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Perio Residency > Medical Emergencies in Dental Office > Flashcards

Medical Emergencies in Dental Office Flashcards

1
Q

What are the top 12 emergencies seen in the dental office?

A
  1. syncope (~50%)
  2. mild allergic reaction
  3. angina pectoris
  4. postural hypotension
  5. seizure
  6. asthma attack
  7. hyperventilation
  8. epinephrine reaction
  9. hypoglycemia
  10. cardiac arrests
  11. anaphylactic reaction
  12. myocardial infarction
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2
Q

What are the differences between myocardial infarction, angina pectoris, cardiac arrest?

A

MI/Coronary Artery Disease: when plaque builds up (atherosclerosis) in the arteries and blocks the blood flow to parts of the heart.

Angina pectoris: chest pain caused by CAD, lack of blood flow to the heart muscle

Cardiac arrest: is caused by the malfunction of the electrical system of the heart

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3
Q

List things that can cause chest pain

A
  1. cardiac
    - rapid heart rate (tachycardia)
    - CAD/MI
  2. pulmonary
    - pleurisy (pleura separated)
    - infection
    - pneumothorax (lung collapsed)
  3. esophageal/GI
  4. Great vessel injury (could be fatal)
  5. musculoskeletal
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4
Q

What is the basic protocol for a patient udnergoing MI?

A 
MONA
M- morphine
O- oxygen 
N- nitroglycerine (vasodilation)
A= aspirin
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5
Q

What other things should you do when a patient undergoes MI?

A
  • consider nitrous
  • monitor vital signs and record
  • perform CPR when indicated
  • transport ot ER ASAP
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6
Q

How do you managae a patient with history of MI?

A
  • defer surgery for 6 months
  • check for anticoagulants
  • reduce anxiety
  • nitroglycerine premedication
  • consider supplemental O2 and N2O
  • limit epi
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7
Q

What are the epi recommended max doses for a healthy patietn vs cardiovascular impaired?

A

Normal = 0.2 mg (10 carps)

Cardio impaired = 0.04 mg (2 carps)

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8
Q

What to do if an anaphylactic reaction occurs?

A
  • administer epi if necessary
  • administer antihistamine (benadryl 50 mg IM)
  • consider steroids (cortisol)
  • support airway as needed
  • consider transport to ER
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9
Q

If a patient is experiencing an anaphylactic reaction what dose of antihistamine would you give?

A

benadryl 50mg IM

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10
Q

What are the signs of cardiac arrest?

A

Cardiac arrest can happen suddenly - sudden loss of responsiveness and no normal breathing.

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11
Q

What is the protocol for cardiac arrest?

A
  1. Yell for help.
  2. Tell someone nearby to call 911 or your emergency response number. Ask that person or another bystander to bring you an AED (automated external defibrillator), if there’s one on hand. Tell them to hurry – time is of the essence.
  3. If you’re alone with an adult who has these signs of cardiac arrest, call 911 and get an AED (if one is available).
  4. Check breathing If the person isn’t breathing or is only gasping, administer CPR.
  5. Give CPR: Push hard and fast Push down at least two inches at a rate of 100 to 120 pushes a minute in the center of the chest, allowing the chest to come back up to its normal position after each push.
  6. Use an AED Use the automated external defibrillator as soon as it arrives. Turn it on and follow the prompts.
  7. Keep pushing Continue administering CPR until the person starts to breathe or move, or until someone with more advanced training takes over, such as an EMS team member.
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12
Q

What are the signs of hypoglycemia? The symptoms depend on rate of fall of blood sugar.

A 
tachycardia
diaphoresis (sweating)
anxiety
hyperventilation 
hunger
nausea
disorientation 
seizures
bradycardia 
bradypnea (slow breathing rate)
hypotension
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13
Q

What are the signs of hyperglycemia?

A

loss of consciousness

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14
Q

What should you do if a patient undergoes hypoglycemia?

A
  • supplemntal O2
  • monitor vitals
  • administer glucose
  • administer glucagon
  • transport patient
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15
Q

What should you do if a patient undergoes hyperglycemia?

A
  • supplement O2
  • monitor vitals
  • transport patient ASAP if patient starts losing consciousness
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16
Q

What are the signs of epi reaction? (overdose epi)

A

tachycardia
hypertension
fever
anxiousness

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17
Q

What do you do when a patient experiences epi reaction?

A
  • seated or supine position
  • supplemental O2
  • monitor vitals
  • consider sedation
  • consider administer esmolol/labetalol
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18
Q

what drug could you administer to treat epi overdose? what is esmolol/labetalol? what is it’s mechanism?

A

esmolol/labetalol 20 mg IV; esmolol is a antiarrythmic; cardioselective beta1 receptor blocker with rapid onset, a very short duration of action, and no significant intrinsic sympathomimetic or membrane stabilising activity at therapeutic dosages. It is a class II antiarrhythmic

19
Q

What are the signs and symptoms of hyperventilation?

A 
anxious 
air hunger
tachypnea (fast breathing)
perioral and extremity tingling
alter level of consciousness
20
Q

What can you do to help with hyperventilation?

A

Breath CO2 enriched air
Anxiety reduction
Consider benzodiazepine

21
Q

What are the signs and symptoms of asthma?

A

Wheezing
Tachypnea
Hypoxemia
Shortness of breath (SOB)

22
Q

What happens if you see a patient that has asthma and asthma like diseases ie bronchospasm and mucus secretion?

A
  • defer if recent upper respiratory tract infection
  • consider listening to lungs
  • consider pretreatment with bronchodilation
  • consider supplemental oxygen
  • epi containing local anesthetic
  • avoid aspirin
23
Q

What happens if a patient has an acute bronchospasm (status asthmaticus)?

A
  • avoid supine position
  • supplmental O2
  • administer bronchodilating inhaler (albuterol 1-2 puffs)
  • administer epi 0.3 mg IV
  • consider antihistamine (benadryl 25-50 mg IM or IV)
  • consider sterioids
  • transport to ER ASAP
24
Q

What to do if your patient has laryngospasm?

A
  • consider muscle relaxants (succinylcholine 20-40 mg IV)
  • consider epi (0.3 mg) IV
  • transport ER
25
Q

What to do if your patient has bronchospasm?

A
  • admin epi 0.3 mg IV
  • O2
  • consider albuterol 2 puffs
  • consider antihistamine (benadryl 25-50 mg IM or IV)
  • consider steroids
26
Q

What to do if patient undergoes a SE (status epilepticus) seizure? (SE seizures are the worst seizures)

A

A seiure is considered a SE if it lasts for more than 5 minutes.
Intervene when you suspect seizure is lasting for more than 5 minutes.

27
Q

What are the steps of intervening SE seizure?

A

Stabilize and assess the patient. Determine the time of onset of seizure and determine if the seizure is based on history or not.

28
Q

What are the steps in stabilizing and assessing the patient?

A
  1. check ABC’s - evaluate/maintain the airway (reposition/suction); assess and support ventilation; monitor vital signs
  2. check vascular access
  3. time of seizure onset
  4. check glucose (if glucose <40 mg/dl administer 5 ml/kg D10w)
  5. antipyretics as needed (anti-fever)
  6. start initial IV therapy = Midazolam IM or IV 5-10 mg
  7. supplemental O2
29
Q

What are the signs of drug overdose?

A
  • perioral and extremity numbness
  • talkativeness
  • seizures
  • LOC
  • hypotension
  • bradycardia
  • asystole
30
Q

What to do if your patient is experiencing drug overdose?

A
  • place patient in supine position
  • supplement O2
  • monitor vitals
  • manage seizures
  • manage CV abnormalities
  • transport ASAP
31
Q

What are the signs of postural hypotension?

A
  • altered level of consciousness
  • LOC
  • tachycardia
  • diaphoresis
32
Q

What are the signs of angina pectoris?

A
  • chest pain (jaw, neck, arm, epigastrium)
  • diaphoresis
  • hypotension
33
Q

What is considered a stable angina?

A

unchanging in frequency and intensity

34
Q

What to do if a patient reports a med hx of regular minor chest pains?

A
  • short, afternoon appts
  • limit epi use
  • premedication nitroglycerine
  • consider nitrous
  • consider supplemental O2
35
Q

What to do i patient experiences unstable angina?

A

this is a medical emergency, risk of MI –> defer treatment, supplement O2, admin nitroglycerine, consider nitrous and transport to ER

36
Q

What is considered unstable angina?

A

chest pain of new onsetm increasing frequencu or intensity, pain at rest

37
Q

What to do if patient experiences mild allergic reactions?

A
  • supplement O2
  • monitor vitals
  • admin antihistamine (benadryl 50 mg IV or IM)
  • consider steroids (cortisol)
  • initiate CPR as needed
38
Q

what are the types of syncope? (9)

A
  • vasovagal syncope
  • postural hypotension
  • hyperbradykininemia
  • cardiac syncope
  • carotid sinus syncope
  • vagal and glossopharyngeal - neuralgia
  • tussive syncope
  • syncope assoc w/ cerebrovascular dx
  • medication induced
39
Q

What is the etiology of vasovagal syncope?

A

emotional stress
injury
pain
exacerbated by poor physical condition

40
Q

what are the signs and symptoms of vasovagal syncope?

A 
nausea
confusion
perspiration
tachycardia
yawning
pupillary dilation
epigastric distress
hyperpnea (breathing more deeply)
tachypnea (more frequent breaths)
weakness
41
Q

what to do if patient experiences vasovagal syncope?

A

trendelenburg position
supplemental O2
monitor vitals
**atropine rarely needed

42
Q

what is the etiology of cerebral vascular accident?

A
  • disturbance of blood flow
  • focal neurological deficits
  • hemiparesis
  • LOC
  • silent
43
Q

what is the most common etiology of cerebral vascular accidents?

A

embolic

44
Q

what does you do if you suspect a patient experiences an embolism?

A
  • supplement O2
  • monitor vitals
  • CPR if indicated
    consider aspirin
  • consider IV access
  • transport ER ASAP

Perio Residency (1 decks)

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