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L9 Medical Emergencies Flashcards

1
Q

What are the most common causes of medical emergencies

A
  1. Stress & anxiety
  2. Extreme age
  3. Improper pt assessment
  4. Longer dental appt
  5. Unhealthy, unfriendly enviornment
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2
Q

Other risk factors for med emergencies?

A
  1. OSA
  2. Obesity
  3. Higher mallampati score
  4. Increased drug administration
  5. Multipharma pt’s
  6. Addict patients
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3
Q

When do most medical emergencies happen?

A 
55% LA 
39% extraction
27% pupal extirpation 
22% ensuing dental tx
2% in the waiting room
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4
Q

What do you have to be concerned about that is stress related?

A 
Syncope
Acute angina
Acute asthma
Stroke
Seizures 
HV (hyperventilation) syndrome
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5
Q

Non stress related

A 
Allergy
Hypoglycemia
Drug overdosage & LA toxicity
Postural hypotension
Airway obstruction
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6
Q

PABCD of BLS

What does BLS stand for?

A

Positioning
Airway
Breathing
Circulation

Definitive tx: diagnosis, drugs, defibrillation

Basic life saving = dentist certification

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7
Q

General emergency drugs that are INJECTABLE for dental office

A
  1. epi
  2. histamine-blocker
  3. antihypoglycemic
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8
Q

Use of epi in office

A

1: 1000 IM
1: 10 000 IV

Anaphylaxis

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9
Q

Histamine-blocker aka benadryl emergency injection

A

Non life threatening allergy - rash, hives, itching

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10
Q

Antihypoglycemic emergency injection

A

50% dextrose in water

glucagon 1mg/IM

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11
Q

Non-injectable & inhalational drugs

A
  1. O2 - almost all emergency
  2. Glucose - hypoglycemia
  3. Nitroglycerin - acute angina
  4. Salbutamol (2 puffs) - acute asthma
  5. Aspirin (chewable) - chest pain, suspected MI
  6. Aromatic ammonia - respiratory stimulant
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12
Q

Parental (non oral) drugs

A
  1. Analgesic - ex morphine, fentanyl
  2. Anticonvulsant - diazepam, midazolam
  3. Antihistamine - Benadryl
  4. Antihypoglycemic - dextrose + glucagon
  5. Corticosteroid - methylprednisolone
  6. Narcotic antagonist - Naloxone
  7. Benzo antagonist - flumazenil
  8. Vasopressor - epi
  9. Vagolytic - atropine, glycopyrolate
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13
Q

Vasovagal Syncope

A

Syncope is a sudden loss of consciousness due to transient brain schema

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14
Q

What type of patients do vasovagal responses occur in?

A

Otherwise healthy people

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15
Q

What causes the vasovagal response?

A

Psychic, smelling, hearing, panic, anxiety, acute pain

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16
Q

What is the mechanism of vagal responses?

A

Vagal stimulation –> slow HR –> decreased CO –> decreased BP and brain schema –> transient LOC

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17
Q

Max dose for LA with and without epi

A

500 –> 5 um/ml in blood

300 mg

18
Q

How to prevent systemic toxicity from LA’s?

A
  1. Slow injection
  2. Aspirate
  3. Small divided doses
  4. Ask about symptoms
  5. Know your max doses
19
Q

How you manage systemic toxicity from LA’s?

A
  1. Stop injecting
  2. Call for help - start lipid emulsion therapy?
  3. Airway mgmt - give 100% oxygen, avoiding HV
  4. Treat seizure - valium?
  5. Treat hypotension and bradycardia
  6. Pulseless - start CPR
20
Q

Manifestations of sedative and GA overdose

A
  1. Medullary depression
  2. Reduced RR and HR
  3. Lower O2 sat, higher CO2 sat
  4. Cyanosis
  5. Heart and resp failure
21
Q

Management of sedative and GA overdose

A
  1. Stop injecting drug
  2. Call for help, call 911
  3. O2, fluids, vasopressor
  4. Reversal drug
  5. Consider admission
22
Q

What if patient hasn’t woken up after from fainting after 5 mins? they are breathing

A
  1. Administer O2
  2. Crush ammonia ampoule under nose
  3. Monitor vitals
  4. Assess pt - good and awake
  5. Get pt escorted home
  6. Plan for anxiety control measures for future dental care
23
Q

What if patient hasn’t woken up after from fainting after 5 mins? they are not breathing

A
  1. Start BLS
  2. Call for help, call EMS
  3. Consider possible non vasovagal syncope - hypoglycemia, seizure etc.
24
Q

What are skin manifestations of allergic rx?

A
  1. Urticaria
  2. Angioedema
  3. Pruritus
  4. Erythema
  5. Rashes
25
What are the respiratory manifestations of an allergic rx?
1. Wheezing | 2. Dyspnoea (laboured breathing)
26
Management of an allergic reaction?
1. Stop administration of all drugs presently in use 2. Call for help 3. Administer epinephrine (0.3 – 0.5 mg SC/ IM) (if respiratory signs) 4. Give oxygen (6 L/Min) by face mask or nasally 5. Monitor vital signs frequently 6. Establish IV access 7. Administer antihistamine, Benadryl 50 mg 8. Consult patient’s physician or emergency room physician 9. Observe in office at least 1 hr 10. Prescribe antihistamine 25-50 mg tabs 4-6 h.
27
Manifestations of anaphylaxis?
``` Malaise Wheezing Moderate to severe dyspnea Stridor Cyanosis Tachycardia Hypotension Dysrhythmias Cardiac arrest ```
28
What are 4 possible causes of chest pain?
1. Cardiac - angina, MI 2. GI - esophagitis, ulcer, heart burn, hernia 3. Skeletomucle - spasm 4. Psychological - hyperventilation
29
What relieves angina?
1. nitroglycerine 2. Oxygen 3. rest
30
What are common causes of chest pain?
1. exertion 2. Large meal 3. anxiety
31
Management of chest pain in dental chair
1. Stop dental tx 2. Put patient in semi-reclined position 3. Give nitroglycerin 4. Give aspirin 5. Give oxygen 6. check pulse and BP If relieved: assume angina 7. slowly taper oxygen 8. Modify dental tx to prevent recurrence 9. hospital referral If not relived: assume MI 7. give morphine for pain 8. call EMS
32
MGMT of basic asthma attack
1. Terminate all dental treatment 2. Position patient in fully sitting posture 3. Administer bronchodilator by spray (Salbutamole, isoproterenol, epinephrine) 4. Administer oxygen 5. monitor vital signs
33
Symptoms of hyperventilation
``` Anxiety Tetany Hyperpnea Light headedness Tingling extremities Circumoral numbness ```
34
Mgmt of hyperventilation
1. Terminate all dental treatment and remove foreign bodies from mouth 2. Position patient in chair in almost fully upright position 3. Attempt to verbally calm patient 4. Have patient breathe CO2 enriched air, such as in and out of a small bag 5. if symptoms persist, administer diazepam 10 mg IM (midazolam 5 gm IM) 6. Monitor vital signs 7. Use anxiety control/ Sedation in future
35
What are mild symptoms of hypoglycemia?
Nausea Hunger Weakness
36
What are moderate symptoms of hypoglycemia?
``` Tachycardia Perspiration Pallor Anxiety Behavioural changes - confusion, uncooperative ```
37
What are severe symptoms of hypoglycemia?
Unconsciousness Seizure Hypotension
38
Symptoms of pt in seizure
Rigid Cyanosis Cheek/tongue biting Loss of consciousness
39
Symptoms post seizure
Guilt Desire to sleep Confused, disoriented
40
Tx of conscious pt in seizure
``` 1, protect from harm 2. suction airway if need be 3. monitor vitals 4. give oxygen 5. call dr 6 observe for 1 hour 7. escort home ```
41
Tx of unconscious pt in seizure
1. call for help 2. protect from harm 3. place on side and suction airway 4. monitor vitals 5. start BLS 6. oxygen if needed 7. Transport ot emerg

Pain and Anxiety (7 decks)

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