or i.m
  • Patient observed for 1 hour
  • Oral antihistamines
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15
Q

Quinckle’s Edema

A
  • Swelling of soft tissues(lips, tongue, buccal mucosa, epiglottis)
  • Obstruction of upper respiratory tract→ dyspnoea and difficulty swallowing
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16
Q

Quincke’s edema treatment

A
  • Adrenaline(0.3mk 0.1%) i.v or i.m
  • Methylprednisolon i.v
  • NaCl (0.9%) i.v
  • Cricothyrotomy or coniotomy
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17
Q

Normal blood pressure for adult is

A

under 140/90mmHg

18
Q

in patients with Bp of 140-160/90-95

A
  • Can undergo dental surgery safely
  • Above these values→ referred to doctor for further treatment
19
Q

Hypertension management

A
  • Premedication before surgery
  • Bp monitoring
  • Aspiration before injection
  • Avoiding Noradrenaline
  • Short appoitments
20
Q

Hypertensive crisis

A
  • Systolic >200/Diastolic >120mmHg
  • Palpitations, increased heart rate, chest pain
  • Headache
  • Nausea, vomiting, tinitus
21
Q

Hypertensive crisis treatment

A
  • Nifedipin tablet(20mg) under toungue
  • Isoket spray
22
Q

Angina Pectoris

A
  • Temporary ischemia in myocardium(reduced oxygen supply)
  • pain(pressure or tightness) posterior to sternum(may radiate to left shoulder, neck, left arm, mandibular teeth)
  • Precipitated by fatigue, stress→ subsides within 2-5 min after rest
23
Q

Angina Pectoris preventive measures

A
  • Written consent from cardiologist
  • Medication (5-10mg diazepam or 1.5-3 bromazepam orally 1 hour before surgery
  • Carried out in hospital
  • Small amounts of vasoconstrictors(aspiration)
  • Short appoitments
24
Q

Angina Pectoris treatment

A
  • Clear airway
  • Nitroglycerinum (0.5mg tablet under tongue)-if needs to be repeated twice→MI
  • Aspirin
  • CPR
25
Q

Myocardial Infarction

A
  • Ischaemic necrosis of area of heart(blocking or coronary artery)
  • Severe pain(increases) posterior to sternum→radiates to left shoulder or arm/neck region/mandibular teeth
  • Does not subside with rest or nitrates
  • Treatment avoided if occurred within 6 months(otherwise in hospotal)
26
Q

Treatment of Myocardial infarction

A
  • Improving airway
  • Consult with cardiologist
  • Nitroglycerinum tablet(0.5mg under tongue)
  • Pain killers
  • CPR
27
Q

Asthma

A
  • Stenosis of bronchi and bronchioles(Bronchioconstriction, edema and mucous production)
  • Expiratory dyspnoea accompanied by non productive cough and wheezing
28
Q

Asthma preventative measures

A
  • Detailed medial history
  • Sedative medication for stress management
  • Pain control(to manage stress)
  • Short appoitments
29
Q

Treatment of Asthma

A
  • Termination of treatment
  • Improve airway
  • Salbutamol
  • Adrenaline(0.1%)
  • Methylprednisolon i.v
30
Q

Collapse

A
  • Acute vascular insufficiency
  • Reduced vessel tonus→hypoxia

→Pallor of face, shortness of breath, hypotension, consciousness preserved

31
Q

Treatment of Collapse

A
  • Termination of treatment-Trendelenburg position
  • Improve airway
  • CPR(ABC)
32
Q

Syncope

A
  • Mild transient brain ischaemia
  • Loss of consciousness
  • Pallor of face, bradycardia, SOB, hypotension
33
Q

Treatment of syncope

A
  • Termination of dental treatment-Trendelenburg position
  • Improving airway
  • Splashing water
  • Ammonia
34
Q

Diabetes mellitus

A

-Abnormalities in secretion mechanism and effect of insulin→ Alteration of carbohydrate, protein and lipid metabolism

35
Q

Best time for surgery with diabetic patient

A

-Morning(1-1.5 h after breakfast)-peak insulin action

36
Q

Administration of drugs for Diabetes Mellitus

A
  • Mild analgesics and sedatives(w/tylenol) used
  • Anxiolytic before procedure
  • Corticosterioids(glycogenolytic action) and aspirin(hypoglycaemic action) avoided
37
Q

Diabetic hypoglycaemia

A
  • Blood glucose <55mg/100ml
  • Hunger, sweating, pallor, headache, mental confusion, blurred vision
  • More severe→loss of consciousness, coma and death
38
Q

Diabetic hypoglycaemia treatment

A
  • Termination of treatment
  • Sugar or honey
  • 1mg Glucagon
39
Q

Diabetic hyperglycaemia

A
  • More rare
  • Slow development
  • Weakness, headache, nausea,, xerostomia, dehydration→coma
40
Q

Diabetic hyperglycaemia

A
  • Termination of treatment
  • Full dose of insulin
41
Q

Types of Haemorrhagic Diatheses

A
  • Vascular disorders
  • Thrombocytic disorder
  • Disorders of coagulation

Oral surgery (106 decks)

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