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Surg Perio > Med Emergencies > Flashcards

Med Emergencies Flashcards

1
Q

sequence for donning PPE

A
  1. gown
  2. mask/ respirator
  3. goggles or face shield
  4. wash hands
  5. gloves
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2
Q

sequence for doffing PPE

A
  1. gloves
  2. goggles
  3. gown
  4. mask/respirator
  5. wash hands
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3
Q

CPR on adult patient
- compressions vs breaths
- order

A

2 in deep compressions; 100-120 per min
and 1 breath/ 5 seconds

Call for help
911
Get AED
check vitals
Start CPR

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4
Q

CPR on child patient
- compressions vs breaths

A

1 breath every 3-4 sec
30 compressions: 2 breaths (same as adult) but change to 15:2 if 2nd rescuer is helping.

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5
Q

Difference in protocol for child CPR witness to collapse vs no witness

A

witness: Call 911, get AED, then start CPR

no witness: start CPR then activate EMS and get AED if still alone

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6
Q

how many compressions to breaths in CPR

A

30 compressions : 2 breaths
* change to 15:2 if second rescuer.

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7
Q

where to check for pulse during CPR

A

child and adult- carotid a.
infant - brachial a

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8
Q

Physical assessment of medically complex pt includes what

A
  • Vitals (BP and HR)
  • visual inspection (including anxiety level, hygiene, distress, appearance)
  • med questionairre.
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9
Q

2 reasons a med consult is indicated

A

A. to clarify med status
B. to obtain additional info
**NOT asking for permission

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10
Q

4 things a med consult should include

A
  1. explanation for “Reason for Consult”
  2. anticipated dental care
  3. type of anesthesia
  4. Anticipated pre-tx and post-tx meds
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11
Q

MC emergency in the dental office=

describe this

A

Vasovagal syncope 90%

aka neurocardiogenic syncope or vasodepressor syncope

brief loss of consciousness due to cerebral ischemia.

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12
Q

does vasovagal syncope happen to healthy people?
when is best time to treat this?
how quick is recovery?

A

yes
best to treat before loss of consciousness

recovery in sec -min

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13
Q

causes of vasovagal syncope (7)

A

needles
blood
blood drawn
fear of injury
heat exposure
standing for long time
straining (like bowel mvmt)

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14
Q

initial response of vasovagal syncope and compensatory response=

how does this cause fainting?

A

initial - sympathetic
compensatory response = parasympathetiv stimulation of vagus nerve (overcompensation)

BP drops from vagal stim causing blood to pool in extremities.
not enough blood to brain = hypoxia.

–> fainting

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15
Q

pre-syncope signs and symptoms

A

NP PATH:
nausea
perspiration
pale
anxiety
tachycardia to bradycardia
hot flashes

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16
Q

how to manage vasovagal syncope in CONSCIOUS patient

A

reassure patient
Trendelenburg position
monitor vitals and ABCs
give supp O2 if breathing is labored

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17
Q

mgmt of vasovagal syncope if pt is UNCONSCIOUS

A
  1. trendelenburg
  2. ABC (airway, breathing, circulation)
  3. monitor vitals
  4. Spirits of Ammonia or cold compress if pt has not recovered.
  5. Call 911 if pt still out
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18
Q

what is orthostatic syncope/ postural

A

syncope from change in position; vasc system cannot adjust

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19
Q

RFs for postural syncope

A
  • Age >65 bc slow responsiveness of baroreceptors
  • MEDICATIONS: ACE inhibs, B-blockers, Ca channel blockers, antidepressange, relaxants, nitrates
  • alcohol
  • pregnancy
  • long appointments in supine position
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20
Q

Medications that inc risk of orthostatic hypotension

A

Ace inhibs
Ca channel blockers
B blockers
antidepressange
muscle relaxants
nitrates

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21
Q

Fastest recovery period of all emergencies=

A

Postural/orthostatic syncope

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22
Q

Presyncope phase of orthostatic/postural syncope

A

no symptoms (bad)

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23
Q

how to prevent postural/orthostatic syncope

A

raise chair slowly and have pt sit for a few

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24
Q

management for orthostatic/postural syncope when pt recovers normally vs does not recover

A

normal: observe for 30 before discharge

delayed: re-evaluate diagnosis. call 911

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25
Q

if pt does not recover quickly from orthostatic/postural syncope, what diagnoses should be considered

A

hypoglycemia
cardiac arrest
CVA or stroke
transient ischemia attack

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26
Q

hypoglycemia def=

most common cause

A

< 70 mg/dL plasma glucose

insulin or oral hypoglycemic agents tx db combined with missing meals.

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27
Q

Threshold for diabetes when:

  • fasting blood sugar =
  • random plasma glucose=
  • 2 hr post-parandial glucose=
  • HbA1c=
  • Fructosamine test=
A

126 mg/dL
>200 mg/dL WITH symptoms
>200 after 75g load
HbA1c >6.5%
>250 umol

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28
Q

should dental tx be deferred if db is not controlled?

A

Yes - if uncontrolled defer unless emergency

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29
Q

**Dr. Shin mentioned: how will HcA1c levels be altered if pt has sickle cell or is pregnant

A

will get false reading

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30
Q

Pre-diabetic levels for A1c, fasting plasma glucose, and oral Gluc tolerance

A

A1c: 5.7-6.4
Fasting plasma: 100-125
Oral gluc tolerance: 140-199

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31
Q

How do blood glucose levels and fructosamine levels compare?

A

for each 30mg/dL change in blood glucose, about 37.5 umol change in fructosamine and 1% CHANGE IN HBA1C **

32
Q

hypoglycemia signs

A

shakiness
feeling cold/clammy
mood changes
lack of energy
hunger/nausea
anxious
pale skin
fast heartbeat
blurred vision
restless sleep

33
Q

mild vs moderate vs severe hypoglycemia signs

A

mild: hunger, nausea, dizzy, headache, lethargic, confusion, restless. BG < 60-65

mod: diaphoretic, tachycardic, anxiety, confused. BG < 50

severe: hypotension, unconscious, seizure. BG < 30

34
Q

when should pt eat meals before dental office

A

within 2 hrs (balanced with fats and protein)

35
Q

if hypoglycemic pt is conscious, how manage?

A
  • stop procedure
  • comfy position
  • ABCs and vitals
  • ORAL*** glucose
  • recheck in 15min
36
Q

unconcious pt managment hypoglycemia:

A

Call 911
Trendelenburg position
ABCs (airway and O2)
administer IM glucose (deltoid)
monitor vitals
prepare for emergency transport

37
Q

2 necessary questions for med consult if pt has cardiovascular condition

A

type of heart problem (verify heart is stable for dental procedures)

and if abx prophylaxis is necessary

38
Q

abx prophylaxis for cardiovascular pt is approved when:

A
  • prosthetic cardiac valces
  • infective endocarditis
  • cardiac transplant
  • congenital heart disease
  • unrepaired cyanotic congenital heart disease
  • repaired congenital heart defect with residual shunts
39
Q

MC condition that pt take prescription med=

what are #’s

A

hypertension

SBP > 130; DBP >80

40
Q

high BP can cause what problems

A
  • enlarged heart
  • aneurysms in vessels
  • narrowing and hardening of blood vessels in the kidneys leading to kid failure
  • rupture of BVs in eyes causing blindness
41
Q

normal
pre-hypertensive
Stage 1
Stage 2
hypertensive crisis

A

less than 120/80
120-129/ <80
130-139/ 80-89
>140/ >90
>180/ >120

42
Q

T/F: for hypertensive crisis to be diagnose, pt must experience signs of angina?

what to do in this situation?

A

false

refer to ER IMMEDIATELY

43
Q

IUSD cutoff for hypertension

A

160/100 mmHg
**elevated risk of stroke/cerebrovascular incident

44
Q

T.F: decrease hypertensive pts exposure to epi

what is bigger threat: exogenous or endogenous epi?

A

true
- limit to 0.04mg = 2.2 carps of 1:100k

endogenous spi from adrenal medulla can produce 0.28mg epi/min - yikes **so def use stress relief protocols

45
Q

angina pectoris=

A

impaired delivery of blood to myocardium *includes CAD, antina, and previous MI
**transient ischemia to myocardium

progressive narrowing or spasm of coronary arteries

46
Q

Sx of angina pectoris

A

substernal pain in left shoulder, arm, or mandible, PRESSURE, SQUEEZING OR BURNING ,
SOB, fatigue, lightheadedness.

47
Q

angina pectoris is relieved by

A

rest and nitroglycerin

48
Q

mgmt for angina pectoris

A

terminate tx
comfy position
call 911
ABCs and vitals
give sublingual nitroglycerin **about .4mg - wait 5 min.
Repeat if no relief 2-3 times
If no relieve with N, give 4 NON-ENTERIC ASPIRIN (81MG EA)

49
Q

T/F: An MI is the same as sudden cardiac arrest

A

no - MI is diminished O2 (circulation prob) causing injury whereas cardiac arrest is electrical issue causing erratic heartbeat or stop

is persistent angina pectoris that is NOT responsive to nitroglycerin over 15min pd (3 doses)

50
Q

how long to defer dental tx after cardiac insult (MI)

A

6 months

51
Q

time after cardiac insult and re-infarction rate:

< 4mo
4-6mo
> 6mo

A

30%
15%
< 5%

52
Q

T/F: Pt has a pulse with MI.

A

True. (no pulse or breathing with cardiac arrest)

53
Q

Tx for cardiac arrest

A

call 911
CPR and AED

54
Q

how long for anaphylaxis to occur

A

seconds to minutes - a type 1 hypersensitivity rxn

55
Q

Immunoglobulin that initially responds in anaphylaxis

vs re-exposure

A

initially IgE just gets produced

@ re-expsoure, IgE binds mast cells causing histamine & other mediators to be released = anaphylaxis

56
Q

signs and Sx of anaphylaxis

A

ITCHY
angioedema
cough, dyspnea, WHEEZING, difficulty to BREATHE
flush, hypOtensive,
seizure
unconsciousness

57
Q

medication for anaphylaxis

give medicine before calling 911, or 911 first?

A

IM Epi
- adult 0.3mg
- child 0.15mg

911 first

58
Q

T/F: Not all allergic reactions are anaphylaxis

what is medicine for allergic rxn (cutaneous)

A

true

diphenhydramine (benadryl 25-50mg qid)

59
Q

Seizure can be caused by:

A

TBI, stroke, tumor, infection, CVD, medication non-compliance …

60
Q

seizures typically last how long

A

< 5 min

61
Q

what seizure medications have gingival hyperplasia risk

A

Dilantin/ phenytoin

62
Q

prodromal phase of seizure is called:

A

Aura phase - visual and auditory disturbances momentarily before siezure starts
- blank stare or crying out

63
Q

arching of back during a seizure is called

A

opisthotonos (clonic phase)

64
Q

T/F: during seizure, pt should not be restrained

A

true. only guide extremities and stabilize to protect from injury

65
Q

if possible, put seizing pt in what position

A

supine

66
Q

Time the siezure: mgmt for < or > 5 min

A

< 5 min: discharge pt once stable.
> 5 min: call 911

67
Q

diagnostic tests to obtain it pt has:
1. liver disorder

  1. plavix, aspirin, other nsaids
  2. thrombocytopenia
  3. anticoags: warfarin, pradaxa, Xarelto/Eliquis
  4. Heparin
A
  1. PT, aPTT, INR
  2. bleeding time or platelt function test
  3. CBC
  4. warfarin INR; others no test needed
  5. aPTT
68
Q

CBC with differential test reports what info

A

RBC and WBC count
platelet count
hemoglobin and hematocrit

69
Q

bleedig time test gives what info

A

how fast stop bleeding (normal is 3-10 min)

70
Q

prothrombin time test provides what info

A

EXTRINSIC pathway of coagulation (10-14 sec normal)

71
Q

aPTT tells what info

A

response to heparin (normal is 25-45sec)

72
Q

INR gives what info

A

used with PT to assess EXTRINSIC cascade

73
Q

INR test is used only for:

A

warfarin or liver disease.
*** pt on warfarin MUST have updated INR within 2 days of appt

74
Q

normal INR result=

should pt discontinue medicine for dental procedure?

A

2-3 for patients on warfarin

do not discontinue as risk of stroke/MI is greater

75
Q

contraindications to dental tx:

A

bleeding time > 10 min
platelet ct less than 150k
aPTT > 45 sec
PT > 15 sec
IN > 3.0

Surg Perio (1 decks)

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