Medical Emergencies Flashcards
___% of over 5000 dentists reported 1 or more emergencies over a 10 year period. According to another survey, dentists will experience ___ emergencies in their lifetime, usually during what procedure? 76% of medical emergencies are due to ___
90%
7.5 (38% occurred during extraction procedures)
Stress
___ is the best medicine to treat emergencies
Prevention
Prevention begins when ________. What are some things you can do to prevent medical emergencies.
The patient enters your office
Training
Have important phone numbers on hand
Go over the health hx
Have proper equipment
What are 7 basic questions you should ask about their health history to prevent medical emergencies?
1) do you have any allergies
2) is there a hx of bleeding
3) do you have SOB
4) do you have or had CP
5) are you taking any medications
6) have you ever been admitted to the hospital
7) are you taking any herbal supplements? (Drug-drug interactions, metabolites. Often cause increase in bleeding.)
What is some office equipment you should have in case of emergencies?
Oxygen tank (green) Ambu bags (given if they are having difficult time breathing) Tonsil suction Forceps Oral airways Flashlight Syringes/needles Venturi suction (portable (in case power goes out)
Medications
What does PRAY stand for in regards to the hierarchy of medical emergencies?
P: prepare in a timely, efficient manner
R: recognition of predisposing signs/symptoms
A: action plan to stabilize pt
Y: yell to know where to obtain help
What are the two classification so medical problems?
Less than life-threatening
Life threatening
Name 7 emergency medications that should be kept in the office.
Epinephrine
Diphenhydramine
Diazepam
Naloxone
Hydrocortisone
Meperidine
50% dextrose
What are 6 monitoring equipment devices that should be kept in the office?
BP
Electrocardiogram
Pulse oximeter
Capnography
Temperature monitor
Defibrillator device
What is the most common emergency in private practice? What is the second and third most common emergency?
1) syncope
2) mild allergic reaction
3) angina pectoris
What is the differential diagnosis for loss of consciousness?
Syncope Orthostatic hypotension Adrenal insufficiency Allergic reaction Airway obstruction Seizures MI/arrhythmia Hypoglycemia Stroke Drug overdose
What is the differential diagnosis for respiratory distress?
Airway obstruction (laryngospasm, foreign body)
Hyperventilation
Allergic reaction (anaphylactic vs. anaphylactioid)
COPD
CHF (pulmonary edema, dyspnea, pe)
What is the differential diagnosis for cardiovascular diseases… chest pain, BP, cardiac dysrythmias?
Chest pain: angina pectoris, MI
BP: HTN, hypotension, stroke
Cardiac dysrhythmias: bradycardia, tachycardia, arrhythmias
What are some drugs that can cause orthostatic hypotension?
Anti-HTNs
Phenothiazines
Tricyclic anti-depressants
Narcotics
Anti-parkinson drugs
What are some non-drug related causes for orthostatic hypotension?
Starvation/exhaustion
Poor postural reflex
Pregnancy
Venous pooling in legs
Endocrine dysfunction (addison’s disease)
What do you do to prevent orthostatic hypotension?
Raise pt slowly and assist pt
Check BP preop and postop
What do you do to treat orthostatic hypotension?
Monitor vital signs
Keep in supine position (feet elevated)
Maintain airway
What is the treatment for vasodepressor syncope?
Keep in supine position with feet elevated
Maintain airway
Monitor vital signs
Ammonia vaporale
Cold towels
Oxygen by cannula, nasal hood
What is the normal blood glucose level?
<110 mg/dl
Fasting Hba1c <6
What are the signs and symptoms of hypoglycemia?
Sudden onset
Insulin dosing and no food
Moist skin, drooling
Strong pulse
Tremors, convulsions
What are the signs/symptoms of hyperglycemia?
Gradual onset, no insulin, food
Dry skin, thirst, abdominal pain
Deep respirations
Weak and rapid pulse
Acetone breath
Match the finger stick (mg/dl) levels to Hba1c levels.
135
170
205
135 = 6 170 = 7 205 = 8
What is the treatment for hypoglycemia?
Oral carbohydrate under tongue
IV access: 50% dextrose, push slowly
If convulsions: loosen clothing, activate 911
Oxygen by cannula: 4L/min
What is the treatment of hyperglycemia?
Insulin at hospital
Activate EMS
BCLS
Glucose finger stick
What are the signs and symptoms of laryngospasms?
Increase RE
Crowing sounds
No air movement
Developing cardiac arrhythmia
What is the treatment of laryngospasms?
Pack off site
100% oxygen
Suction
Alter tongue position
What is the treatment of chest pain?
Stop procedure
Place pt in comfortable position
Loosen clothing
Can give nitroglycerine
Give oxygen
What category is this pt according to their BP?
120-139/80-89
Prehypertension
What is the category of pt according to their BP?
140-159/90-99
Stage 1
What is the category of pt according to their BP?
Over 160/over 100
Stage 2 hypertension
What are the signs and symptoms of a stroke?
Headache
Weakness/paralysis
Altered/slurred speech
Vertigo
Nausea, vomiting
What is the treatment of a stroke?
Stop procedure
Administer oxygen
If conscious: call EMS
If unconscious: basic cardiac life support
Both hyperthyroidism and hypothyroidism may cause altered consciousness. What are their signs and symptoms?
Hyperthyroidism: anxiety, tremors, elevated BP, racing pulse, flushed moist skin
Hypothyroidism: lethargic, decreased speech, bradycardia with elevated or lowered BP, edema, course skin, cold intolerance
What should you avoid in hypothyroid pts and hyperthyroid pts?
Avoid CNS depressants in hypothyroidism
Avoid epinephrine in hyperthyroidism
Most LA systemic complications occur when?
During or after LA
What are the signs and symptoms of an epinephrine overdose?
Palpitations
Flushing
Diaphoretic
Headache
Anxiety
Briefly describe the 4 types of allergic reaction.
Type 1: anaphylactic. IgE. Occurs within seconds to minutes
Type 2: cytotoxic. Activates complement. (IgG and IgM)
Type 3: immune complexes form. (IgG) Occurs within 6-8 hours
Type 4: cell mediated. Delayed. Occurs within 48 hours
What do you do to manage rapid onset allergic skin reactions that have no CVS or respiratory involvement?
Administer oral or IM histamine blocker
Allow recovery ad discharge pt
What do you do to manage a rapid onset allergic skin reaction with CVS and/or respiratory involvement?
Administer oxygen and perform venipuncture
Reposition patient
Keep supine with legs elevated
Administer histamine blocker
