Emergencies & Records - Outcome 7 Flashcards
To ensure a positive outcome during a medical emergency, the following should be followed through:
-Training of personnel
-Team approach
-Scenario practices (simulated emergencies)
-Office preparation
Training of Personnel
- All personnel should have an understanding of commonly encountered medical emergencies in the dental office.
Allergic reactions
Cardiovascular emergencies
Diabetic emergencies
Respiratory emergencies
Seizures
Syncope
Drug overdoses - All personnel should maintain a current Basic Life Support certification – re-certification should take place every year
- Annual continuing education on medical emergencies that commonly occur in a dental office should be taken/reviewed to reinforce previously learned theory
Team Approach
In order for a team approach to be effective specific duties should be assigned to each team member.
- First-person to discover the victim should call for help (dentist and team) and provide emergency first aid as required.
primary survey and treatment as needed
Stays with the victim
Calls for help - The second person should assist the rescuer one with basic life support.
brings equipment
emergency kit
AED
Oxygen - Third-person should gather all the necessary equipment.
assigned various tasks
Office Preparation
- Have emergency equipment available
- Assign individuals to check the emergency kit and oxygen on a regular basis and after every use.
a. ensure appropriate numbers of supplies are present in the kit
b. check drug expiration dates
c. change oxygen tank at 500 p.s.i.
d. utilize a checklist to assist in this procedure - Store the emergency kit and oxygen together.
- Rotate emergency care responsibilities between team members to ensure all rescuers can function in each role.
- Post emergency numbers by all phones, to ensure quick access to the EMS system.
How to Call an Ambulance
- Stay calm.
- Be as accurate as possible when providing patient information.
- Be prepared to answer the following questions:
-Location
-Phone number from which you are calling
-Problem
-Gender of the patient
-Approximate age of the patient
-Conscious/unconscious
-Breathing/Non-breathing - Never hang up the phone until the communication specialist hangs up or informs you to hang up.
- After the call for help has been placed, return to the emergency scene to notify the dentist and rescuers that EMS is on the way.
Your Role Upon Arrival of EMS
- The first rescuer will provide the report to the attending paramedic. Ensure to review all the details from the onset of the emergency until the arrival of EMS.
- The second and third rescuer will provide a detailed written report of the patient’s past history, physical examination findings, and vital signs.
- All of the remaining dental staff members should wait to assist the paramedics as necessary.
Dental Emergency Kit Equipment:
The contents of dental emergency kits can vary depending on the preferences of emergency drugs, products, and equipment that a dentist and their dental team are comfortable with using.
According to the College of Dental Surgeons of Alberta (2019) all dental offices must have an emergency kit.
Drugs in Dental Emergency Kit
Drugs must be inventoried and expiry dates listed.
- Oxygen
- Epinephrine (Injectable) (adult and pediatric)
- Nitroglycerin
- Diphenhydramine
- Bronchodilator (e.g.; Albuterol)
- Acetylsalicylic acid (Aspirin)
- Agents for management of hypoglycemia (e.g.; glucagon/glucose tablets)
- Ammonia inhalant
- Naloxone
The SAIT dental emergency kit contains:
-Apo-Salvent CFC Free Salbutamol Sulphate USP Broncholdilator
-Rho-Nitro Pumpspray
-Diphenhydramine HCL Injection USP (4 vials x 1ml)
-Epinephrine Injection USP (Adrenalin 1:1000) – 2 Ampoules x 1ml
-Sulfate D-Atrophine Sulfate Injection USP (2 Ampoules x 1 ml)
-Rescue Breather
-Ten – BC 1ml TB Syringes
-Children’s Benadryl
-Adult EpiPen
-EpiPen Jr.
-Aspirin (81mg)
-Instaglucose 31g
-Thermometer
-Magill forceps
-Latex free gloves and mask
For medical use, oxygen is stored in…
For medical use, oxygen is stored in steel or aluminum tanks under the pressure of 2000 pounds per square inch (psi)
Indications for the Medical Use of Oxygen
-Critically ill patients (i.e. shock, head injuries, etc.)
-Hypoxemia (deficient oxygen of the blood)
Patients with a decreased level of consciousness.
-Patients with ischemic chest pain
-Patients with respiratory difficulties
-Patients with a decreased level of consciousness.
Components of Medical Oxygen Equipment
Oxygen Tank
-Steel or aluminum tanks filled with oxygen
-Available in different sizes
-Coloured coded green
Gauge Regulator
-Control gas flow.
-Reduces the high tank pressure from 2000 psi to a safe range of 50 psi
Tubing
-Connects the oxygen tank at the gauge regulator to the face mask.
-Allows delivery of oxygen.
Face Mask
Available as a:
-Non-rebreather mask (full mask with bag); or
-Nasal cannula (inserted into nostrils only)
-Simple mask (full mask only)
Oxygen is considered a drug, therefore a dental assistant cannot administer oxygen.
Dental assistant may not:
set, start or adjust flows and or ratios of oxygen, or
place the face mask on a patient
Dental assistants may assist with the administration of oxygen by:
-preparing and checking oxygen equipment,
-selecting mask size and placing the mask on the tubing,
-having the patient put on the mask and adjust the fit,
-tightening the tubing once the mask is comfortable for the patient, and
-assisting with observing, documenting and reporting the patient’s condition
The Hazards of Oxygen
Oxygen supports combustion. Never allow combustible material (oil and grease) to touch the oxygen cylinder, the regulator, fittings, valves, or hoses, and keep the oxygen tanks away from all sources of fire while it is in use.
It must be used with caution with COPD patients (emphysema, chronic bronchitis, etc.). COPD patients have a low breathing stimulus. If large quantities of oxygen are administered to them, their stimulus to breathe will be removed – not allowing them to breathe properly. However, never withhold oxygen just start administering oxygen at low levels and increase as required.
Safe Storage and Use of Oxygen Tanks
-Store oxygen cylinders below 52 degrees Celsius.
-Use proper regulators for oxygen administration.
-Keep all valves closed when not in use.
-Secure all oxygen tanks to a wall or store them in a carrier rack.
-Never place any body part over the cylinder valve when working with it
Postural (Orthostatic) Hypotension
Postural hypotension is a decrease in blood pressure. It occurs due to an abrupt change in position such as suddenly standing or sitting erect. It can also be caused by standing motionless in a fixed position and is common for the elderly and pregnant women. It can cause dizziness, syncope, blurred vision. If postural hypotension does occur treat as syncope.
Signs and Symptoms of Postural Hypotension
-low blood pressure
-altered state of consciousness to possible loss of consciousness
Response Steps for Postural Hypotension
- Place the patient in a subsupine position with the head lower than the feet.
- Establish an airway.
- Slowly move the patient to an upright position.
- Monitor and record vital signs.
- If unresponsive, call for emergency assistance (911).
- Document emergency
Syncope (Fainting) is…
Syncope (Fainting): is a transient loss of consciousness due to reduced blood flow to the brain
Signs and Symptoms of Presyncope
-feeling warm or flushed
-nausea
-rapid heart rate
-perspiration
-pallor (pale skin colour)
-lower blood pressure
Response Steps for Syncope (fainting)
- If the patient has not fainted yet but tells you they feel like fainting: Lie the patient down in the supine position and elevate their legs.
- If fainting has occurred place the patient supine/subsupine position and elevate their legs slightly.
- Complete head tilt/jaw thrust to open airway.
- Loosen binding clothing.
- Evaluate oxygen level. If below 94%, administer 100% oxygen.
- Have ammonia inhalant ready to be administered.
- Monitor and record the patient’s vital signs.
- If unresponsive, call for emergency assistance (911)
- Document emergency
Angina Pectoris is..
Angina pectoris literally means a pain in the chest. More specifically, it is a spasmodic pain in the chest characterized by a sensation of severe constriction or pressure on the anterior chest.
Possible Causes of Angina Pectoris..
This medical emergency is associated with insufficient blood supply to the myocardium and is usually due to the narrowing of coronary arteries (atherosclerosis). Other causes include coronary vasospasms, thrombus or anemia (a condition in which there is an inadequate supply of hemoglobin to carry oxygen). Angina pectoris is usually aggravated by exercise, tension, cold weather, or a large meal.
Signs and Symptoms of Angina Pectoris
-Tightness or squeezing sensation in chest
-Pain radiating to left shoulder
-Pain radiating to the left side of the face, the jaw, and the teeth
Management of Angina
The goal of the treatment of an angina attack is the decrease the myocardium’s demand for oxygen.
- Call for emergency assistance (9-1-1).
- Position the patient semi-upright comfortable position.
- Monitor vital signs
- Ready nitroglycerin (tablets, spray, or topical cream) from emergency kit.
- Administer oxygen if needed.
- Document emergency
Myocardial Infarction (Heart Attack)
Death of the myocardium results when the blood supply to the heart is significantly reduced or occluded
Signs and Symptoms of Myocardial Infarction
-Chest pain ranging from mild to severe
-Pain in the left arm, the jaw, and the teeth
-Shortness of breath and sweating
-Nausea and vomiting
-Pressure, aching, or burning feeling of indigestion
- Generalized feeling of weakness
Management of Myocardial Infarction
- Call for emergency assistance (9-1-1).
- Position the patient semi-upright comfortable position.
- Monitor vital signs
- Administer oxygen if needed.
- Ready aspirin and nitroglycerin from the emergency kit.
- Initiate basic life support (CPR) if the patient becomes unconscious.
- Document emergency
Allergic Reaction
An allergic reaction is a sensitivity to an allergen. There are 4 main types of allergic reactions; type I, type II, type III, and type IV. For the purpose of our studies, we will familiarize ourselves with type III and type 1.
Anaphylaxis (type III) Signs and Symptoms
Anaphylaxis or anaphylactic shock is a severe life-threatening form of an allergic reaction.
Signs and Symptoms
-Feeling physically ill
-Nausea and vomiting
-Shortness of breath
-Heart arrhythmia (irregular heartbeats)
-Sudden drop in blood pressure
-Loss of consciousness
Management for Anaphylaxis (type III)
- Call for emergency assistance (9-1-1).
- Place the patient in a supine position.
- Monitor vital signs
- Start basic life support (CPR) if the patient becomes unconscious.
- Prepare EpiPen for administration.
- Administer oxygen if needed.
- Document emergency response
Common Allergic Reaction (type I)
-Itching
-Erythema (skin redness)
-Hives
Management for a Common Allergic Reaction (type 1)
- Identify area of rash.
- Monitor vital signs.
- Prepare an antihistamine for administration if necessary.
- Be prepared to administer basic life support (CPR) if necessary.
- Refer the patient for medical consultation
- Document emergency response
Airway Obstructions
The slippery environment of the oral cavity created by saliva and blood along with the reclined position of the patient increases the risk for airway obstruction. This can be caused by the aspiration of dental debris such as a tooth fragment or restorations.
Airway obstructions can be prevented by:
-Using a high volume evacuator (HVE).
-Using a rubber dam.
-Tying ligatures on a rubber dam clamp.
-Using a throat pack (gauze placed at the base of the throat) during sedation surgical procedures.
-Positioning the client upright to prevent airway obstructions when taking a dental impression.
Asthma
Asthma is the reversible narrowing of the airways (bronchospasms) as a response to the sensitivity that the trachea, the bronchi, and the bronchioles have to various stimuli
Possible Causes of Asthma
- Extrinsic (Allergic)
Dust, pollen, or other irritants in the atmosphere
Often seasonal
Occurs most often in children and often clears up after adolescence - Intrinsic (Nonallergic)
Most common in adults
Not due to allergic reactions
Non-seasonal
Precipitating factors include emotional stress, inhaled fumes, viral infections, acetylsalicylic acid (ASA), cold air, strenuous exercise. Note: All patients are asymptomatic between attacks.
Common Characteristics of Asthma Attacks
- Bronchospasms
- Swelling of mucous membranes in bronchial walls (edema)
- Plugging of bronchi by thick mucus secretions
Signs and Symptoms of Asthma Attack
- Coughing
- Wheezing
- Increased anxiety
- Pallor
- Cyanosis (bluish skin around the nails)
- Increased pulse rate
Management of Asthma Attacks
Asthma can be managed with attempts to improve oxygenation, relieve bronchospasms and improve ventilation.
- Call for assistance.
- Position the patient as comfortably as possible (upright is usually best).
- Have patient self-medicate with an inhaler.
- Administer oxygen as needed.
- Monitor vital signs.
- Document emergency response
Hyperventilation is..
Hyperventilation is characterized by deep rapid breathing patterns (above 20 breaths a minute). It results from the overabundance of carbon dioxide in the body when a patient breathes too rapidly. This can be dangerous because it can cause alkalosis, affecting the homeostasis of a body.
Possible Causes of Hyperventilation
- Psychological
Anxiety
Stress - Medical
ASA overdose
Head injury
Signs and Symptoms of Hyperventilation
-Rapid, shallow breathing
-Light-headedness
-Tightness in the chest
-Rapid heartbeat
-Lump in the throat
-Panic-stricken appearance
Management of Hyperventilation
- Place the patient in an upright comfortable position.
- Use a quiet tone of voice to calm and reassure the patient.
- Have the patient breathe into his or her cupped hands.
- Monitor vital signs.
- Document emergency response
Seizures are..
An involuntary, sudden change in sensation, behaviour, muscle activity or level of consciousness resulting from overactive brain cells.
Possible Causes of Seizures
-Epilepsy *A chronic brain disorder characterized by recurrent seizures with or without a loss of consciousness
-High fever
-Head injury
-Cerebrovascular accident (CVA) (stroke)
-Alcohol or drug withdrawal
-Hypoxia
-Hypoglycemia
-Central nervous system infections
-Brain Tumors
Signs and Symptoms of Seizure
There are various stages of a generalized seizure. Each individual that experiences seizures may not go through all of the stages. The following outlines the general signs and symptoms of a generalized seizure (grand mal):
- Unconsciousness
- Increased body temperature
- Rapid heart rate
- Increased blood pressure
Management of a Generalized Seizure (Grand Mal)
- Call for emergency assistance (9-1-1).
- If a seizure occurs while the patient is in the dental chair, quickly remove all materials and dental instruments from the mouth and place the patient in a supine position.The patient could inflict self-harm if something is in the mouth. Do not place anything in the patient’s mouth during a seizure.
- Protect the patient from self-injury during movements caused by the convulsion.
- Prepare anticonvulsant (diazepam) from the drug kit if necessary.
- Initiate basic life support (CPR) if necessary.
- Monitor vital signs.
- Document emergency
Focal Seizure (Partial) Signs & Symptoms
- Intermittent blinking
- Mouth movements
- Blank stare
- Not responsive to surroundings; seems to be in his or her “own world”
Management of a Partial Seizure
- Position in comfortable position.
- Monitor vital signs.
- Refer patient for medical consultation
- Document emergency
Stroke – Cerebrovascular Accident (CVA)
A stroke is the interruption of the blood flow to the brain. If the interruption of the blood flow is long enough, damage to the brain may occur
Possible Causes of Stroke
Ischemia – blockage of a blood vessel in the brain. Most often a blood clot.
Hemorrhage due to ruptured or traumatized cerebral blood vessels.
Signs and Symptoms of Stroke
-Face drooping
-Arm weakness
-Speech difficulty
Management of a Stroke
- Call for emergency assistance (9-1-1).
- Place patient in a semi-sitting position with head elevated.
- Monitor vital signs
- Initiate basic life support (CPR) if the patient becomes unconscious.
- Document emergency
Hypoglycemia (Insulin Shock)
An abnormally low blood sugar level. The brain relies on a continuous supply of glucose. When levels drop below normal function, the brain will be affected
Possible Causes of Hypoglycemia (Insulin Shock)
Hypoglycemia is most often caused by the treatment of diabetes, not the disease process itself. However, non-diabetics can also experience hypoglycemia if there is not enough sugar in the blood at a given time. Causes:
-Skipping meals
-Vomiting after meals
-Taking an insulin overdose, whether accidental or intentional
-Excessive or strenuous exercise
-Stress
-Alcohol or drug overdose (Aspirin)
Signs and Symptoms of Hypoglycemia
Signs and symptoms of hypoglycemia develop suddenly and progress rapidly, usually within minutes.
- Mood changes
- Hunger
- Perspiration
- Increased anxiety
- Possible unconsciousness
Management of Hypoglycemia
- If the patient is conscious, ask when he or she last ate, whether he or she has taken insulin, and whether he or she brought insulin along to the dental appointment.
- Give oral glucose from emergency kit or a concentrated form of carbohydrate, such as a concentrated orange juice or soda pop. PURPOSE These substances will be absorbed rapidly into the bloodstream.
- Call for emergency assistance (9-1-1) if necessary.
- Provide basic life support (CPR) if the patient becomes unconscious.
- Monitor vital signs.
- Document emergency
Hyperglycemia
An abnormally high blood sugar level
In a diabetic patient, a serious condition known as diabetic ketoacidosis (DKA) may result when glucose levels become excessively high and the body has too little insulin. This is a serious, potentially life-threatening complication associated with Type I diabetes.
Common Causes of Hyperglycemia
-Cessation of or incorrect insulin regulation.
-Physiologic stress such as infection or surgery
-Uncontrolled diabetes
Signs and Symptoms of Hyperglycemia
- Excessive urination
- Excessive thirst, dry mouth, and dry skin
- Acetone breath (fruity smell)
- Blurred vision and headache
- Rapid pulse
- Lower blood pressure
- Loss of consciousness
Management of Hyperglycemia
- If the patient is conscious, ask when he or she last ate, whether the patient has taken insulin, and whether he or she brought insulin along to the dental appointment. PURPOSE If the patient has already eaten but has not taken insulin, he or she needs insulin immediately.
- Position the patient in a comfortable position.
- Call for emergency assistance (9-1-1) if necessary.
- Provide basic life support (CPR) if the patient becomes unconscious.
- Monitor vital signs.
- Document emergency
