Medical Emergencies/Office Hazards Flashcards
AIDS/HIV
Found in: blood, semen, rectal fluid, vaginal fluid, breast milk
Transmitted by: IV drug use, unprotected sex, childbirth/breastfeeding
High risk patients: IV drug users, male-male sex contact
Prevention in dental office: standard precautions, education of employees
Herpetic whitlow
Causes: direct contact with infected skin
Affects: fingers
Symptoms: swelling/pain/blisters/sores
Treatment: antivirals can shorten outbreak. Clears in several weeks
Prevention: avoid exposure, wear gloves, wash hands thoroughly. Standard precautions
Oral herpes (HSV-1)
Causes- contact with active lesion
Symptoms: sores/lesions, pain, burning, stinging, swelling before lesion appears
Prevention: avoid contact w/ infected person or another active lesion
Herpes gladiatorum (HSV-1)
Passes between people during sports like boxing and wrestling
Symptoms- usually occur around 8 days after exposure
Fever, blisters, swollen glands
Cerebral herpes
Rare brain infection by direct neuronal transmission of HSV-1
Headache, fever, seizures, drowsiness
Speech abnormalities, memory loss, behavior change
Treatment: hospitalization, antivirals, steroids
Hepatitis A
Carriers cannot practice dentistry
Transmission: close contact with infected person (sex/needles). Eating/drinking contaminated food/water. Not common in US
Prevention: vaccination
Treatment: no treatment, can resolve without permanent liver damage. 6-9 mos
Hepatitis B
Transmitted by semen, blood, exchanged bodily fluids. Childbirth
Prevention: vaccination. 2-3 shots over several months
Treatment: meds won’t clear infection but can stop replication to minimize liver damage
Hepatitis C
Transmitted by blood/body fluids. Easily through sexual contact, IV drug use, childbirth
Prevention: no vaccine. Condoms, clean needles, avoid contact with knownninfected person
Standard precautions
Most common in US
Hepatitis E
Transmitted through decal/oral routes from contaminated water
Common in areas with poor sanitation
No vaccine
Symptoms clear in 4-6 weeks
Signs and symptoms of Hepatitis
Fatigue Jaundice Nausea/vomiting Abdominal pain Fever Loss of appetite Joint pain
Mercury contamination
Most exposure comes from seafood, dental amalgam (silver fillings)
Released during placement, replacement and removal of amalgam
Lasts 6mos-1 year after exposure STOPS
Inhaled/absorbed in lungs- happens from brushing, cleaning, clenching, chewing
Prevention: standard precautions, proper PPE, instrument handling, sharp safety, spill management
Health risks of Mercury contamination
Tremors Insomnia Emotional changes Neuromuscular changes Headaches Changes in nerve response Reproductive hazards to women
High levels of exposure can cause kidney damage, respiratory failure
Soft tissue trauma
Includes lacerations to the lips, tongue, frenum, cheeks, hard/soft palate
Rarely need sutures
Treatment for soft tissue injuries
Sutures if indicated with injury to oropharynx. Hemorrhage control, cleansing, antibiotics
Maintain soft diet
Rinse after meals
Alveolitis
Dry socket- blood clot dislodges from tooth socket
Complication from post surgical care after extractions. Most common in mandibular molars
Signs/symptoms: bad breath, low fever, foul mouth taste, empty socket, intense pain, radiating pain
Treatment: irrigated with warm saline solution, place gauze
5 S’s of Alveolitis
No swishing No spitting No smoking No straws No solid food
Broken needles
Anesthesia needles can break if defective, technique is poor or if patient jumps
Treatment: needle tip removed. Post op xrays to ensure all foreign objects removed. If not visible send to ER
Risks from leaving broken needle in mouth
Pain Infection Muscle/nerve damage Limited mouth opening Can migrate in body
Broken endodontic instruments
Files can break in root canal
Causes- defective instruments, provider technique, tooth anatomy
Treatment- if too far in, pack and seal the root canal. Attempt to bypass, if unable, pack and seal (obturate). If broken near the crown, try to remove so canal can be sterilized
Patients may need to see endodontist
Aspiration of foreign objects
Crowns, burs, dental dam clamps
Cause: slippery, wet oral environment. Small objects maneuvered around airway, patient in supine
Treatment: make sure airway is clear. If not begin CPR. If unable to remove object refer to ER
Place in reverse trendellenberg and instruct patient to cough
If swallowed, may pass naturally
Risks of aspiration of foreign objects
Damage to digestive tract Infection Abscess Pneumonia Foreign body granulocytes Septicemia Peritonitis Fistulas
Nitrous oxide
Used to help with anxiety and pain during procedures- MILD
adverse reactions: headache, shivers, excessive sweating, sleepiness, nausea and vomiting
Administer O2
Do not use on pregnant women and people with COPD
Syncope
Fainting- sudden drop in pulse or BP
Situational syncope: hunger, fear, pain, dehydration, anxiety, intense emotional distress
Symptoms: blacking out, feeling lightheaded, falling, dizziness, drowsy
Treatments: meds, wearing compression garments, diet changes, caution when standing, pacemaker
Surgical intervention for an obstructed airway
Cricothyrotomy
Types of asthmas
Intermittent
Persistent-mild
Persistent-moderate
Persistent-severe
Causes by allergies or viral infections at a young age when immune system is still developing
Intrinsic factors of asthma
Stress/anxiety
Viruses
Respiratory infection
Extrinsic factors of asthma/allergies
Cigarette smoke Weather changes Cold/dry air Dust mites Mold Pests Pets
What happens during an allergic reaction
Airway inflammation
Airway thickening
Mast cells degranulate
Antibodies are made
Allergen enters the body, immune system reacts, airways narrow
Signs and symptoms of asthma
Wheezing
Breathless
Chest tightness
Night/morning coughing
Signs/symptoms of allergic reaction
Sneezing Itchy/runny/blocked nose Raised, itchy, red rash Swollen lips/eyes/tongue/face Stomach pain Vomiting Diarrhea
Treatments for asthma
Inhalers, controlled substances, epinephrine
Treatment for allergic reactions
Antihistamine
Epinephrine
Hydrocortisone
Status asthmaticus
Acute, severe asthmas unresponsive to repeated courses of beta agonist therapy such as albuterol, levalbuterol and epinephrine
What does epinephrine do?
Constricts blood vessels which causes increases blood pressure, decreases swelling
Relaxes muscles around airways
Prevents the release of more allergic chemicals, stops response
IgE
Stimulates release of histamines
Capillary dilation w/ resulting swelling
Increase gastric secretions
Constriction of certain smooth muscle in respiratory tract
Prevention of reaction
Types of allergic reactions
Contact dermatitis
Urticaria
Respiratory
Anaphylactic
What will we see with a latex allergy?
Hives, itching, runny or stuffy nose
Can cause asthmas symptoms
Can occur within minutes
Who are high risk groups for latex allergies?
Rubber factory workers
People with spina bifida
Health care workers
People with family history
People who have undergone several surgical treatments
How to prevent latex allergies
Avoid contact with latex
Avoid areas where you may inhale the powder from latex gloves
Wear medical alert bracelet
Inform medical care team
Hyperventilation
Caused by anxiety. Increased breathing
Physiology: difficulty breathing due to lack of CO2 in blood
Signs/symptoms: dizziness, shortness of breath,weakness/confusion, muscle spasms in hands and feet, numbness/tingling in extremities and around mouth
Treatment: breathe through pursed lips or one nostril. Cover face with hands and breathe
Epilepsy
Triggers: stress, drugs/alcohol, flashing lights, noise, exercise, neglecting meds, physical trauma, low blood sugar
Onset of epilepsy
Generalized onset- whole brain, tonic-clonic seizure, absence seizure
Focal onset- one part of brain- partial seizure
Unknown onset
Tonic-clonic seizure
Slower onset. Body constricts and relaxes
Lasts 3-5 min
Absence seizure
Sudden onset. Lose complete awareness
Conscious, stiff, blank stare. Lasts 5-30 seconds
Focal onset seizure
Patient is aware/confused
Affects only certain body parts since it is only in one part of the brain
Can lead to a tonic-clonic seizure
Grand map seizure
Involves loss of consciousness and violent muscle contractions
Causes: epilepsy, low BS, high fever or stroke
Petit mal seizure
Brief, sudden lapses in attention
More common in children
Classifications of CVA/stroke
Ischemic or hemorrhagic
Signs and symptoms of CVA/stroke
Numbness/weakness in face, arm or leg on one side of the body Confusion Trouble speaking Trouble seeing Trouble waking Dizziness, loss of balance or coordination Severe headache Temporary paralysis Fainting Coma
Transient Ischemic Attack
Causes: blood supply to the brain is blocked by a clot or there is reduced blood flow to the brain
Cerebral embolism
Occurs when a blood clot forms somewhere in the body and travels to the brain via the blood stream.
Can get lodged in an artery and block flow of blood to the brain
Cerebral thrombosis
When a blood clot forms in the brains venous sinuses
Keeps blood from draining from the brain. Pressure builds and can lead to swelling and bleeding in the brain
Cerebral infarction
Ischemic stroke
Blood flow to brain is distrusted keeping vital nutrients and oxygen from reaching the brain. Brain tissue may die
Cerebral hemorrhage
Result of bleeding in the brain
Can be caused by trauma or defective blood vessels that can no longer withstand blood pressure
Age, disease, trauma
Treatments/prevention for CVA’s
Blood thinners
Cardiac monitoring
Surgery
Therapies
Diabetes
Metabolic disease that affects the pancreas and overall cells in the body
Pancreas makes too much insulin, not enough or none at all
Insulin
Hormone produced by the pancreas
Regulates the metabolism of carbohydrates, fats and proteins by promoting the absorption of glucose from the blood into liver, fat and skeletal muscle cells
What is glucose
Fuel for our cells
Main type of sugar found in the blood
Insulin controls glucose levels. If the pancreas cannot produce insulin, the body cannot accept glucose
Type 1 diabetes
Insulin dependent
Juvenile diabetes
Insulin pump usually used to regulate insulin levels
Type 2 diabetes
Adult onset
Impairment in the way the body regulates and uses sugar as fuel. Causes by long term high levels of sugar in the blood stream
Symptoms of diabetes
Increases thirst, frequent urination, excessive hunger, weight gain/loss, fatigue, blurred vision
Adult onset occurs around age 45
Hyperglycemia
Can turn to diabetic coma due to thirst, dehydration- overproduction of insulin
Symptoms: fruity smelling breath, nausea/vomiting, shortness of breath, dry mouth, weakness, confusion, coma, abdominal pain
Diabetic coma
Causes by untreated hyperglycemia, can be fatal
Treatment: IV fluids, potassium/sodium/phosphate supplements, insulin
Hypoglycemia
Insulin shock due to lack of glucose- can cause brain damage
Symptoms: confusion, heart palpitations, shakiness, anxiety
Glucose tablets, food/drink high in sugar
Prevention: monitor blood sugar, don’t skip meals, medication management
Unconscious patient
Stop procedure Stay calm Call 911 Get emergency kit/oxygen Check airway, breathing, pulse- begin CPR if necessary If breathing, place in recovery position
Medical problems associated with unconscious patient
Macro vascular
Micro vascular
Neuropathy
Oral manifestations of macro/micro vascular conditions and neuropathy
Periodontal disease
Slow healing
Prone to secondary infections
Pericardium
Membrane enclosing the heart in double layer serous membrane
Coronary circulation
Supplies blood to and provides drainage from tissues of the heart
Heart chambers
Left/right atrium
Left/right ventricle
Valves of the heart
Tricuspid: located btw right atrium and right ventricle
Pulmonary valve: btw right ventricle and pulmonary artery
Mitral valve: btw left atrium and left ventricle
Aortic valve: btw left ventricle and aorta
Systemic circulation
Provides functional blood supply to all body tissues
Cardiac conduction system
Network of nodes, cells and signals that controls the heartbeat
Atherosclerosis
Buildup of fatty plaques on artery wall
Ruptured or dislodged plaques can lead to clotting
Narrowing the blood flow on artery
Angina pectoris
Chest pain caused by coronary artery disease
Reduced blood flow to the coronary arteries
Reduced O2 in cardiac cells
Sudden pain, tightness and squeezing in chest
4 types of angina
Stable- happens with stress or physical activity
Unstable- happens at rest
Micro vascular- no blockage, inadequate oxygen in coronary arteries
Variant- rare, spasm of coronary arteries, may occur at night
Treatment for angina
Beta blockers
Angioplasty
Aspirin
Cardiac rehabilitation
Myocardial infarction
Heart attack
Blockage of one or more of the coronary arteries. Heart becomes oxygen starved
Signs/symptoms: chest pain, headache, difficulty breathing, nausea, indigestion, upper back pain, sweating, vomiting, stomach pain
Treatment: defibrillation, O2 therapy, beta blockers, aspirin, anticoagulants, coronary artery bypass surgery
