Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pain Control II > management of emergencies > Flashcards

management of emergencies Flashcards

1
Q

T/F most ARD’s are not life threatening

A

true - most adverse drug reactions are not life threatening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ARD’s are usually due to what three things

A
  1. dentists are at fault
  2. some events may be RANDOM
  3. some events may be a REASONABLE RISK OF TX - example- if patient faints - neither the dentist or the patient is responsible - sncope is merely unavoidable complication of injections that everyone must accept
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

most common in sedation

A

overdose
- toxic reaction

clinical manifestations of an overdose are related directly to the NORMAL PHARMOCOLGICAL actions of the agent
- example - sedatives = sleep = more sleep = deeper level of sleep or more duration of sleep

barbs have greatest potential

opioid analgesics are involved with the greater number because opioids are more widely used than barbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ingested vs injected

A

injected has faster route of transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

which permit tirtration

A

inhalation and IV routes

altering amount of drug given based on weight

vs. pill = get a pill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

more erratic absorption seen with

A

intranasal (IN), intramuscular (IM), and oral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

if presence of drug sensitivity?

A

lower than average doses should be administered or diff drug categories substituted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

cardiac arrest

A

resp distress most often reason

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

moderate to deep sedation affects

A

hypothalamis and RAS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

GA effects

A

cortex – unconsciousness with progressive respiratory and cardio depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

respiratory arrest occurs where

A

medulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

diagnostic clues of overdose reaction

A

recent administrtion of a ssedative hypnotic drug

lack of response

resp depresision - rapid rate but shallow

ataxia

slurred speech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

general steps after overdose

A

step1 - terminate tx

step 2 - position the patient - unconscious = supine and legs slightly elevated

step 3 - airway breathing circulation
ABC ***

look listen and feel for breathe

head tilt and chin lift

step 4 - definitive care
- oxygen, monitor, establish IV line, manage

  • definitive management of sedative hypntoic overdose produced by a barbiturate is based on MAINTENANCE of a patent airway and adequacy of ventilation until the patient recovers

step 5 - recovery and discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

flumazenil

A

benzo antagonist - ,2 mg in 15 seconds waiting 45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

NO discharge if

A

patient is alone or if not adequately recovered

needto be standing and walking without assistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

therapeutic dosed of meperidine?

what is this

A

an opioid

analgesia, sedation, euphoris, and a degree of resp depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

diagnostic clues of overdose of opioids

A

altered consciousness

resp depression - slow rate

miosis - contraction / pinpoint pupils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

not reported allergy

A
  1. nitrous oxide

2. oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

barbs allergy in who?

manifests as?

A

more seen with past history of asthma, uticaria, and angioedema

manifests as skin lesions, such as hives, and uticaria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

meperidine with allergies?

A

can release histamine locally but this is NOT AN ALLERGIC RXN

along path of vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

ANAPHYLACTIC when

A

type i response

if hypotension is also a clinical component – this term can be applies

can take up to even 60 minutes to cause reaction
- if take longer to develop - more mild response usually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

four main syndromes with anaphylaxis

A
  1. skin
  2. smooth muscle spasms
  3. resp distress
  4. cardio collapse

typical generalized anaphylaxis - go through a range of these progressively

fatal anaphylaxis– resp and cardio distrubances predominate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

manage immediate skin rxn?

delayed?

A

epi 1:10,000
IM 1:1000 or subcutaneous .3mg

histamine blocker - diphenydramine

delayed
IM or IV histamine blocker - diphenhydramine 40 mg

prescription for histamine blocker - oral benedryl 50 mg for 3-5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

bronchospasm is? manage?

A

resp reaction
wheezing and using accessory muscles to breathe

P-A-B-C

bronchodilator
- ALBUTEROL or epinephrine
IM or subcutaneous 3 ml of 1:1000 dilution for adults or IV .1ml of 1:10000 every 15 to 30

histamine blocker - diphenhydramine - 50 mg intramuscullary or 2mg/kg IM or IV (children

25
Q

caviate to using epi for bronchodilation

A

does NOT releive bronchospasm produced by leukotrienes

26
Q

laryngeal edema

endpoint must know if not fixed?

A

when little or no air movement can be heard or felt through the mouth and nose DESPITE exaggereated spontaneous respiratory efforts by patient

high pitched crowing and sound of stridor - partially obstructed in presence of respiratory movements

LOSES CONSCIOUSNESS DUE TO HYPOXIA, ANOXIA
- lack of oxygen to brain?

27
Q

management of laryngeal edema

A

PABC

definitve
- give epi
maintain airway
administer oxygen

additional - diphenhydramine 50 mg for adults and 25 for children
corticosteroid
cricothyrotomy

28
Q

hypotension

A

systolic bp of 90 mmHg in an ASA I adult (might not require tx)
- but same blood pressure in an elderly hypertensive patient may be life threatening

29
Q

causes of hypotension

A

exceessive premedicattion

other drugs like steroids. anti HTN, tranquilizers

overdose of sedatives/ anesthetics

reflexes
vascular absorption of LA
hemorrage

theres a very long list

30
Q

signs of hypotension

A 
chest pain
dyspnea
systolic below 90 
heart failure 
ischemia

WIDE RANGE – depends on the system it is affecting

like could have adverse skin reacions / cold / clammy

31
Q

management of hypotension

A

directed to its cause
PABC

if using inhlation anesthetic like NO2 - decrease concentration

if opioids or benzo
- naloxone or flumazenil

if barbs - no antagonist so basic ife support

can give fluids – 5% dextrose and water, physiiologic saline

administer vasopressors like dopamine – reserved for hypotension that is more severe

32
Q

hypertensive - overview

A

can be normal or common due to level of pain or anxiety control is inadequate – can try to prevent by readministration of local anesthesia

if sustained or significant elevation - must be treated aggressively

33
Q

causes of high blood pressure

A

light anesthesia or sedation

pain

hypercabia - more Co2
hypoxia
(both these cause catecholamine release)

emergence delirium
fluid overload - over hydraton
hyperthermia
pre existing cardiac problems

34
Q

hypertensive crisis level

most common in?

A

Systolic 250 mm Hg or greater

diastolic - is 130 mm Hg or greater

most common / likely to occur in patients with chronic, stable hypertension

35
Q

definitive care of hypertensive crisis

A

adinsiter fluids
IV

titrate NITROPRUSSIDE – nipride at an infusion rate of 5 mg/kg/min until the blood pressure is lowered
therapeutic range is 5-10 mg/kg/min

IV nitro - 50 mg bolus - followed by infusion of 10-20 mg / min
- potent vasodilator

IV diazoxide - hyperstat - in doses of 1 to 3 mg/kg up to 150 mg

36
Q

cardiac dysrhythmias

A

detectable with monitoring

most common intraoperative complication
ranging from 4% to 60% incidence in preoperative dysrhthmias under GA

even during extraction of bicuspids - patients receiving local anesthesia and sedation levels can be at 24%
(happening but probably under reported))

37
Q

DeRango’s observations

A
  1. majority who are monitored with ECG will demonstrate some dys-rhythmia
  2. incidence higher in paitents with a past heart history
  3. higher in trachea intubated patients
  4. more frequent in surgeries lasting more than 3 hours
  5. patients receiving digitalis preop (like digoxin) have higher incidence
38
Q

precipitating factors for dysthrhthmias

A

anestesia like HALOTHANE

elevated levels of Co2

pain

vagal responses

intubation

anoxia

duration of procedure

39
Q

management of dysrhythmias

A

ensuring adequate ventilation
increasing / decreasing level of anesthesia or sedation and providing adequate pain control

continuous ECG monitoring

40
Q

angina and MI

A

stable angina

  • thoracic pain, usually substernal
  • tightness
  • heavy weight on chest

result of mild inadequacy of the coronary circulation

  • vasodilator drugs and rest can relieve it
41
Q

significance of chest pain for LONGER DURATION

A

more likely to lead to a presumptive MI than angina

42
Q

status of patients who get an MI

A

51% are at REST when MI occurs – where as onset of angina - usually occuring with increased myocardial activity

43
Q

management if NO history of angina

A

activate EMS

administer O2 and nitro

44
Q

management if history of angina

A

administer O2 – if pain resolves – make modifications in tx next time

if pain does not resolve – activate EMS - administer aspirin and monitor

MONA 
morphine 
oxygen
nitroglyxerine 
aspirin
45
Q

airway obstruction

important to recognize?

A

if it is chest pain or not (cardiac origin or not)

46
Q

airway obstruction due to

A

most common cause during sedation or GA is POSTERIOR DISPLACMENT OF THE TONGUE – into the pharynx as muscle tonus is lost as a result of the CNS depression

presence of foreign object in airway - produces partial airway obstruction - rather than total obstruction

fluids blood saliva and water / or vomit can produce obstruction

47
Q

signs of NORMAL UNOBSTRUCTED AIRFLOW

A

LOW WHOOSING SOUND –

through the mouth and nose has a very distinctive low whoosing sound

movement of the chest during respiration is minimal and looks “smooth”

48
Q

signs of complete obstruction of airway

A

absence of sound!!! but observed respiratory movements appear exaggerated with evvident suprclavicular and intercostal soft tissue retraction

49
Q

partial airway obstruction sound

A

resulting from tongue posteriorly displaced

SNORING SOUND - that is often heard by all persons in the tx room

50
Q

wheezing sound
cause?
manage?

A

bronchospams

administer a bronchodilator

51
Q

gurgling sound
cause?
manage?

A

fluid in airway

pharyngeal sunction

52
Q

snoring sound
cause?
manage?

A

soft tissue / tongue - displaced in pharynx

  1. head tilt
  2. anterior displacement of tongue with hemostat or gauze
53
Q

no sound bt exxaggerated resp
cause?
manage?

A

complete obstruction

  1. head tilt chin lift
  2. anterior displacement of tongue
  3. pharyngeal suctioning
  4. adbominal thrusts
  5. cricothyrotomy
54
Q

no sound / no resp
cause?
manage?

A

apnea

control the ventilation efforts

55
Q

laryngospasm

A

protective reflex - maintain integrity of airway

partial = high pitch sounds

complete = no sound with exggerated respiration

management

  • supine position
  • administer 100 % oxygen and non stop nitrous
  • positive pressure with oxygen to maintain airway and break the laryngospasm

muscle relaxant like succinylcholine 10 mg

56
Q

emesis and aspiratio of foreign material

A

(vomitting) and possible aspiration of this into airway is one of MOST FRIGHTENING of potential emergencies arising during GA and deep sedation

lower pH of material aspirated – morbidity and death more likely

if go into trachea – potential for disaster

57
Q

three common factors in incidents in dental offices with relatio to morbidity

A
  1. improper preoperative evalutation of the patient
  2. lack of knowledge of drug pharm by the dentist
  3. lack of adequate monitoring during the procedure
58
Q

monitoring for CNS? Resp?

Cardio?

A

CNS
- direct verbal contact with patient

Resp

  • pulse oximetry
  • pretracheal stethescope

cardio

  • continuous of vitals
  • ECG
59
Q

physician desk reference

A

compilation of prescribing info on rx drugs

provides with mandated info for prescriing

chemical info
function / action
indications and contra
trial research, side effects, warnings

widely available

Pain Control II (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions