FINAL exam_powerpoints Flashcards
What is the role of the rapid response team?
respond to medical emergencies in the school. They are ACLS/PALS providers
T/F after you fill out the med emergency evaluation, you should file in the patient’s chart?
false
What are common emergencies encountered in dental setting?
- syncope
- intravascular injection
- Hypoglycemia
- seizures
- cardiac disease (chest pain)
What is the least common emergency in a private practice?
MI, cardiac arrest, and anaphylactic
Top 3 emergencies encoutnered in dental setting?
syncope, mild allergic, angina
what causes angina?
blockage of the coronary arteries
Describe unstable angina?
- fatty deposits or atherosclerotic plaques build up on inside of blood vessels of the heart
- blood clot forms and the blood vessel becomes clogged further
- occlusion of artery reduced blood flow and O2 supply to heart muscle = CHEST PAIN
What are the first steps in the treatment of angina–> MI?
First give oxygen and nitroglycerin to open the artery to get blood flow. If this doesn’t work, then you want to give Morphine for pain and Aspirin to decrease platelets!
What is acute coronary syndrome?
Progressive occlusion of the coronary arteries leads to this–>total occlusion of the artery. This occlusion may ultimately result in MI
what is the role of morphine in MONA?
-provides pain relief, feeling of euphoria and vasodilation which diminishes volume of blood returning to the compromised heart.
what is the role of aspirin in MONA
prevents platelets from sticking to one another and cause further clotting
If angina pain persists for longer than 10 mins, what should you do?
Assume MI and give morphine sulfate + aspirin then transfer to the hospital
what are the potential causes of a seizure?
- underlying seizure disorder
- high dose of local anesthetic and epi, alcohol withdrawal, high fevers, hypoglycemia
what should you do if patient is suffering a siezure?
- protect patient from injury BUT DO NOT RESTRAIN
- place pillow beneath head and rolled towel between teeth if biting tongue
what do you do if a seizure is lasting longer than 5 minutes?
-give Valium (diazepam) or MIDAZOLAM (best) IZV or IM or Versed. Monitor the ABCS
what is the purpose of administering glucagon?
-stimulate glycogenolysis (breakdown of the storage form of glucose) in the liver and provide sugar through this route
Describe how you would treat a patient experiencing insulin shock?
- if Conscious- give sugar by mouth
- If stuperous patient- give glucagon IM and then monitor vital signs and airway
- If unconscious, recline patient and support airway breathing. Start IV and administer DEXTROSE, if you can’t start IV give glucagon. Watch for seizures and treat PRN.
How is dextrose administered?
IV
how is glucagon administered?
IM
Describe symptoms of insulin shock/hypoglycemia?
-Mental clouding, lethargy followed by diaphoresis, coolness of skin, anxiety, hypersalivation, tachycardia. May lead to loss of consciousness and seizure.
What position should patient be in if experiencing insulin shock?
semi reclined unless unconscious- then recline the patient
if your patient has suspected anaphylaxis with hypotension, what should you do?
-epi 1:10,000 and titrate slowly, give benedryl and then decadron (glucocorticosteriod)
if an object is aspirated, where will it likely end up?
right stem bronchus
Describe treatment if patient has aspirited gastric contents into lungs?
- trenderlenberg position and turn to the right
- suction and finger sweeps
- Patient INTUBATED (muscle relaxant first-succinylcholine) and suction perfored with a catheter placed through the endotracheal tube
what is succinylcholine?
muscle relaxant. used for rapid intubation
____ disease is cause of the majority of blood flow decreases?
atherosclerotic
what might precipitate an anginal attack?
physical or psychological stress (dental office visit)
What is a big difference between angina and unstable angina?
-unstable occurs at rest vs. angina usually after physical or psychological stress.
Unstable is the progression of atherosclerosis and a higher chance of MI
What is variant angina?
- coronary artery spasm
- likely to occur at rest
describe the signs of angina?
-patient appears apprehensive, sweating, eleveated BP, tachycardia, Dyspnea
where does pain typically radiate in Angina?
left arm/shoulder
sometimes also right arm, jaw, and epigastrium
When might avoid giving nitroglycerin to a patient with angina?
if patient systolic pressure is
If patient has no history of chest pain, and has angina, what should you do?
-terminate the procedure and activate EMS right away. Position patient comfortably. Give O2 + nitroglycerin
Describe acute MI?
- decrease in blood supply to myocardium which results in cellular death and necrosis
- LONGER duration than angina
- complications could be shock, cardiac arrest, heart failure
two types of MI?
NSTEMI= incomplete occlusion STEMI= complete occlusion
If your patient previously had an MI more than 6 months ago with no residual complications, what is their ASA status, and what should you consider while treating?
They could be an ASA 2 or 3. Consider giving O2 during treatment and follow up phone call afterwards
If patient had an MI more than 6 months ago but has angina, heart failure, or dsyrthmia present, what is their ASA status? What should you consider if you treat them?
3 or 4
Consider giving Nitroglycerin 5 mins before surgery if history of angina, O2 through nasal canula or nasal hood, and follow up phoen call
If patient had one documented episode of MI more than 6 months ago with further cardiovascular complications, what’ their status?
3
Give O2 during treatment
If Patient had an MI less than 6 months ago and has severe post MI complications, what is their ASA status?
4
Name 6 possible causes of cardiac arrest
- airway obstruction
- MI
- Sudden cardiac arrest
- Drug OD
- Anaphylaxis
- Seizure
if patient experiences cardiac arrest, what do you do?
- Management with early activation of EMS
- Early CPR
- Early Defibrillation
- Early ACLS
List the critical “drugs” to include in your basic kit
Injectible- EPI and Diphenhydraime
NON injectible- Oxygen, sugar, aspirin, albuterol, nitroglycerin
Think of the basic 7
Describe 6 essential items to include in your basic kit?
-Positive pressure and demand valve, AED, Syringes for drug admin, suction and suction tips, tourniquets, magill intubation forceps
what is the purpose of Atropine?
anticholinergic — speed up heart rate
What is esmolol?
antihypertensive
what is the purpose of ephedrine?
vasopressor (cardiac arrest)
If patient has bradycardia, what would you administer?
atropine
If patient has an opioid OD, what can you give?
naloxine
if patient has benzodiazepine OD, what is the antidote?
flumazenil
what is the majority of adverse drug reactions caused by?
85% from drug OD
what age group does local anesthetic OD usually affect?
Either end of spectrum! old and young
What are factors that can affect local anesethic OD?
- Age
- Body weight
- pathologic process- liver, cardiac (decreased blood flow or decreased hepatic flow), pulmonary disease
- genetics- enzyme deficiencies
- sex- decreased renal blood flow and drug excretion during pregnancy
What is an adverse effect associated specifically with prilocaine, articaine and topical use of benzocaines if in high dose?
methmoglbineami- induces the formation of methemoglobin
Bluish coloring of the skin
what is a risk assoicated with lidocaine?
sedation. caused by two metabolites- monoethylglycinexlidide and glycinexide can produce mild sedation
Cyanosis condition in absence of cardiac or respiratory depression
Blood appears chocolate brown if severe
methemoglobinemia
When do signs and symptos of methemoglobinemia typically occur?
3-4 hours after admin
How do you treat methemoglobinemia?
treated with 1% methylene blue infusion of 1.5 mg/kg
what is the purpose of intralipid during local anesthetic toxicity?
fat emulsion to bind to local anesthetic molecules
if your patient experiences minimal local anesthic OD, what should you do?
reassure patient, BLS, oxygen, monitor vitals, Active EMS
Describe a drug allergy?
hypersensitive response to a substance to which an individual has been previously exposed and has developed antibodies.
Exaggerated response of the body immune system
noninflammatory edema involving the skin, subcutaneous tissue, GI, erspirtoary tract etc.
angioedema
An antigen that can elicit allergic symptoms?
allergen
pruitis?
itching
Type I hypersenstivity
IgE
type III hypersensitivity?
serum sickness and IgG
uticaria vs. angioedema?
Uticaria= putitis, tingly and warmth, flushing hives. Diffuse erythema
Angioedema= NONPURITIC extremity, around the eyes and around the mouth swelling. Nonpitting edema and frequently ASYMMETRIC
If patient has larygneal edema, what should you do?
BLS care, activate EMS
GIve Epi IM
Histamine blocker
describe symptoms and signs of laryngeal edema?
dyspnea, hoarseness, tight throat.
Patient signs include laryngeal stridor, supgraglottic and glottic edema
why might an allergic reaction lead to circulatory collapse?
-increased vascular permeability= loss of vasomotor tone and increased venuous capactiance
what are signs of circulatory collapse related to allergic reaction?
lightheadness, generalized weakness, syncope, ischemic chest pain
-signs = tachycardia, hypotension and shock
Depressed level of consciousness with inability to be fully aroused.
obtunded
most common cause of altered consciousness!?
drugs!
The most important inhibitory neurotransmitter in the central nervous system.
GABA A
Potentiation of the GABA (inhibitory) receptors =?
increased chloride conductance.
Those that do this are barbiturate, propfol, and inhalation anesthetics
Inhibition of NMDA (excitatory) receptors–
reduce sodium conductance
- Ketamine
- N2O
Increased in alpha/ beta cell ratio = excess ____ secretion over insulin
glucAgon
what are some of the macrovascular complications of diabetes?
- coronary artery disease
- Stroke
- peripheral aterial disease
what constitutes severe hypoglycemia?
If
what is mild hypoglycemia?
blood sugar betwen 60-80 mg/dl
what are the 3 Ps associated with diabetes?
Polydispia (thirst)
polyuria (urination)
Polyphagia (excessive hunger)
clinical signs assoicated with diabetic ketoacidosis?
abdominal pain, nausae, vomitting, weakness
What constitutes hyperglycemia blood glucose when fasting?
> 140 mg/dl on two occasions
what glycosylated hemoglobin (hemoglobin A1c) is of a concern?
> 6.5%
insulin that is ultra short acting
Lispro
Onset is 10 mins and lasts 2-4 hour
insulin that is short acting/regular
humulin, novolin
30 min onset, 5-8 hour duration
long acting insulin?
glargine, lantus
2 hours and lasts 20-24 hours
if you have a diabetic patient with an infection, what should you do?
-if on oral agents, may need insulin, or increase insulin dose
