Final Exam Flashcards
What are the ASA Levels?
ASA I- Normal Healthy patient
ASA II- Mild systemic disease or a risk factor for systemic disease
ASA III- Severe systemic disease with some functional limitation
ASA IV- Severe systemic disease that is a constant threat to life
ASA V- Moribund patient, who is not expected to survive without operation
ASA VI- Decleared brain-dead
What is the Role structure within a emergency?
P1- Clinician: Stays with patient, performs emergency procedure
P2- check time at the start of an emergency, bring o2 and prepare it, assits with vitals, prepare drugs
P3- Summon faculty and await instruction to call 3-3333, record data on record, assist as needed, relieve others in CPR
A student next to your operatory unit informs you that there is a medical emergency and you are designated as Person #2 in an emergency team response. Another student is designated as Person #3. You excuse yourself from your patient and approach the scene. What are the appropriate next steps
Check the time at the start of an emergency
Wait for Person #1’s specific instructions
Be ready to bring oxygen apparatus and Emergency Cart (AED, emergency kit, record of emergency form, wrist blood pressure cuff)
Assist with vitals
If necessary, be the second person role in a two-people CPR response
If necessary, prepare drugs
Call 911 prior to Person’s #1 instructions or faculty arrival
What are the appropriate steps if your patient is having a medical emergency ?
- Stay with the patient
- Inform the nearest faculty member or students that there is an emergency
- Designate team members 2 and 3
- Let the faculty know the operatory unit number if appropriate
- Reposition patient as necessary
- Evaluate vital signs.
(All of the above )
What is the rate for pulse?
(30 seconds then multipy by 2)
Normal is 60-80 BPM
Active: 40-60 BPM
+/- 1
What is the respiration rate?
Normal is 12-20
Newborns is 40-50
Kussmaul if more than 20
What is the rate for temperature?
Normal 98.6 F +/- 1
What is the rate for Blood Pressure?
- Normal- 120/80
- Elevated- 120-129/ 80
- High Blood Pressure Stage 1: 130-139 or 80-89
- High Blood Pressure Stage 2: 140-higher or 90-higher
- Hypertensive crisis: Higher than 180/ or higher than 120
What are the basic 7 emergency medications?
- Epinephrine 1:1000
- diphenhydramine (injection)
- Nitroglycerin
- Oxygen
- Asprin (1- 35mg)
- Albuterol
- Glucose
Identify the medicatiions in a Emergency Kit
A, B, M- Epinephrine
C- Diphenhydramine
D- ammonia inhalants
F- Nitroglycerin
E- Glucose
G- Naloxone
H- Albuterol
J- Diphenhydramine
Aspirin may reduce overall mortality from MI with the recommended dose 162-325 mg. However, it can have an adverse effect for an hemorrhagic stroke
True
If a patient who has diabetes skips a meal and their vitals are 110/70 and pulse 100. then becomes disoriented and unconscious what is not an appropriate response?
DO NOT put glucose in a patient mouth if they are unconscious
Where is the most effective injection route for anaphylaxis?
thigh
What are the indications and contraindications for epinephrine?
Indications: alaphylaxis and severe asthma attack
Contraindications: Ischemic heart disease or severe hypertension
Half of dental medical emergencies happen during/after?
Local anesthetic administration
What should you ask a patient who has a history of asthma?
Severity
Frequency
Triggers
What is the time for brain damage or coma ?
10 minutes
What are the two most important equipment needed in a medical emergency?
AED and Oxygen
What can prevent an emergency within a dental office?
- Accurate medical history taking
- Taking and recording vital signs
- Reviewing medical history (hx) of a returning patient before the appointment
- Updating medical hx change
75% of diabetics die from some form of CAD or complication?
True
Diabetes may suffer silent myocardial infraction?
True
What is the difference between Stable and unstable Angina?
Stable angina- responds to nitroglycerine, and if there has been no change within the passed 60days
Unstable angina- Does not respond to medications, Pt at high risk for MI and vascononstrictor contraindicated
What is variant angina?
occurs spontaneously while the person is at rest and at odd hours of the day or night.
Low risk for CAD
How is unstable angina different from stable angina?
- Symptoms of unstable is longer
- ASA level
- Unstable may occur for no reason
- intensity of unstable may be more acute
What are the risk factors for Coronary Artery Disease?
- Tobacco
- Physical inactivity
- Gender
- Heredity
- Age
- Obesity
- High BP
- High cholesterol
What is acute myocardial infraction (AMI)
- Necrosis of a portion of the myocardium due to total or partial occlusion of coronary artery.
- Can lead to cardiac arrest
What is Cardiac Dysrhytmia?
may occur after MI adn is a high risk for death
What are the signs and Symptoms of AMI?
Chest pain longer than 20 min
Pain going to arms shoulders jaw or back
women show different symptoms: atypical discomfor, upper abdominal pain, short breath and fatigue
What are the risk factors for CVA?
- Diabeteics
- Oral ceontraceptives
- Carotid bruit
- Familial history
- Menopause due to estrogen changes
What are the two main causes of heart failure?
MI and Hyertension
What can Heart Failure lead to ?
Pulmonary edema
What are the treatment for heart failure?
Smoking cessation
Exercise
Weight loss
limit consumption of caffeine, salt and alcohol
reduce stress
Drug therapy: ACE inhib, diruectics, vasodilator, beta blockers and calcium channel blockers
What is a major red flag for patient with HF?
Swelling in feet and ankles
Weight agin of three pounds over seven days with edema
What is acute pulmonary edema?
- Most dramatic life-threatening symptom of left HF
- inhibits lung expansion
What causes Acute pulmonary edema?
Stress
Infection
Failure to take meds
Meal high in sodium
What are signs of acute pulmonary edema?
- gasping for air
What to watch out for with a patient who has Acute pulmonary edema and his on oxygen?
If the patient is complains of suffication from use of non-rebreather mask a nasal cannula can be used at the rate of 2-5l.
What are the parts of the regulator and its function?
__4__
This is where you connect a oxygen delivery device such as a nasal cannula to the oxygen tank apparatus
__2__
Allows the oxygen to flow out of the green oxygen tank to the regulator
__1__
Regulates the flow of the oxygen. E.g.) This allows you to increase the oxygen from 4L to 6L per minute
What are the different typesof delivery devices in dental office?
Nasal cannula
None-rebreathing face mask
Bag mask
What is syncope?
- Sudden transient loss of consciousness and postural tone with spontaneous recovery
- Most Common medical emergency in the dental office
- Occurs during local anesthetics administration
What should not be used if a patient has syncope?
Ammonia inhalant
When is shock produced?
When cardiovascular pulmonary system fails
What are the the stages of shock?
Inital
Compensatory- body performs physiological adaptations in an attempt to overcome shock.
Progressive - 2nd stage failed, vital organs compromised
Refractory- Organ failure
What are the different types of shock?
- Hypovolemic shock (most common)
- Cardiogenic
- Distributive
- Obstructive
What is correct about shock?
- Can lead to death
- associated with excessive venous returns
- involves vasodilation
- Cells in the body become depreived of oxygen
- patient suffers from hypertension
What should you do in a hyperventilation medical emergency?
- Work with patient to control rate of respirations
- Asking pateint to breathe into his cupped hands
- The patient suffers from decrease carbon dioxide
What is a misconception for hyperventilation
Do not use a paper bag due to risk of CA
DO not use oxygen
What are the signs and symptoms of an obstructive airway?
Partiially
* Coughing
* Cyanosis
* Placing hands in throat area
* Wheexing
* Dyspnea
* Anxious
* Fearful
Complete
* distress
* grip throat
* cyanosis
What is the treatment for an asthma attack?
- Nitrous oxide not contraindicated
- local anesthetics with epinephrine may trigger attack and is not recommended
- If the symptoms do not subside, contact EMS
- Monitor vital signs.
- Sit the patient in a comfortable position for breathing
- Ask if the patient has her own bronchodilator and help self-administer
- Use Epinephrine (.3 mg of 1:1,000) if bronchodilator is ineffective
- Administer oxygen 4–6 liters/minute
What is the most concerned reaction with allergy?
- Biphasic reaction- recurance of allergy symptoms.
- 1-72 hourst after treatment
What is the treatment for Mild allergic reaction?
- administer oral histamine blocker
- Place pt in supine postion and observe for worsening symptoms
- Oral diphenydramine- 25-50mg
- Chlorpheniramine (less dorwsiness)
What is the moderate allergic reaction treatment?
- Inject diphenhydramine
- Monitor VS
- Oxygen
- observation of pt for one hour to nsure signs and symptoms do not worsen
What is the treatment for Sever allergic reaction?
- contact EMS
- Epinephrine .3ml in thigh - repeat 5 montes if no improvement
- Supine postion, legs elevated
- Monitor vitals
- Oxygen
- administer steroid
- Administer histamine blocker
- Monitor pt for biphasic reaction
- refer to ED
What are the descriptons for Mild Allergic Reaction?
- Some edema of the lips, but the patients blood pressure, pulse rate and respirations are still within normal range
- intramuscular injection of diphenhydramine
What are the descriptons for Moderate Allergic Reaction?
- Oral Benadryl or chlorpheniramine
- Slight redness or itching
What are the descriptons for severe Allergic Reaction?
Dyspena, hypotension, laryngeal edema
Epinephrine
What is gestational diabetes?
Glucose intolerance with inital onset during pregnancy
What are the HBA1C ranges?
Normal: 5.7
Prediabetes: 5.7-6.4
Diabetes 6.4
What is the most common medication for diabetes?
Metformin
Type 1 diabetes is?
absolute lack of insulin
Diabetic ketoacidosis is?
Hyperglycemic, kussmaul breathing fruity odor
What is HHNKS?
Hyperglycemic, not aciotic
If HBA1C levels are high what is the patient at risk for ?
compromised wound healing
What are the complications of diabetes?
Blindness
Increased risk of amputation
Increased risk of MI
Periodontal disease
Delay wound healing
Kidney failure
Increased risk of CVA
What is the treatment for a conscious patient with sever hypoglycemia?
Monitor Vital Sign
Eat/drink 15-20 g of sugar
Determine need for additional sugar intake 10-15 minutes after the first 15-20 g of sugar consumption
What is thyroxine?
- increase respiration
- increases cellular metabolism
- increased body temp
- stimulates gastrointestinal activity
- stimulates heart activity
What are the signs and symptoms of thyroid storm?
- Exaggeration of hyperthyroid symptoms
- Fever
- Diaphoresis
- CNS
What is hypothyroidism ?
not enough hormone, sever form is myoedema
Treatment: levothyroxine
What is hyperthyroidism?
too much hormoe produced, ASSOCIATED with graves disease
treatment: antithyroid medications
What are the two types of thyroid emergencies
?
Myxedema coma
Thyroid storm
What is myxedema?
- occurs in winter months
- defieciency in thyroid hormone
- Bradycardia
What is thyroid strom?
- Patient may have fever
- Body temp too high and responder needs to lower body temp
- Contraindicated is asprin
- Tachycardia, elevated BP, hyperthermia
Hypothermia is ?
temp lower than 95
What is adrenal crisis?
body severly lacking cortisol
associated with addisons disease
Signs: weakness, dizziness, nausea and abdominal pain , dehydration and hypotension
What is the rule of twos for adrenal crisis?
More than 20 mg cortisone (amount)
Two weeks ( length of treatment)
within 2 years (lenght of removal)
What are possible causes of an episode of severe cortisol deficiency?
Addison disease
stressful situations and history of steroid therapy
illness or infections
What is the difference between seizure and epilepsy ?
Seizure- Generally a short change in normal brain activity
Epilepsy - A disorder of the brain
What are the order of the phases of generalized tonic-clonic seizures?
- Aura
- Preictal
- Ictal
- Postictal
What is a preventive strategies for an appointment with a patient with a seizure history
- Ask about the severity, duration and the length of time since last seizure
- Consider using mouth prop
- Advise patient to let him/her know if they feel onset of seizure
During a grand mal seizure what should you do?
- Be ready to respond to CNS and respiratory depression and airway obstruction
- Time the seizure.
- Prevent the patient falling from a dental chair
- Monitor vital signs
- Clear the area around the person of anything hard or sharp
- If the seizure lasts more than 5 minutes consider calling campus to request EMS
- Administer O2 4-6 liters/minute
What are the descriptions for tonic-clonic seizures?
Aura- Unusal tastes, visual disturbances lasting few seconds.
Preictal- PT losses consciousness
Ictal- Muscular contractions and relaxation, foaming at mouth
Postictal- PT stop moving may wake up and CNS and respiratory depression which lead to airway obstruction can occur
If a patient complaints about hot and cold sensitivity what could be the possible cause ?
Possible postoperative sensitivity
Recent tooth restoration that interferes with the occlusion
Deep restoration near the pulp
What are some desensitizing agents?
Arginine and calcium carbonate
Stannous Fluoride (SnF2)
Dipotassium oxalate
Sodium Fluoride (NaF)
Casein phosphopeptides (CPP)
What are natural desensitizing agents?
- Smear layer
- Tertiary Dentin
- Secondary Dentin
- Calculus
If a patient comes in and complains about pain what are some actions that should be taken to identify the source?
- Pulp test erupted upper right posterior teeth
- Ask patient questions such as onset, duration, stimuli and relieving factors
- Update the medical history
- Take a panoramic image to get the up-to-date radiograph
- Ask whether the patient if that they nasal / sinus problems
Define the locations of a anterior and posterior bleeds
- Anterior bleeds: Often due to childs digital manipulation and within the Kisselbachs plexus
- Posterior: PRofused and dark red often bilateral
- Common in genriatic population
What medications are given for partial seizures and blood thinners
- Partial seizure: Topiramate
- Blood thinners: Eliquis Xarelto Plavix
What is the difference between warfin and heparin?
Warfin: INR 3, last longer
Heparin: Reduces blood clotting immediately, short acting
What are some postsurgical instructions for excessive bleeding?
No exercise 12–24 hours
* Lie down with head elevated for several hours.
* Place gauze over socket and apply pressure for two hours.
* Can use wet tea bag wrapped in gauze and bite on it
* Tannic acid provides clotting.
* Oozing blood for 12 hours normal; but steady flow not normal.
What are three possible reasons why the patient has excessive bleeding?
- Taking herbal medications such as gingki biloba
- Patient is taking blood thinners
- Patient has von willibrands disease
Epilepsy are more common in neurological disorders in?
Pediatrics
What is status epilepticus?
- Continuous GTCS or repetitive
- recurrence
- Life threatening
- May persist for hours or days
- Mortality 3–23%
- Temperature may rise to 106°F.
What are some hydrodynamic therapy for dental hypersenitivity?
- transmission of outside stimuli causes fluid movement within dental tubules
- Hypersenstivity grester number of widened dentinl tubules
- stimuli
What are the different types of burn?
thermal
chemical
electrical
radiation
A patient using meth should not use what?
Local anesthetic with epin
What is the treatment for amphetamine toxicity?
Activated charcoal
What are the orofacial complications from cocaine?
- Vasocontriction can lead to necrosis and ischemia of nasal septum
- Palatal necrosis
Opiates and Opiods produce what and what are two signs and symptoms?
Produces depression in CNS and a sign is hypotension, respiratiory depression and bradycardia
What is a treatmen for broken instrument tip?
Ask patient not to swallow or move head
