Medical emergencies Flashcards
1
Q
how many emergencies are life threatening
A
- about a third
- increasing age of population will lead to increase in medical emergencies
2
Q
what should the office emergency kit be based on
A
- the office patient population
- distance to the nearest hospital
- rapid availability of skilled EMS services and
- the dental clinicians’ skill and comfort in using the medications and equipment
3
Q
what are the most common emergencies
A
- syncope
- mild allergic reactions
- angina pectoris
- orthostatic hypotension
- most likely to occur after the administration of a local anesthetic, extraction or endodontics
4
Q
how can we prevent emergencies
A
- thorough medical history
- vital signs
- preparing for medical emergency
5
Q
what steps should be followed for medical emergencies in the dental office
A
- stop dental procedures
- call for assistance (911)
- get someone to bring oxygen and emergency kit
- monitor vital signs
- be prepared to support respiration, support circulation, call for additional help
6
Q
how can we prepare for dental emergencies
A
- well-equipped medical emergency kit with O2 tank
- current CPR training
- attendance at CE courses on medical emergencies
- in-office simulated medical emergencies
7
Q
what is the emergency team structure
A
- P1: person in whose operator emergency is occurring. stays with patient, performs emergency procedure
- P2: next most available person. assist P1, responsible for vital signs and application of oxygen, records events and informs clinician of time elapsed since medication delivered
- P3: next available person. retrieves emergency kit, prepares emergencies drugs for P1
- office receptionist: makes all necessary phone calls
8
Q
what is the emergency kit
A
- simple and includes only materials with which the dental team is familiar and will use
- there is no mandatory list of emergency drugs that must be maintained in every dental office
- consider location. urban setting with quick EMS response time – less components; rural setting – full complement of products
9
Q
what are essential drugs
A
- epinephrine
- nitroglycerine
- diphenhydramine or chlorpheneramine (injection possibly)
- salbutamol
- aspirin
- oral carbohydrate
- glucagon
- atropine
- corticosteroid
- injectable benzodiazepine
10
Q
what is epinephrine used for in dental emergencies
A
- anaphylaxis
- counteracts major physiological events in anaphylaxis
- reduces hypotension, bronchospasm, laryngeal edema, prevents additional release of histamine and other chemical mediators
- rapid onset and short duration
- adult dosage - 0.3 mg of 1:1000 concentration for intramuscular and intralingual injections
- paediatric dosage - 0.3 mg and 1:2000 concentration
- severe asthma attack
- should not use with ischemic heart disease or severe hypertension
11
Q
what is nitroglycerine used for in dental emergencies
A
- angina pectoris, MI or CHF
- dilates coronary blood vessels
- rapid onset
- tablet and spray form
- tablets become impotent if exposed to light or air
- shelf life reduced to 12 weeks
- spray shelf life usually 2 years
- administer sublingually
- administer at 5 minute intervals – up to 3 doses
- should not administer if systolic BP < 90 mmHg
12
Q
what is diphenhydramine or chlorpheneramine used for in dental emergencies
A
- moderate allergic reaction with respiratory symptoms
- mild, non-life threatening allergic reactions
- oral histamine blocker
injection: - chlorpheneramine - 10 mg or diphenhydramine 25-50 mg
- paediatric dose is 1 mg/kg of body weight and should not exceed adult dose
- chlorpheneamine does not cause as much drowsiness
13
Q
what is salbutamol used for in dental emergencies
A
- asthma attach or bronchospasm
- inhaler
- dilation of bronchioles with minimal cardiovascular side effects
- quick onset - 30-60 mins
- long duration of actions - 4-6 hours
- adult dose 2 sprays
- paediatric dose 1 spray
- can repeat dose if necessary
14
Q
what is aspirin used for in dental emergencies
A
- reduces overall mortality from MI
- prevents progression of cardiac ischemia to cardiac injury or cardiac tissue death
- recommended dose 162 mg - 325 mg: 2-4 baby aspirin (81 mg each)
- check medical history for allergy
15
Q
what are oral carbohydrates used for in dental emergencies
A
- hypoglycemia
- not actually a drug, but inclusion necessary
- paste or tablets do not require refrigeration
16
Q
what is glucagon used for in dental emergencies
A
- unconscious hypoglycaemic patient administered IM
- adult dose - 1 mg
- paediatric dose - 0.5 mg
17
Q
what is atropine used for in dental emergencies
A
- hypotension
- increases heart rate which may also increase BP
- recommended dosage - 0.5 mg/mL IM
- 3 mg maximum
18
Q
what is corticosteroid used for in dental emergencies
A
- prevention of recurrence of anaphylaxis
- adrenal crisis
- 100 mg hydrocortisone drug of choice for dental office emergency kit
- reduce histamine release
- slow onset > 1 hour
19
Q
what is injectable benzodiazepine used for in dental emergencies
A
- prolonged seizures or hyperventilation
- skeletal muscle relaxation - anticonvulsant
- lorazepam drug of choice
- 4 mg IM
20
Q
what are some additional items we should keep in the emergency kit
A
- BP cuff and stethoscope
- thermometer with sleeves
- pocket mask with one way valve
- syringes
- perioretriever
- bandaids and sterile gauze
- ice pack
- AED
21
Q
contents of an oulton college medical emergency kit
A
- diphenhydramine
- epipen
- nitroglycerine spray
- dextrosol
- clindamycin
- amoxicillin
- salbutamol
- syringes 1.0 mL
- ASA 81 mg
- blood glucose monitor
- blood glucose strips
- thermometer
- polysporin cold sore
- polysporin
- pair of scissors
- tweezers
- safety pins
- liquid bandage
- gauze pads
- gauze bandages
- adhesive bandages
- triangular bandages
- adhesive tape
- PEG lotion
- pair of examination gloves
- resguard CPR protection device
- cotton tip applicators
- antiseptic toilettes
- tongue depressors
- hydrogen peroxide
