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5th yr- AMS > inhalation sedation 2 > Flashcards

inhalation sedation 2 Flashcards

1
Q

What equipment is needed for inhalation sedation

A
  1. Gas cylinder of oxygen (white)
  2. Gas cylinder of nitrous oxide (blue)
  3. 2 pipes one for oxygen one for nitrous oxide
  4. Spare gas cylinders for oxygen and nitrous oxide
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2
Q

What is the average flow rate of nitrous oxide we give to an adult

A

6L / Min

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3
Q

What is active scavenging

A

Actively removing residual nitrous oxide

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4
Q

At what rate do we actively scavenge

A

45L/ Min

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5
Q

Name the 2 different types of nasal masks

A
  1. Autoclavable
  2. Single use
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6
Q

List some of the safety features used during inhalation sedation

A
  1. Colour coding gas tubes
  2. pin index system
  3. Minimum oxygen of 30%
  4. Oxygen flush
  5. Oxygen fail safe
  6. Reservoir bag
  7. Air trap valve
  8. Active scavenging
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7
Q

What is an oxygen flush and when is it delivered

A

Allows for 100% oxygen to be delivered in case of emergency

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8
Q

What is an oxygen fail safe

A

Ensures 100% nitrous oxide cannot be delivered

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9
Q

What does active scavenging help do

A

Reduce trace levels of nitrous oxide in the atmosphere

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10
Q

What does the pin index system ensure

A

Oxygen and nitrous oxide are connected to the correct fixings

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11
Q

What does a reservoir bad do

A

Assists in monitoring the patients breathing

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12
Q

What does the air entrainment valve allow for

A

The flow of atmospheric air into the system should the gases run out

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13
Q

How often is the inhalation sedation equipment serviced

A

Every 6-12 months

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14
Q

When should you check the equipment

A

Daily checks before use

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15
Q

Prior to doing the inhalation sedation what can we do with the patient

A
  1. Show them the nasal mask and let them try I ton
  2. Consent prior to the appoint
  3. Give pre op and post instructions
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16
Q

What do patients need to consent to prior to IHS

A

Dental treatment and sedation

17
Q

What do we need to do and what information do we need to gather in the pre sedation assessment

A
  1. Full medical history
  2. Allergies
  3. Airway and nasal pathency
  4. BMI
  5. ASA Status
  6. Dental history
  7. Anxiety assessment
  8. Sedation and GA history
  9. Social history
  10. dental treatment plan and radiographs
  11. Which sedation we are opting for
  12. Any requests from the patients
18
Q

What pre operative instructions do we need to give to the patient

A
  1. Light meal 2 hours before appt
  2. No alcohol 24 hours prior
  3. Children to be accompanied by a responsible adult (no other children)
  4. Transport home in car or taxi
  5. Avoid bikes, trampolines, machinery and driving
  6. Child should be accompanied by an adult after appt
19
Q

Does an adult need an escort following IHS

A

Not according to SDCEP unless the adult has other indications such as mobility issues

20
Q

What is IHS described as

A

A psycho pharmacological sedation

21
Q

What do we need to of to ensure the dental treatment during iHS is successful

A
  1. Good behaviour management
  2. Good rapport with patient
  3. Consider an intro appt with no treatment
  4. Stop signals
  5. Gain trust
  6. Effective LA including topical
22
Q

What pre op checks do we need to Carry out

A
  1. Check we have the correct staff: operator, nurse and runner nurse
  2. Check equipment
23
Q

What pre op checks do we need to carry out on the patients

A
  1. Patient identification
  2. Written consent
  3. Patients nose
  4. When they had their last meal and alcoholic drink
  5. MH
  6. Pregnancy status of both patients and carer
  7. For a child is there a responsible adult with them
  8. Transport arrangements
24
Q

Talk through the delivery of nitrous oxide for IHS

A
  1. Fit the appropriate mask and make pt comfortable
  2. deliver 100% oxygen
  3. Adjust flow rate to 4-6L/min
  4. Observe reservoir bad it should expand with each breath
  5. After a few mins begin to titrate nitrous oxide in 10% increments per min
  6. Once you reach 30% nitrous oxide start increasing in 5% increments
25
Q

State the most common percentage of nitrous oxide we tend to give

A

30% with 70% oxygen

26
Q

What state do we want the patient to be in during IHS

A

Semi hypnotic

27
Q

What do we need to keep doing during the IHS

A
  1. Distract the patient
  2. Encourage nose breathing and minimise pt talking
  3. Reassure pt
28
Q

List some signs of an adequate sedation

A
  1. Relaxed
  2. Warm feeling
  3. Tingling in hands and feet
  4. Lethargic/ tired
  5. Dreamy
  6. Reduced gag reflex
  7. Responding to questions
  8. Vital signs and reflexed in tact
  9. Pt happy to proceed with treatment
29
Q

What should we be monitoring during IHS

A
  1. Level of consciousness
  2. Depth of sedation
  3. Airway patently
  4. Respiration rate and depth
  5. Skin colour
  6. Blood pressure if indicated
30
Q

What factors could lead to ineffective sedation

A
  1. Nasal obstruction
  2. Mouth breathing or talking
  3. Ineffective seal around the nasal mask
  4. Patient resisting the effects
  5. Too anxious
  6. Faulty equipment
31
Q

What are some of the signs of over sedation

A

Patient may squint, complain of headaches or nausea

32
Q

What should you do if you think you have over sedated the patients

A
  1. Reduce nitrous oxide by 5-10%
  2. Reassure the patient
  3. Monitor the patient
  4. If they recover continue if not postpone the treatment
33
Q

How do you bring the patient out of the sedated state following treatment

A
  1. Reduce nitrous oxide to zero
  2. give 100% oxygen
  3. Let patient breath for at least 3 mins
  4. Sit patient upright
  5. Check pt is not dizzy or nauseous
  6. Check pt can walk steadily
  7. Post op instructions
34
Q

What should we put in the patients sedation record

A
  1. Dose, route and time of nitrous oxide administration
  2. Details of clinical monitoring
  3. The staff present in the surgery
  4. Dental treatment provided
  5. Patient reaction, sedation score and success of sedation
  6. Time of discharge

5th yr- AMS (11 decks)

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