Exam 2 Medical Emergencies Flashcards
What is the most common type of diabetes?
type 2
What causes type 2 diabetes?
obesity, high fat/ low fiber diets, sedentary lifestyle, heredity, and increased life span (old age).
What is a metabolic disorder characterized by hyperglycemia?
diabetes mellitus
What produces insulin in the pancreas?
beta cells
What diseases is characterized by the body being unable to produce sufficient insulin or the body is not able to use the insulin that is produced?
Type 2 diabetes mellitus
What causes an increase in type 2 diabetes?
old age, sedentary lifestyle, poor diet and exercise and obesity
Which disease is characterized by an absolute lack of insulin?
type 1 diabetes
In which type of diabetes are pancreatic beta cells within Islets of Langerhans destroyed due to immune dysfunction?
type 1 diabetes
Which type of diabetes requires supplemental insulin for survival?
type 1 diabetes
Glucose intolerance with initial onset during pregnancy is known as
gestational diabetes
What is the leading cause of blindness in ages 20-74?
diabetic retinopathy
What is diabetic retinopathy?
a complication of diabetes that affects the eyes
What is diabetic neuropathy?
A type of nerve damage that occurs with diabetes
What is diabetic nephropathy?
kidney damage that results from diabetes
What vascular changes are a result of diabetes?
gangrene, loss of limbs, fingers, toes, etc. and increased risk of CVA and MI
Name the types of diabetes tests
fasting plasma glucose test
oral glucose tolerance test
A1c
Self testing
How long do you have to fast when doing the fasting plasma glucose test and what are the numbered results?
12-14 hours; 100-125 pre diabetes, >125 diabetes
How does the oral glucose tolerance test work?
12-14 hour fast and then drink a glucose rich beverage…. two hours later have the reading 140-199 pre diabetes; >200 diabetes
How many diabetics are affected by neuropathy?
60-70%
What are the 3 types of diabetes?
Type 1 (juvenile onset, insulin dependent) Type 2 (adult onset, non insulin dependent) Gestational
What is the normal reading on a self testing glucometer?
70-180
What does a reading of less than 70 on a self testing glucometer indicate?
hypoglycemia
What does an A1c reveal?
average blood glucose over the past 3 months
What should the glucose reading be 2 hours after eating a meal?
less than 180
What should the glucose reading be after 8 hours of fasting?
130
What is the normal reading for A1c?
5.7
What is the A1c reading for prediabetes?
5.7-6.4
What A1c reading indicates diabetes?
6.5 (2 tests to check)
The FPG (fasting plasma glucose test) requires no food or drink 8 hours before the test. What are the readings for normal, prediabetes, and diabetes?
Normal- less than 100
Pre- 100-125
Diabetes- 126+
The OGTT (oral glucose tolerance test) which requires no food or drink for 12 hours and then a glucose drink is given has what readings for normal, prediabetes and diabetes?
Normal-less than 140
Pre-140-199
Diabetes-200+
True or False: Insulin needs to be refrigerated to lengthen effectiveness
True
For which type of diabetes can exercise and diet control be an option instead of medicine?
Type 2
What is Diabetic Ketoacidosis?
Sugar too high, insufficient levels in blood
What is hypoglycemia?
Sugar too low
Who is at risk for Diabetic Ketoacidosis?
newly diagnosed type 1 diabetics, alcohol and drug users, poor diet
Fruity breath, altered mental state and increased thirst are all indicative of what?
Diabetic Ketoacidosis
How is DKA (diabetic ketoacidosis) treated?
check glucose level and lower w/ insulin, contact ems
What is another name for severe hypoglycemia?
insulin shock
How many diabetics are affected by severe hypoglycemia?
30%
What are things that can lead to severe hypoglycemia?
missed meal, alcohol, increased exercise without adjusting insulin dosage
What is the first step in treating severe hypoglycemia?
Give sugar
What is the 15-15 rule and when should it be applied?
Give 15 grams of sugar, check in 15 minutes. If it’s still below 70, repeat.
If a patient suffering severe hypoglycemia becomes unconscious, what is the first step taken?
contact EMS
The risk of hypoglycemia can be reduced 58% if body fat is reduced by
7%
When should a diabetic patient be scheduled?
early to mid morning, short and frequent appointments
What should diabetic patients remember to do before appointments?
eat
Where is the butterfly shaped thyroid gland located?
anterior to the trachea
The thyroid gland produces hormones that determine
metabolic rate and growth rate
Hypothyroidism is when not enough____is produced.
thyroid hormone
What is another name for hypothyroidism?
Myxedema
True or False: Myxedema causes facial swelling
True
What is another word for Thyrotoxicosis?
Hyperthyroidism
What happens when a patient has thyrotoxicosis?
Too much thyroid hormone is produced
True or False: When a patient has thyrotoxicosis, the eyes are very small.
False, the eyes are big and have a fixed staring expression
What swells on a patient with thyrotoxicosis?
neck
How is hypothyroidism treated?
synthetic thyroid hormone, must be taken for life
What is Levothyroxine?
Synthetic thyroid hormone
How is hyperthyrodism treated?
anti thyroid medications, ablation therapy, or surgery for removal of thyroid.
What is a myxedema coma?
Severe hypothyroidism leading to decreased mental status, hypothermia and slowing of function in multiple organs
What is a thyroid storm?
thyroid too high and heart rate, blood pressure and body temperature soar dangerously high-
What occurs when the body is unable to compensate for thyroid hormone deficiency due to some precipiating event and what time of year does this normally occur?
Myxedema Coma, winter
Hypothermia patients usually have a temperature reading of less than
95 degrees
For Myxedema and thyroid storm, what is the first step to take?
Contact EMS
What is Epistaxis?
nosebleed
85% of nose bleeds are: anterior or posterior
anterior
For whom are posterior bleeds normally found in the case of Epistaxis?
Geriatric (occurs at Woodruffs Plexus)
People with what condition are more likely (3 times more) to have Epistaxis?
hypertension
What color is posterior Epistaxis?
dark red
What color is anterior Epistaxis?
bright red
When treating Epistaxis, the patient should be seated upright with the head tilted____.
forward
All of the following statements are true for the treatment of Epistaxis except one. Which one is the exception?
Pinch the lower part of the nose for 10-20 minutes
Have patient breath through mouth
Apply an ice pack over the bridge of the nose
Have patient blow the nose to get rid of the blood
Have patient blow the nose-this should NEVER occur
Hemophilia is excessive_____
bleeding
How many types of hemophilia are there?
3 types: A, B, and C
True or False: Patients with hemophilia clott excessively
False
What do anticoagulants reduce?
clotting
What is a hematoma?
Collection of blood trapped beneath the skin
What is the usual casue of a hematoma?
trauma
Individuals are 2 to 4 times more likely to have____and 5 times more likely to have_____
heart disease, stroke
A normal blood glucose reading is between ___and ___mg/dL
50 and 150
A glucose reading below___indicates the patient is hypoglycemic
50
A glucose reading above___indicates that a patient is hyperglycemic
150
The HbA1c test reveals a patients average blood sugar level over the past_______
2-3 months
The drugs Humalog or Novolog are types of___
insulin
What type diabetes does Humalog and Novolog treat?
Type 1
Oral agents such as metformin, tolbutamide and glyburide (glucophage, orinase, glyburide, micronase) are prescribed to treat____
Type 2 diabetes
If a patient has an insulin pump, do they still need to measure glucose levels?
yes
What type of insulin medication is more rapidly absorbed than the injectible type?
insulin via inhalation device
What is happening in the body when it begins to exhale excess carbon dioxide, which results in tachypnea accompanied by an increased depth in respiration known as Kussmaul respirations or air hunger?
Diabetic ketoacidosis
What is a common complication in children with diabetic ketoacidosis?
cerebral edema (fluid builds around the brain)
True or False: The first step in treating a pt. with DKA is to determine an accurate blood glucose level.
True
In what diabetic emergency are pt.’s hyperglycemic and dehydrated?
hyperosmolar hyperglycemic state
Graves disease results in an enlarged___
thyroid gland
Where there are multiple nodules on an enlarged thyroid gland, what is the condition called?
nodular goiter
What two illnesses can thyroid medications cause?
aranulocytosis and hepatitis
Why is aspririn not recommended in patients experiencing a thyroid storm?
Because it can increase serum levels of T3 and T4.
Warfarin, aspirin, heparin, clopidogrel and prasugrel are all types of_____
anticoagulants
What should patients be advised to do after extractions?
No exercise for 12-24 hours
lie down with head elevated for several hours
Place gauze over the tooth socket and apply pressure for at least two hours.
What is the most effective way to control bleeding?
Apply pressure
Wrapping a tea bag with guaze and placing it on the extracted socket with pressure is recommended because it contains____
tannic acid
It is normal for blood to ooze out of the extraction site for ____hours.
12
What is the most common inherited bleeding disorder?
Von Williebrands disease (VWD)
What is the most common dental office emergency?
syncope
How can medical emergencies be prevented in the dental office?
Taking a complete and accurate medical history
What type of patient falls under ASA PS I?
Normal healthy patient
What type of patient falls under ASA PS II?
Mild systemic disease such as: controlled type 2 diabetes controlled epilepsy controlled stage 1 hypertension allergies fearful dental patient pregnancy
What type of patient falls under ASA PS III?
Severe systemic disease that limits activity but is not incapacitating such as:
stable angina
myocardial infarction longer than 6 months ago
controlled type 1 diabetes
renal failure
controlled heart failure
poorly controlled hypertension with BP >160/100 (stage 2)
morbid obesity
What type of patient falls under ASA PS IV?
Incapacitating systemic disease that is a constant threat to life such as: MI or CVA within the past 6 months unstable angina heart failure uncontrolled diabetes uncontrolled epilepsy hypertension with blood pressure >180/110 uncontrolled thyroid conditions
What patient falls under ASA PS V?
Moribound patient not expected to survive 24 hours with or without operation:
multiorgan failure
poorly controlled coagulopathy
Sepsis with hemodynamic istability
What patient falls under ASA PS VI
A declared brain dead patient who’s organs are being harvested for donation
What is a normal pulse rate?
60-100
What is the normal respiration rate?
12-20
What is the normal blood pressure?
120/80
What is the normal temperature?
98.6
What is considered stage 1 hypertension?
130-139/80-89
What is considered stage 2 hypertension?
140+/90+
What blood pressure is considered critical?
Any systolic over 180 and diastolic over 120
What treatment is recommended for a severe allergic reaction?
Epinepherine
What size oxygen tank is recommended for use in the dental office?
Size E
What things should oxygen NOT be administered for?
hyperventilation, ischemic heart disease, or severe hypertension
What is nitroglycerin indicated for?
acute angina, myocardial infarction, heart failure
What does the reducing valve do an oxygen tank?
allows for the safe release of oxygen
What does the flow meter do on an oxygen tank?
allows the operator to determine how much oxygen the patient is receiving
What type of patient would a nasal cannula be recommended for and what should the setting be?
A conscious patient suffering from MI or CVA. Set between 1 and 6/L per minute
What type of patient should the non rebreathing face mask used on?
asthma or angina pectoris; can deliver 6-12 L per minute
When is the bag mask device used and what should the regulator be set at?
when the patient is in respiratiory arrest and requires complete oxygen delivery. Regulator should be set at 8-12 L/minute
What is noncardiac syncope?
involves situations that do not affect the heart such as seizures, orthostatic hypotension, hyperventilation and metabolic diseases
What is orthostatic hypotension?
At least a 20mmHG drop in BP after assuming an upright position after prolong suppine position
Which type of syncope is the most common form?
neurocardiac syncope– commonly associated with pain, fear, exhaustion or illness
What causes cardiac syncope?
inadequate cardaic output as a result of an underlying heart disease
What is tachyarrhythmia?
rapid, irrelgular heart beat
What is bradyarrhythmia?
slow irregular heart beat
How is syncope treated?
If possible, pt. should be in suppine position, open the airway and assess breathing, loosen tight clothing, deliver oxygen at 4-6L/minute
What is the condition produced when the cardiovascular-pulmonary system fails to deliver enough oxygenated blood to body tissues to support the metabolic needs of those tissues and leads to abnormal cellular and tissue function?
shock
How many types of shock are there? Describe each
4 types of shock:
hypovolemic shock-MOST COMMON caused by inadequate venous return to the heart or dehydration
cardiogenic shock-destruction in tissue perforation caused by a decrease in cardiac output
distribtive- also called vasogenic shock. caused by loss of sypathetic nerve activity from the brains vasomotor center. 3 types: anaphylactic, septic, and neurogenic
obstructive-indirect heart pump failure, leading to decreased cardiac function and reduced circulation
What part of the eye covers the iris?
The cornea
What is the white part of the eye called?
sclera
What is the thin layer of the eye that covers the sclera and inside of eyelids?
conjunctiva
What types of foreign body are inorganic?
metallic and nonmetallic
What types of foreign body are organic?
dirt, wood, or vegetation
What types of foreign body are metallic?
steel, iron, lead, aluminum
What types of foreign body are nonmetallic?
plastic, stone, glass and other minerals
Which type of foreign body creates a higher chance of infections if it enters the eye?
organic
When a high velocity object enters the globe or orbit of the eye, what is likely?
loss of vision
What should the patient be instructed NOT TO DO when a foreign object enters the eye?
DO NOT RUB
Is loss of vision likely when a low velocity object is on the cornea?
no
What should be done if a foreign body becomes embedded in the eye?
do not attempt to remove, cover both eyes to limit eye movement, seek immediate care for a specialist to remove
What is a perioretriever?
magnetized instrument used to retrieve broken instrument tips
What are amphetamines?
central nervous system stimulants
dexadrine, ritalin, adderalll, meth,
What are the side effects of adderall?
excessive excitability, restlessness, dizziness, headache and blurred vision/ improves focus in pt.’s with ADHD
What are the side effects of ritalin?
rapid heartbeat, psychosis, heart failure
True or False: Amphetamines activate the sympathetic nervous system and result in increased heart rate, pupil dialation, bronchodilation, increased blood flow to the brain and skeletal muscles.
True
What type of drug users have bruxism and tooth wear due to an overall increase in energy and neuromuscaular function?
methamphetamine users
What type of drug users have rampant caries developing from dehydration and xerstomia and also have an increased intake of carbohydrates and high-calorie carbonated beverages?
methamphetamine users
What type of anesthetic should methamphetamine users NOT receive?
anesthetic agent with a vasoconstrictor
What will happen if a methamphetimine user recieves anesthetic with a vasoconstrictor?
myocardial ischemia and cardiac dysrhythmias
What are some signs and symptoms of amphetamine toxicity?
euphoria restlessness anxiety agitation confusion seizures, possible coma or MI
Is it safe to give a pt. with amphetamine toxicity an emetic agent to induce vomiting? Why or why not?
No because vomiting can induce seizures
What are pt.’s with amphetamine toxicity given charcoal for in the hospital?
to prevent systemic absorption of the drugs
What was cocaine used as a local anesthetic for?
mucous membranes
What are the ways cocaine can be taken as a street drug?
snorted, smoked, IV or oral
Does cocaine have a slow onset?
No it is rapid and powerful
How long does it take cocaine to reach it’s peak affect? How long does it last?
10-30 minutes; 1 hour (intranasal effects in 3-5 minutes after snorting)
What does cocaine do to the mind and body of it’s users?
produces a feeling of euphoria and well being, increases cardiac bp and body temperature,
Palatal necrosis and perforation is common with usage of what drug?
cocaine
Which drug decreases the sense of smell?
cocaine
What are some complications of using cocaine?
Chronic sinusitis, decreased sense of smell, vasoconstriction can lead to necrosis sand ischemia of nasal septum and perforation, bruxism, increased caries due to carb intake, gingival lesions if repeatedly applied to tissues
Name the CNS depressants
opiods (poppies)-heroine, oxycodone, fentanyl, tramadol
barbiturates- phenobarb, sleep
benzodiaepines- diazepam (valium), versed, xanax, klonapin
Why are heroin users sometimes given opiods?
to counteract heroin
True or False, Opiate and Opioids inhibit gastrointestinal motility which lead to constipation
True
What drugs are uppers?
Uppers include amphetamines, methamphetamine, cocaine and khat. Pharmaceutical examples include Adderall, Ritalin and Concerta.
What drugs are downers?
Downers include benzodiazepines, barbiturates, GHB and flunitrazepam.
What drug relieves anxiety, causes CNS depression and acts as a sedative?
Barbituates
What RX replaced barbituates?
benzodiazepines
What are benzodiazepines used in the place of barbituates for?
reduction of anxiety, anticonvulsant properties, and muscle relaxant properties (versed, zanax, klonopin, ataivan, halciaon, valuim, etc.) Produces sedation, hypnosis and antianxiety
What are the signs and symptoms of benzodiazepine toxicity?
lethargy, slurred speech, mental confusion, coma and respiratiory arrest, usually in combination with other CNS depressants
What are the mild signs of barbituate toxicity? What are the severe signs of barbituate toxicity?
Mild signs: lethargy, slurred speech and rapid eyeball movement
Severe signs: hypothermia, hypotension, pulmonary edema, coma, and respiratory arrest
Why would Flumazenil be administered in the hospital to a patient experiencing Benzodiazepine toxicity?
act as an antidote as it counteracts the sedative effect
What are the 2 Options for treatment of a superficial foreiogn in the eye?
Option 1: Instruct the pt. not to rub, operator wash hands and re glove, gently pull down lower lid and have pt. look up, then direct object away using a moist cotton tip (better to let pt. remove)
Option 2:Irrigate the eye with saline or water, use the emergency eyewash station or eye cup, irrigate from medial to lateral portion of eye.
If an foreign body becomes embedded in the eye, is okay to try to remove it?
No, never
What condition often mimics CVA?
hypoglycemia
Left ventricular heart failure results in?
respiratory distress
When does RV heart failure occur?
after LV
Is Cyanosis a symptom of late stage heart failure?
yes
LV heart failure occurs before___?
RV
Which ventricle pumps blood out to the body?
LV
Which ventricle pumps blood to the lungs?
right
Which heart failure fills the lungs up with blood?
LV
What is dyspnea?
difficulty breathing
Is nitroglycerin recommended for patients with a stystolic pressure lower than 100mmHg?
no
Prominent jugular veins while seated in an upright position is indicative of?
pulmonary embolism
What is the most frequent etiology of heart failure?
myocardial infarction
