Lecture 2 Flashcards
Most Common Medical Emergencies (12)
- Syncope
- Mild allergic reaction
- Angina pectoris
- Orthostatic hypotension
- Seizures
- Asthmatic attack (bronchospasm)
- Hyperventilation
- Epinephrine reaction
- Hypoglycemia
- Cardiac arrest
- Anaphylactic reaction
- Myocardial infarction
Emergency Kit needs to be
• Customized for dental office use
• Readily available
• Mobile
• Easily accessible 02
What is the dosage of epinephrine for adults in case of anaphylaxis?
The dosage of epinephrine for adults is 0.3 mg of 1:1,000 solution.
How much epinephrine should be administered to children aged 6-12 years?
Children aged 6-12 years should receive 0.25 mg of 1:1,000 solution.
What is the appropriate epinephrine dosage for children aged 6 months to 6 years?
Children aged 6 months to 6 years should receive 0.12 mg of 1:1,000 solution.
For which medical emergency is epinephrine used?
Epinephrine is used for anaphylaxis.
What is the recommended dosage of nitroglycerine?
The recommended dosage is 0.2-0.6 mg every 5 minutes, with a maximum of 3 doses.
What medical conditions is nitroglycerine used for?
Nitroglycerine is used for angina, heart failure, or myocardial infarction (MI).
What is the dosage of diphenhydramine for mild allergic reactions in adults?
For mild allergic reactions, adults should take 25-50 mg every 6-8 hours.
What is the recommended diphenhydramine dosage for children weighing more than 10 kg?
Children weighing more than 10 kg should take 12.5-25 mg, 3 to 4 times per day.
What is the dosage of diphenhydramine for moderate allergic reactions?
The dosage for moderate allergic reactions is 25-50 mg IM
What medical emergency is diphenhydramine used for?
Diphenhydramine is used for mild to moderate allergic reactions with urticaria and pruritus.
What is the recommended dosage of chlorpheniramine for children aged 2-6 years?
Children aged 2-6 years should receive 1 mg every 4-6 hours.
How much chlorpheniramine should be given to children aged 6-12 years?
Children aged 6-12 years should receive 2 mg every 4-6 hours.
What is the appropriate chlorpheniramine dosage for children older than 12 years and adults?
Children >12 years and adults should take 4 mg every 4-6 hours.
What medical emergency is chlorpheniramine used for?
Chlorpheniramine is used for mild allergies.
What is the dosage of albuterol for children during an asthma attack?
The dosage for children is 1 spray (90 mcg per spray).
What is the dosage of albuterol for adults during an asthma attack?
The dosage for adults is 2 sprays (90 mcg per spray).
What medical emergency is albuterol used for?
Albuterol is used for asthma attacks.
What is the recommended dosage of aspirin for myocardial infarction?
The dosage is 162-325 mg chewed and absorbed in the mouth.
What medical emergency is aspirin used for?
Aspirin is used for myocardial infarction (heart attack).
What is the recommended dosage of oral carbohydrate (glucose) for hypoglycemia?
The recommended dosage is 15-20 grams.
What medical emergency is oral carbohydrate (glucose) used for?
It is used for hypoglycemia.
What is the recommended dosage of lorazepam for seizures or hyperventilation?
The recommended dosage is 0.5-1 mg intramuscularly (IM).
What medical emergency is lorazepam used for?
seizures or hyperventilation.
What is the appropriate glucagon dosage for children weighing less than 20 kg?
The dosage is 0.5 mg or 20-30 mcg/kg per dose.
What is the recommended glucagon dosage for children weighing 20 kg or more and for adults?
The dosage is 1 mg.
What medical emergency is glucagon used for?
Glucagon is used for hypoglycemia with an unconscious patient.
What is the recommended dosage of hydrocortisone for anaphylaxis?
The recommended dosage is 100-500 mg intramuscularly (IM).
What medical emergency is hydrocortisone used for?
Hydrocortisone is used for anaphylaxis.
What are the main indications for using epinephrine?
Epinephrine is primarily indicated for anaphylaxis (a severe, potentially life-threatening allergic reaction) and severe asthma attacks.
How quickly can anaphylaxis occur after exposure to an allergen?
Anaphylaxis can occur within seconds or minutes of exposure to an allergen.
What are the symptoms of anaphylaxis?
Symptoms of anaphylaxis include skin rash, nausea, vomiting, difficulty breathing, and shock.
What is the onset and duration of action of epinephrine?
Epinephrine has a rapid onset and short duration of action.
How does epinephrine counteract anaphylaxis?
Epinephrine counteracts major physiological events in anaphylaxis by:
• Reducing hypotension (low blood pressure)
• Relieving bronchospasm (airway constriction)
• Reducing laryngeal edema (swelling of the throat)
• Preventing additional release of histamine and other chemical mediators
In which medical conditions should epinephrine be avoided?
Epinephrine should not be used in patients with ischemic heart disease or severe hypertension.
What is the recommended adult dosage of epinephrine for intramuscular and intralingual injections?
The recommended adult dosage is 0.3 mg of 1:1,000 concentration for intramuscular and intralingual injections.
What is the recommended pediatric dosage of epinephrine?
The pediatric dosage is 0.15 mg of 1:1,000 concentration.
What is the half-life of epinephrine?
The half-life of epinephrine is 2 minutes.
Why might repeat doses of epinephrine be necessary?
Repeat doses may be necessary depending on the patient’s symptoms and their response to the initial dose.
What is the recommended site for epinephrine injection?
The recommended site for epinephrine injection is the thigh.
What is diphenhydramine, and what is its primary function?
Diphenhydramine is an antihistamine that acts as a histamine blocker. It is used in dental offices to treat allergic reactions, hypersensitivity reactions, and anaphylaxis.
What are the available route options for administering diphenhydramine?
Diphenhydramine can be administered through:
1. Tablets
• Benadryl
• Chlorpheniramine
2. Deltoid Injection
• Diphenhydramine 50 mg
When should diphenhydramine be used for allergic reactions?
Diphenhydramine is used for:
• Mild or delayed-onset allergic reactions, as it helps manage mild symptoms.
• Anaphylaxis, in combination with epinephrine and other treatments to treat life-threatening allergic reactions.
What are the primary medical conditions that nitroglycerine is used to treat?
Nitroglycerine is used to treat angina pectoris, heart attack, and heart failure.
What causes angina?
Angina occurs when there is a mismatch between the body’s oxygen demand and oxygen supply in the coronary circulation.
What does the term ‘coronary’ refer to?
‘Coronary’ refers to the arteries that surround and supply the heart.
What is the function of nitroglycerine?
Nitroglycerine functions as a potent coronary vasodilator.
How does nitroglycerine help in angina?
Nitroglycerine dilates the coronary arteries, which improves blood flow and oxygen supply, relieving chest pain.
When should you NOT give nitroglycerine and call 911?
You should NOT give nitroglycerine and call 911 if:
• The patient has taken Viagra or Levitra in the last 24 hours.
• The patient has taken Cialis in the last 48 hours.
Why is it dangerous to give nitroglycerine to a patient who is already on vasodilators?
If a patient is already on vasodilators, adding nitroglycerine can dangerously lower blood pressure, leading to critical hypotension.
What classes of medications can interact dangerously with nitroglycerine?
The following three classes of medications can interact with nitroglycerine:
1. ACE Inhibitors
• Benazepril (Lotensin)
• Lisinopril (Prinivil, Zestril)
2. ARBs (Angiotensin II Receptor Blockers)
• Losartan (Cozaar)
• Azilsartan (Edarbi)
• Candesartan (Atacand)
• Eprosartan (Teveten)
• Irbesartan (Avapro)
• Telmisartan (Micardis)
• Valsartan (Diovan)
• Olmesartan (Benicar)
3. CCBs (Calcium Channel Blockers)
• Diltiazem (Cardizem, Tiazac)
• Amlodipine (Norvasc)
• Clevidipine (Cleviprex)
• Felodipine (Cardene, Cardene SR)
• Isradipine
• Nicardipine
• Nimodipine
• Nisoldipine (Sular)
• Verapamil (Calan)
What is the recommended route of administration for nitroglycerine?
The recommended route is sublingual (under the tongue).
Why is proper storage important for nitroglycerine tablets?
Nitroglycerine tablets become impotent if exposed to light or air, which significantly reduces their shelf life.
How should adults take nitroglycerine tablets during an angina attack?
Adults should place 1 tablet under the tongue or between the cheek and gum at the first sign of an angina attack.
How frequently can nitroglycerine tablets be used?
1 tablet may be used every 5 minutes as needed, for up to 15 minutes.
How should nitroglycerine spray be administered?
1-2 pumps of the spray should be sprayed underneath the tongue.
How long is the shelf life of nitroglycerine spray?
The shelf life of nitroglycerine spray is usually two years.
When should nitroglycerine not be administered?
if the patient’s systolic blood pressure (BP) is less than 90 mmHg.
For which medical situations is oxygen used?
Oxygen is used for all emergencies except hyperventilation.
What is the primary benefit of aspirin in cardiac emergencies?
Aspirin reduces overall mortality from myocardial infarction (MI) and prevents the progression of cardiac ischemia to cardiac injury or tissue death.
What is the recommended dosage of aspirin for cardiac events?
The recommended dose is 162–325 mg, or two to four baby aspirins (81 mg each).
Why is it important to check medical history before giving aspirin?
Some patients may have an allergy to aspirin, which could lead to severe allergic reactions if administered.
What is the main contraindication for aspirin use?
Aspirin should not be given to patients with a hemorrhagic stroke, as it can worsen bleeding.
What is an example of a bronchodilator?
An example of a bronchodilator is Albuterol inhaler.
What is the primary use of a bronchodilator inhaler?
It is used for treating asthma attacks or bronchospasms.
How does a bronchodilator work?
It causes dilation of the bronchioles, allowing for improved airflow while having minimal cardiovascular effects.
How long does it take for a bronchodilator to reach peak effect?
The peak effect occurs within 30–60 minutes after use.
What is the duration of action for a bronchodilator?
The effects last for approximately 4–6 hours.
What is the recommended dosage for a bronchodilator in adults and children?
Pediatrics: One spray
Adults: Two sprays
What are the proper steps for using a bronchodilator inhaler?
- Shake well before use.
- Test pump before administering to ensure proper function.
Do oral carbohydrate pastes or tablets require refrigeration?
No, paste or tablets do not require refrigeration.
Do oral carbohydrates have to be medications?
No, you can use:
• Frosting/Icing
• Sugar packets
• Orange juice
• Coke/Soda/Pop (non-diet)
Why are carbonated drinks like soda used as an oral carbohydrate source?
allow very rapid transit of liquid sugar to the small intestine, making them an effective option for quick sugar absorption.
What is Naloxone commonly known as?
Naloxone is commonly known as “Narcan”.
Why is Naloxone included in many emergency kits?
due to the current opioid crisis, as it is used to reverse opioid overdoses.
What is Naloxone used for?
Naloxone is used for treating opioid overdose by rapidly reversing its effects.
How should Narcan be administered?
Narcan should be administered by spraying every 2-3 minutes into one nostril until the person responds or emergency help arrives.
Your patient is a 48 year old woman. Parts of your patient’s face during the appt starts to swell. Your patient seconds later reports feeling nauseous. Your patient starts to develop a red rash on her face and arm. You patient starts panicking while clutching her throat unable to breathe. Your patient is experiencing what medical emergency and what would you do?
Patient is experiencing anaphylaxis. I would retrieve epinephrine, dispense 0.3 mg 1:1000 and inject it IM into her thigh. I would also consider using diphenhydramine as an adjunct.
I could also use Hydrocortisone 100-500 mg IM
Your 7 year old weighing 6 kg pediatric patients starts scratching his skin during the appointment. Urticaria start to form on his face, neck, arms and back. What medical emergency is your patient having? What do you do?
My patient is having an allergic reaction. I would either dispense 12.5-25 mg of diphenhydramine and instruct my patient to take it 3-4 times that day. Or i could dispense 2 mg of chlorpheniramine and have him take it every 4-6 hours.
Your patient has a history of angina pectoralis. Patient starts grabbing his chest in the patient chair. What medical emergency is your patient having and what would you give him?
My patient is having an episode of angina pectoralis. I would ensure patient hasn’t taken viagra and levitra within that last 24 hours and cialis within the last 48 hours. I would also check the medical history form to see if my patient is taking any vasodilating medications like Ace inhibitors, ARBs, and CCBs. I would not dispense if patient’s systolic was below 90.
I would dispense 3 doses of 0.2-0.6 mg Nitroglycerin every 5 minutes.
Your adult patient with a history of asthma reports in the chair that they are having difficulty breathing and look flushed and confused. You patient is having what type of medical emergency and what do you do?
Patient is having an asthma attack. I would see if the patient brought their inhaler but if not, I would retrieve Albuterol, shake well dispense 2 pumps in the patients mouth. I would also consider dispensing Oxygen.
Your patient with a history of MI is having an heart attack. What do you do?
Ensure patient isn’t having hemorrhagic stroke and dispense 2-4 (81 mg) baby asprins for patient to chew. Ensure dose is between 162-325 mg
Your patient is having a seizure. What do you do?
Dispense 0.5-1 mg of Lorazepam IM
Your pediatric patient with a history of diabetes passes out during her appt. Her mom reports that she did not eat breakfast. Your patient weighs 23 kg. What medical emergency is she having and what do you do?
Patient is experiencing hypoglycemia. I would dispense 1mg of glucagon and inject in the thigh.
Your conscious patient who is a diabetic patient reports that she feels weak and dizzy. She says she hasn’t eaten in the entire day. What medical emergency is she having and what do you do?
Patient is experiencing hypoglycemia. I would let the patient eat something that would give her 15 to 20 g of sugar like soda or icing.
