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Spring 2020 Applied Dental Hygiene > Medical Emergency Preparedness > Flashcards

Medical Emergency Preparedness Flashcards

1
Q

5 Most Common Medical Emergencies in the Dental Office listed from most common to least

A
  1. Vasovagal Syncope
  2. Mild Allergic Reaction
  3. Angina Pectoris/Myocardial Infarction
  4. Postural Hypotension/Orthostatic Hypotension
  5. (Seizures, Bronchospasm(asthma attack), hyperventilation/panic attack, epinepherin reaction, diabetic emergencies/hypoglycemia, chocking and aspiration
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2
Q

4 Ways to Prevent a Medical Emergency

A
  • Complete a thorough Medical History
  • Obtaining Vital Signs and Physical Exam
  • Recognizing Signs and Symptoms of anxious patient/increased risk for ME
  • Effectively use stress reducation techniques accordingly
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3
Q

Stress Induced Emergencies

A
  1. Syncope
  2. Hyperventilation
  3. Acute cardiovascular emergencies
  4. Bronchospam
  5. Seizure
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4
Q

Drug Induced Emergencies

A
  • Hypoglycemia (not eating when taking diabetes medication)
  • Hypotension (BP medication dose too large)
  • Overdose of local anesthetics
  • Allergy of local anesthetics
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5
Q

<120/<80

What are the tx modifcations

A

None

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6
Q

Elevated 120/120-129/<80

What are the tx modications

A

Inform patient medical referral (if warrented)
Elective dental tx is appropriate
Consider shorter appt

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7
Q

Stage 1 Hypertension
Systolic 130-139/<80-89
What are the tx modications

A

Inform pt medical consult advisable.

Selective dental care (prophy, restorative, nonsurgical tx) is appropriate with proper modifications to tx

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8
Q

Stage 2 Hypertension
>140/>90
What are the tx modications

A

Inform patient medical consult advisable

selective dental care (Prophy, restorative, nonsurgical tx) is appropriate with proper modifications to tx

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9
Q

Pacific Dental Hygiene Clinic Cut Off
>equal to 160/ > equal to 100
What are the tx modications

A

Inform patient
Immediate referral to medical provider and medical clearance needed prior to next appointment.
No elective dental tx
retake bloop pressure 5 minutes

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10
Q

A1C: Patients should maintain _ % or less HbA1C with well controlled diabetes or __ %in elderly patients with well controlled diabetes

A

7

7.5

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11
Q

If the patient has not been diagnosed with diabetes and the blood glucose is at or above __ mg/dl we will delay tx and refer to the physican

A

200

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12
Q

Blood glucose limit up to ___ mg/dl if the patient has a current A1C at 7% or below

A

250

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13
Q

Any patient with a blood glucose of ___ mg/dl or higher receives an immediate referral to a physician and all tx is delayed until a med clearance is received

A

300

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14
Q

Etiology of Dental Anxiety

A
  • Previous negative or traumatic experience (childhood)
  • Signs of needle or drill
  • Sounds of drill or screaming
  • Smell of eugenol/clove (dental materials/products /anesthetics
  • Sensation of high frequency vibrations
  • Fear of pain
  • Fear of blood
  • Fear of being ridiculed/judgment
  • Fear of unknown
  • Fear of choking and or gagging
  • Lack of control in the dental chair
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15
Q

Physical responses of a anxious patient

A
  • Muscle Tightness- Hands gripping or grasping arm rests
  • Sweating (hands, forehead, upper lip)
  • Frequent urination
  • Stiff posture
  • Pulsation in carotid and temporal arteries
  • Clearing throat
  • Restlesness
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16
Q

Behavioral and emotional responses in a Anxious Patient

A
  • Hyperactive
  • Walking/Talking faster
  • Seems to be in a hurry
  • Irritated
  • Panicky
  • Poor memory/confusion
  • Stumbling over words
  • Outburst of emotions
  • Sitting on edge of chair/leaning forward
  • Inattentiveness
  • Lack of eye contact
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17
Q

Stress Reduction Techniques

A

• Communication skills, rapport, trust building
• Office can be made calm and unthreatening through soft
music, avoiding bright lights, cooler environment with blankets
• Minimal to no wait time and morning appointments
• Aromatherapy- pleasant inhalation of ambient odors such as
essential oils (lavandar has been shown to increase blood flow and reduce cortisol levels)
• Visual stimulation through movies or videos
• Te l l -show-do

18
Q

interpersonal cognitive process (clinician- patient) when a patient’s dental phobia is calmed by the behaviors, attitudes, and communicative stance of the clinician.

A

Latrosedation

19
Q

Preparation

Emergency Team Structure

A

Person 1: Ask person 2 by name to alert and get dentist, clinic instructor and front office NOW
Ask Person 3 by name retrieve oxygen and emergency cart NOW. Position patient accordinly.

Person 2:
Retrieves the dental emergency team. Assists person 1 with patient (vitals, oxygen, records events)

Person 3:
Retrieves medical er supplies
Assists person 1 and 2 with patient (vitals, oxgyen, records events)

20
Q

Basic Plan of Action

A
  1. Get Help (Remain Calm & Stay with the Patient)

2. Position

21
Q

Basic Plan of Action

A
  1. Get Help (Remain Calm & Stay with the Patient)
  2. Position the patient apprpriately based on their conditon
  3. Provide basic life support as needed/monitor vital signs: CAB
  4. Activate EMS if directed to by the clinical instructor/denist and campus public safety
    - Dial 9 then 911
    - Dial x7207 or 9 then 503-352-7207
  5. Additional management
    - continually observe, monitor vital signs, and evaluate for any signs of recovery or deterioartion
  6. Documentation
    - record appropriate information in the patient record
    - Faculty will complete an incident report form in axium personal planner
  7. De-briefing
    - The director of clinical education will schedule a debriefing meeting with 24-72 hours
22
Q

CAB

A

Compressions- 30
Airway
Breathing- 2

23
Q

Oxygen used for all emergency except

A

hyperventalation

24
Q

Epinephrine (Injectable)

A

Anaphylaxis (allergic reaction)

  • Counteracts major physiological events in anaphalaxis
  • Reduces hypotension, bronchospasm, laryngeal edema prevents additonal release of histamine and other chemical mediators
25
Q

Epinephrine (Injectable)

A

Anaphylaxis (allergic reaction)

  • Counteracts major physiological events in anaphalaxis
  • Reduces hypotension, bronchospasm, laryngeal edema prevents additonal release of histamine and other chemical mediators

-

26
Q 
Epinephrine (Injectable) 
§ Rapid onset and short duration
§ Adult dosage - 
concentration for intramuscular injections
§ Pediatric dosage -
A

.3 mg of 1:1,000

.15 mg of
1:1,000

27
Q

Epinephrine (Injectable)

A

Severe Asthma attack

- Should not use with ischemic heart disease or severe hypertension

28
Q

Nitroglycerin

A

Angina pectoris
MI or CHF • Va s o d i l a t o r - dilates coronary
blood vessels • Rapid onset • Ta b l e t a n d s p r a y f o r m
§ Ta b l e t s b e c o m e i m p o t e n t i f
exposed to light or air
§ Shelf life reduced to 12
weeks
§ Spray shelf life usually 2
years

29
Q

Nitroglycerine
• Administer ___ or onto the tongue
• Administer at 5 minute intervals – up to 3 doses
• Should not administer if systolic BP _____ or
patient has taken ED drugs within 24 hours- sudden
decrease in blood pressure
• If regular dosage doesn’t resolve symptoms,
activate EMS and assume MI

A

sublingually

BP < 90 mmHg

30
Q

Diphenhydramine (Benadryl) or Chlorpheniramine (non injectable forms)

A

• Mild, slow onset, non-life threatening allergic reactions
§ Oral histamine blocker
§ Chlorpheneramine – 10 mg or
§ Diphenhydramine 25 – 50 mg

31
Q

Diphenhydramine or
Chlorpheniramine (injectable forms)
• Intramuscular histamine blocker
• ____ allergic reaction (urticaria, pertussis) with
some respiratory symptoms
• Diphenhydramine 25 – 50 mg or Chlorpheneramine 10
– 20 mg
• Pediatric dose is 1 mg/kg of body weight and should
not exceed adult dose (lbs./2.2=kg)
Note: Chlorpheniramine does not cause as much drowsiness

A

moderate

32
Q

Albuterol

A 
• Asthma attack or
bronchospasm
• Inhaler
• Bronchodilator- dilation
of bronchioles with
minimal cardiovascular
effects
• Quick onset – peak
effect 30 to 60 minutes 
• Long duration of action
4 to 6 hours
• Adult dose 2 sprays
 • Pediatric dose 1
spray 
• Can repeat dose if
necessary
33
Q

Aspirin

A

• Reduces overall mortality from MI
• Inhibitor of platelet aggregation-prevents progression
of cardiac ischemia to cardiac injury or cardiac
tissue death
• Recommended dose 162 mg – 325 mg: 2 - 4 baby
aspirin (81 mg each) • Check medical history for allergy

34
Q

Retrieving broken instrument tips

A

Perioretriever

35
Q

Magill Forceps

A

Retrieving object from airway

36
Q

Hypertensive Urgency/Crisis

A 
• Extremely high blood pressure
reading, BP undiagnosed or
poorly controlled- 180/120 
• Immediately take patient to ER
for further eval 
• Symptoms
• Headache (moderate to severe) 
• Anxiety 
• Shortness of breath 
• Tinnitus 
• Edema 
• Epistaxis
37
Q

**Hypertensive Urgency/Crisis

A 
• Extremely high blood pressure
reading, BP undiagnosed or
poorly controlled- 180/120 
• Immediately take patient to ER
for further eval 
• Symptoms
• Headache (moderate to severe) 
• Anxiety 
• Shortness of breath 
• Tinnitus 
• Edema 
• Epistaxis
38
Q

Symptoms of Hypertensive Urgency Crisis

A
  • Headache (moderate to severe)
  • Anxiety
  • Shortness of breath
  • Tinnitus
  • Edema
  • Epistaxis
39
Q

Hypertensive Emergency

A

• Extremely high BP with target end organ damage
• Symptoms – similar to MI or CVA – difficult to determine exact
emergency
• Sudden increase in BP greater than 180/110 often as high as 220/140
• Dyspnea • Chest pain
• Dysarthria- difficulty speaking
• Weakness
• Altered consciousness
• Visual loss
• Seizures
• Nausea and vomiting

40
Q

Tx of a Hypertensive Emergency

A
  • Treat end organ damage (i.e. MI or CVA) If hypertensive emergency
  • Otherwise retake BP
  • Seat patient upright
  • Contact EMS
  • Monitor BP every five mintues
  • Administer 4-6 L O2 if patient complains of Dyspnea
41
Q

• Abnormal condition in which BP is not adequate to
oxygenate body tissues
• Usually reduction in baseline systolic or diastolic
BP of 15–20 mmHg*
• Often caused by medications (antihypertensive) or
postural/orthostatic hypotension
• Can lead to shock

A

Hypotension

42
Q

Hypotension Treatment

A

Tr e a t m e n t
• Position supine with feet
raised. • Assess airway. • Administer O2 4–6
liters/minute. • Monitor vital signs. • If no improvement,
contact EMS.

Spring 2020 Applied Dental Hygiene (6 decks)

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