Medical Emergencies in the Dental Office Flashcards
it is estimated that each dentist will experience - to - life threatening emergencies during his or her professional career
1-2
preparation
FEMA’s: motivates people and communities to take action to prepare for and protect themselves against disasters
category 1: minor
simple fate
trendelenburg position
the body is laid supine or flat with a 15-30 degree incline with the feet elevated above the head
category 2: intermediate
O2 + repositioning
category 3: major
referral to MD or hopsital (ER)
ideal blood pressure
120/80
ideal heart rate and rhythm
60-110
ideal respiratory rate
16-18
determination of medical risks (5)
medical history questionnaire physical evaluation dialogue history medical consultation (if necessary) ASA classification
what we might see in the dental office (8)
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
ASA 1
healthy patient, no systemic disease
ASA 2
mild systemic disease
ASA 3
severe systemic disease
ASAA 4
incapacitating systemic disease that is a constant threat to life
ASA 5
moribund patient not expected to survive 24 hours without an operation
ASA 6
brain dead, organ harvest for donation
ASA E
emergency operation
added to patients physical status classification
levels of consciousness (4)
awake
altered
unconscious
seizures
altered
pre-syncope, TIA (ischemic attack, mini stroke)
unconscious
syncope, orthostatic hypotension
seizures
hyperventilation, syncope, epilepsy
airway- breathing (4)
obstruction
hyperventilation
asthma
COPD, emphysema
cardiovascular (5)
angina hypo/hypertension dysrhythmia myocardial infarction cardiac arrest
angina
chest pain
dysrhythmia
bradycardia, tachycardia
drug related overdoes (overdose)
local anesthetics
sedatives
reaction to drugs
allergy (rash, itching, airway)
goals of physical evaluation (6)
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
recognition of anxiety (6)
increased BP and pulse trembling diaphoresis restlessness hyperventilation dilated pupils
stress reductional protocol (8)
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
treatment modifications (6)
intra-op oxygen sedation - oral, N2O, IV patient position antibiotic premedication cardiac pacemaker or defibrillator anticoagulant
syncope
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
orthostatic hypotension
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
orthostatic hypotension increases with
age
syncope (pathophysiology) (7)
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
syncope (psychogenic factors) (6)
fright or anxiety pain emotional stress sight of blood sight of dental instruments unwelcome news
causes of syncope (5)
upright or stand positions for extended periods of time hunger exhaustion poor physical condition hot humid crowded environment
vasovagal syncope (3)
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
syncope manifestations (7) (symptoms)
warmth loss of color sweating feels bad nausea BP at baseline tachycardia
late syncope manifestations (7)
yawning difficult breathing pupillary dilation cold hands and feet dizziness loss of consciousness hypotension and bradycardia
syncope treatment (8)
position patient horizontally airway and breathing circulation- vital signs oxygen cool compress aromatic spirits of ammonia loosen clothing reassurance
prevention of hyperventilation (4)
medical history
physical exam
recognize signs of anxiety
stress reduction protocol
hyperventilation
to breathe at an abnormally rapid rate, so increasing the rate of loss of carbon dioxide
in hyperventilation, rate of removal of CO2 from the blood is
increased
as the partial pressure of CO2 in the blood decreases,
respiratory alkalosis ensues
symptoms of hyperventilation (4)
tightness is chest - suffocation
rapid respiration - rapid pulse
light headless - apprehension
lump in throat - precordial pain
signs and symptoms of hyperventilation (5)
rapid and shallow breathing confusion dizziness cold hands carpal-deal spasms; can lead to seizures
hyperventilation management (7)
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
