Medical Emergencies in the Dental Office

Question 1

it is estimated that each dentist will experience - to - life threatening emergencies during his or her professional career

Answer 1

1-2

Question 2

preparation

Answer 2

FEMA’s: motivates people and communities to take action to prepare for and protect themselves against disasters

Question 3

category 1: minor

Answer 3

simple fate

Question 4

trendelenburg position

Answer 4

the body is laid supine or flat with a 15-30 degree incline with the feet elevated above the head

Question 5

category 2: intermediate

Answer 5

O2 + repositioning

Question 6

category 3: major

Answer 6

referral to MD or hopsital (ER)

Question 7

ideal blood pressure

Answer 7

120/80

Question 8

ideal heart rate and rhythm

Answer 8

60-110

Question 9

ideal respiratory rate

Answer 9

16-18

Question 10

determination of medical risks (5)

Answer 10

medical history questionnaire 
physical evaluation 
dialogue history 
medical consultation (if necessary)
ASA classification

Question 11

what we might see in the dental office (8)

Answer 11

bleeding that will not stop
breathing problems (difficulty breathing, shortness of breath)
change in mental status (unusual behavior, confusion)
chest pain
choking
coughing up or vomiting blood
fainting or loss of conciousness

Question 12

ASA 1

Answer 12

healthy patient, no systemic disease

Question 13

ASA 2

Answer 13

mild systemic disease

Question 14

ASA 3

Answer 14

severe systemic disease

Question 15

ASAA 4

Answer 15

incapacitating systemic disease that is a constant threat to life

Question 16

ASA 5

Answer 16

moribund patient not expected to survive 24 hours without an operation

Question 17

ASA 6

Answer 17

brain dead, organ harvest for donation

Question 18

ASA E

Answer 18

emergency operation

added to patients physical status classification

Question 19

levels of consciousness (4)

Answer 19

awake
altered
unconscious
seizures

Question 20

altered

Answer 20

pre-syncope, TIA (ischemic attack, mini stroke)

Question 21

unconscious

Answer 21

syncope, orthostatic hypotension

Question 22

seizures

Answer 22

hyperventilation, syncope, epilepsy

Question 23

airway- breathing (4)

Answer 23

obstruction
hyperventilation
asthma
COPD, emphysema

Question 24

cardiovascular (5)

Answer 24

angina 
hypo/hypertension
dysrhythmia 
myocardial infarction
cardiac arrest

Question 25

angina

Answer 25

chest pain

Question 26

dysrhythmia

Answer 26

bradycardia, tachycardia

Question 27

drug related overdoes (overdose)

Answer 27

local anesthetics | sedatives

Question 28

reaction to drugs

Answer 28

allergy (rash, itching, airway)

Question 29

goals of physical evaluation (6)

Answer 29

ability to psychologically tolerate stress ability to physically tolerate treatment is treatment modification indicated is psychosedation indicated which sedation technique is indicated any contraindications to premedications used

Question 30

recognition of anxiety (6)

Answer 30

``` increased BP and pulse trembling diaphoresis restlessness hyperventilation dilated pupils ```

Question 31

stress reductional protocol (8)

Answer 31

``` oral sedation (pm and am) intraoperative sedation effective pain control - local anesthesia AM appointment time factor - short appointments hot and humid weather post-op RX prn post-op phone call ```

Question 32

treatment modifications (6)

Answer 32

``` intra-op oxygen sedation - oral, N2O, IV patient position antibiotic premedication cardiac pacemaker or defibrillator anticoagulant ```

Question 33

syncope

Answer 33

a transient loss of consciousness due to hypo perfusion of the brain and is characterized by a rapid onset and spontaneous resolution a transient vascular and neurogenic reaction marked by pallor, nausea, sweating, bradycardia, and rapid fall in BP, which when below a critical Lebel, results in loss of consciousness due to generalized cerebral ischemia usually evoke by emotional stress associated with fear or pain

Question 34

orthostatic hypotension

Answer 34

a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within 3 minutes of standing when compared with baseline BP

Question 35

orthostatic hypotension increases with

Answer 35

age

Question 36

syncope (pathophysiology) (7)

Answer 36

``` stimulation of sympathetic system fear or anxiety greater than 20% bone loss rapid head up position decreased cerebral flow reflex bradycardia complete recovery takes 24 hours ```

Question 37

syncope (psychogenic factors) (6)

Answer 37

``` fright or anxiety pain emotional stress sight of blood sight of dental instruments unwelcome news ```

Question 38

causes of syncope (5)

Answer 38

``` upright or stand positions for extended periods of time hunger exhaustion poor physical condition hot humid crowded environment ```

Question 39

vasovagal syncope (3)

Answer 39

sudden, rapid drop in HR and BP which leads to fainting most common cause of syncope (about 32%) most patients experience their first episode as a teenage or adolescent

Question 40

syncope manifestations (7) (symptoms)

Answer 40

``` warmth loss of color sweating feels bad nausea BP at baseline tachycardia ```

Question 41

late syncope manifestations (7)

Answer 41

``` yawning difficult breathing pupillary dilation cold hands and feet dizziness loss of consciousness hypotension and bradycardia ```

Question 42

syncope treatment (8)

Answer 42

``` position patient horizontally airway and breathing circulation- vital signs oxygen cool compress aromatic spirits of ammonia loosen clothing reassurance ```

Question 43

prevention of hyperventilation (4)

Answer 43

medical history physical exam recognize signs of anxiety stress reduction protocol

Question 44

hyperventilation

Answer 44

to breathe at an abnormally rapid rate, so increasing the rate of loss of carbon dioxide

Question 45

in hyperventilation, rate of removal of CO2 from the blood is

Answer 45

increased

Question 46

as the partial pressure of CO2 in the blood decreases,

Answer 46

respiratory alkalosis ensues

Question 47

symptoms of hyperventilation (4)

Answer 47

tightness is chest - suffocation rapid respiration - rapid pulse light headless - apprehension lump in throat - precordial pain

Question 48

signs and symptoms of hyperventilation (5)

Answer 48

``` rapid and shallow breathing confusion dizziness cold hands carpal-deal spasms; can lead to seizures ```

Question 49

hyperventilation management (7)

Answer 49

``` terminate procedure position comfortably - usually upright rassure patient no oxygen breathe into paper bag or headrest cover count to ten between breaths valium 5 mg IM or IV for severe cases ```