Medical Emergency Preparedness Flashcards
5 Most Common Medical Emergencies in the Dental Office listed from most common to least
- Vasovagal Syncope
- Mild Allergic Reaction
- Angina Pectoris/Myocardial Infarction
- Postural Hypotension/Orthostatic Hypotension
- (Seizures, Bronchospasm(asthma attack), hyperventilation/panic attack, epinepherin reaction, diabetic emergencies/hypoglycemia, chocking and aspiration
4 Ways to Prevent a Medical Emergency
- 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
Stress Induced Emergencies
- Syncope
- Hyperventilation
- Acute cardiovascular emergencies
- Bronchospam
- Seizure
Drug Induced Emergencies
- Hypoglycemia (not eating when taking diabetes medication)
- Hypotension (BP medication dose too large)
- Overdose of local anesthetics
- Allergy of local anesthetics
<120/<80
What are the tx modifcations
None
Elevated 120/120-129/<80
What are the tx modications
Inform patient medical referral (if warrented)
Elective dental tx is appropriate
Consider shorter appt
Stage 1 Hypertension
Systolic 130-139/<80-89
What are the tx modications
Inform pt medical consult advisable.
Selective dental care (prophy, restorative, nonsurgical tx) is appropriate with proper modifications to tx
Stage 2 Hypertension
>140/>90
What are the tx modications
Inform patient medical consult advisable
selective dental care (Prophy, restorative, nonsurgical tx) is appropriate with proper modifications to tx
Pacific Dental Hygiene Clinic Cut Off
>equal to 160/ > equal to 100
What are the tx modications
Inform patient
Immediate referral to medical provider and medical clearance needed prior to next appointment.
No elective dental tx
retake bloop pressure 5 minutes
A1C: Patients should maintain _ % or less HbA1C with well controlled diabetes or __ %in elderly patients with well controlled diabetes
7
7.5
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
200
Blood glucose limit up to ___ mg/dl if the patient has a current A1C at 7% or below
250
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
300
Etiology of Dental Anxiety
- 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
Physical responses of a anxious patient
- 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
Behavioral and emotional responses in a Anxious Patient
- 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
Stress Reduction Techniques
• 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
interpersonal cognitive process (clinician- patient) when a patient’s dental phobia is calmed by the behaviors, attitudes, and communicative stance of the clinician.
Latrosedation
Preparation
Emergency Team Structure
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)
Basic Plan of Action
- Get Help (Remain Calm & Stay with the Patient)
2. Position
Basic Plan of Action
- Get Help (Remain Calm & Stay with the Patient)
- Position the patient apprpriately based on their conditon
- Provide basic life support as needed/monitor vital signs: CAB
- 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 - Additional management
- continually observe, monitor vital signs, and evaluate for any signs of recovery or deterioartion - Documentation
- record appropriate information in the patient record
- Faculty will complete an incident report form in axium personal planner - De-briefing
- The director of clinical education will schedule a debriefing meeting with 24-72 hours
CAB
Compressions- 30
Airway
Breathing- 2
Oxygen used for all emergency except
hyperventalation
Epinephrine (Injectable)
Anaphylaxis (allergic reaction)
- Counteracts major physiological events in anaphalaxis
- Reduces hypotension, bronchospasm, laryngeal edema prevents additonal release of histamine and other chemical mediators
Epinephrine (Injectable)
Anaphylaxis (allergic reaction)
- Counteracts major physiological events in anaphalaxis
- Reduces hypotension, bronchospasm, laryngeal edema prevents additonal release of histamine and other chemical mediators
-
Epinephrine (Injectable) § Rapid onset and short duration § Adult dosage - concentration for intramuscular injections § Pediatric dosage -
.3 mg of 1:1,000
.15 mg of
1:1,000
Epinephrine (Injectable)
Severe Asthma attack
- Should not use with ischemic heart disease or severe hypertension
Nitroglycerin
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
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
sublingually
BP < 90 mmHg
Diphenhydramine (Benadryl) or Chlorpheniramine (non injectable forms)
• Mild, slow onset, non-life threatening allergic reactions
§ Oral histamine blocker
§ Chlorpheneramine – 10 mg or
§ Diphenhydramine 25 – 50 mg
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
moderate
Albuterol
• 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
Aspirin
• 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
Retrieving broken instrument tips
Perioretriever
Magill Forceps
Retrieving object from airway
Hypertensive Urgency/Crisis
• 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
**Hypertensive Urgency/Crisis
• 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
Symptoms of Hypertensive Urgency Crisis
- Headache (moderate to severe)
- Anxiety
- Shortness of breath
- Tinnitus
- Edema
- Epistaxis
Hypertensive Emergency
• 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
Tx of a Hypertensive Emergency
- 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
• 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
Hypotension
Hypotension Treatment
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.