Medical Emergencies in the Dental Office Flashcards
3 components of emergency drills
1-keep it simple
2- designate a specific task to each staff member
3-quarterly drills
ABCs of any emergancy
- supine position
- 100% oxygen
- Airway, Breathing, Circulation
- vitals
- knowledge of AED
5 things to include in documenting of an ermergency
1-history of event 2- positive primary and secondary survey 3- tx provided 4-time of events 5-disposition
what is the most common medical emergency in dentistry?
vasodepression synope
*30% of adults will have this at some point
what is the etiology of syncope?
decreased cerebral blood flow
what are some common causes of syncope?
needles, stress, fear, pain, etc
what is the differential for syncope?
- anxiety
- hyperventilation syndrome
- MI
- hypoglycemia
- epilepsy
- hypotension
- neurocardiogenic syncope
early pre-syncope signs
nausea, warmth, sweating, loss of color, tachycardia
late pre-syncope signs
hypotension, bradycardia, pupil dilation, coldness, visual disturbances, loss of consciousness
what are the phases of syncope?
1-decreases CBF
2-loss of consciousness
3-loss of postural tone
*if you are out for longer than a couple minutes you can get seizures
risk of cardiovascular disease doubles for every increment of ____ mmHg of systolic or every ___ mm Hg of diastolic bp
20, 10
if over 50 ears old, a systolic BP of what is a more important risk factor than diastolic?
> 140
stage 1 hypertension
140-159/or90-99
*confirm BP, proceed with elective tx, recheck BP
stage 2 hypertension
> 160/or100
*emergency tx, see dr. before elective tx
2nd most common cause of loss of consciousness in dental office?
orthostatic hypotension
**standing systolic drops by 25, standing diastolic drops 10
why do the elderly get orthostatic hypotension?
decreased baroreflex mechanism. impairs cardiac response to preload
*meds can make worse, elderly are most susceptible
what two things should a diabetic patient be instructed to do prior to an appointment?
Eat and take their meds prior to coming in
what are some common ways patients will become hypoglycemic?
too much insulin, alcohol, too much exercise, missed meal
Autonomic symptoms of hypoglycemia
sweating, trembling, palpitations, anxiety, nausea
Neuroglycopenic symptoms
dizziness confusion difficulty speaking headache inability to concentrate weakness blurred vision
Tx for the hypoglycemic patient
give sugary food/water, seek med. attention, give glucose
**if tx is delayed, death or serious injury may result
What are some cause of seizures?
brain tumor/injury, poison, electric shock, heat stroke, fever, etc.
What are some symptoms of seizures?
muscle rigidity, short scream, drooling, etc
If a patient is having a seizure, what are two things you should NOT do?
1- Do NOT put anything in patient’s mouth
2-Do NOT hold patient down
What are 3 possible sequelae of aspiration in the dental office?
1-infection
2-pneumonia
3-lung abscess
2 steps to remove a dropped object in the mouth
1-suction
2-use forceps (martin or magill)
3 steps if object falls in px throat?
1-position dental chair with head below chest
2-turn px on their side
3-if object is retrieved, dismiss them without radiographs
What are Some symptoms of anaphylactic shock?
Coughing, itching/hives, swelling, bluish skin, perioral edema, weakness, etc
What are some Tx for anaphylactic shock featuring respiratory distress?
1-supine position, summon EMS, ABCs, O2,
2-EPI pen (IM or SC) or diphenhydramine (IV or IM)
What are some Tx for anaphylactic shock featuring milder symptoms like itching?
1-diphenhydramine (IM or IV)
2-monitor px to make sure it does not progress to shock
Local anesthetics are linked to what percent of dental office deaths?
50%
what is the max dose of epinephrine for cardiac patients?
.04 mg
*this equates to 2 carps of LA with 1:100,000 epi
Tx for LA overdose
position px comfortably, give O2, if bp is elevated with cerebrovascuar accident call EMS, if no cerebrovascular problems, send home.
Do asthmatics have a more challenging time inhaling or exhaling?
exhaling
*remind px to bring inhaler
what two things should you not give an asthmatic px?
1-Aspirin and other non-steroidal anti-inflammatory drugs
2-LA containing bisulfites (acts as a preservative)
If a patient has an asthma attack, what should you do?
give them their inhaler (beta agonist), give O2 if needed, epinephrine SC or IM
Tx for angina
sublingual nitroglycerin, O2, stop dental tx,
*if nitroglycerine is not effective, call EMS and give a second dose of nitro
pathogenesis of an MI
mismatch in oxygen consumption and delivery
besides the arm, where else might a px feel an MI
shoulder, neck, jaw, midback, stomach
if you have conscious px have and MI, what do you do?
seat px, keep them calm, call 911, administer MONA
*morphine, oxygen, nitroglycerine, aspirin
how long should a patient avoid elective dental treatments following and MI?
6 months
T/F antibiotic prophylaxis might cause more harm than good
true
*allergies, bad reactions, etc
what are 4 indications for antibiotic prophylaxis?
1-artificial heart valves
2-history of previous infective endocarditis
3-congenital heart conditions
4-cardiac transplat ONLY if valvulopathy occurs
is it necessary to give antibiotics to a px who has a prosthetic joint?
No
*but it is common practice to give it up to 2 years after its placement
basic emergency drug for asthma/allergy
epinephrine
basic emergency drug for mild allergic reaction?
Benadryl
basic emergency drug for angina
nitroglycerine
basic emergency drug for bronchospasm
albuterol
basic emergency drug for hypoglycemia
glucose
basic emergency drug for MI
aspirin
basic emergency drug for syncope
ammonia
basic emergency drug for most things
oxygen
