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Spring 2020 Applied Dental Hygiene > Neurological Emergencies Cont. > Flashcards

Neurological Emergencies Cont. Flashcards

1
Q

Seizures/Epilepsy :

  • Paroxysmal (spasm/seizure) disorder of cerebral function. –
  • A temporary episode of ____ alteration due to massive
    abnormal ____ _____ in one or more areas of the brain
  • Sudden onset and a brief span of activity
A

behavior

electrical discharges

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2
Q

Seizures may lead to… alterations in …

A
  • State of consciousness
  • Motor activity and functions
  • Sensory activity or function
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3
Q

Etiology @ the cellular level of Seizures

A

Alterations in cell membrane permeability which inability of ions able to move across cell membrane of neuron

  1. Excess of excitatory neurotransmitters acetylcholine or glutamate= too much water coming through
  2. Decreased inhibitory neurotransmitor GABA= Cant close the gates= excess coming through
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4
Q

Etiology of Seizures/epilepsy

A
  • Congenital, genetic, CNS infections, neoplasm tumors, trauma, metabolic and toxic, cerebrovascular and degenerative…. OR *** IDIOPATHIC
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5
Q 
Prevention of Seizures- Information about
seizures essential (Comp MH Review) INCLUDES?
A
  • length of time since last seizure
  • types of seizures, severity, duration
  • presence of aura?
  • alteration or loss of consciousness
  • history of injuries
  • post-ictal symptoms
  • medications
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6
Q

2 Classifications of Seiures

A
  1. Primary (unprovoked or idiopathic) 65%
    - usually part of epileptic tendency
    - usually require daily antiseizure medication
  2. Secondary/provoked or acute symptomatic 35%
    - Traced back to some type of underlying cause
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7
Q

Seizures that are Secondary provoked or acute symptomatic 35% underlying causes
8 answers?

A
  1. Hypoglycemia
  2. Electrolyte imbalances
  3. Hypoxia
  4. Hypocalcemia/alkalosis
  5. Ingestion of toxins
  6. Rapid withdrawal from addictive drugs
  7. Injury or trauma to CNS
  8. Epileptogenic (seizure provoking) medications- penicllin hypoglycemic agents, LOCAL ANESTHETICS /toxicity phenothiazine
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8
Q

What are the 4 common etiologies in the DENTAL SETTING

A
  1. HYPOGLYCEMIA
  2. HYPOXIA-SECONDARY TO SYNCOPE
  3. LOCAL ANESTHETIC TOXICITY
  4. EPILEPSY
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9
Q

TYPES OF SEIZURES

  1. PARTIAL (FOCAL/LOCAL)
  2. GENERALIZED
  3. Status Epilepticus

Explain the categories in each type and what they entail

A
  1. Partial
    - Simple (focal) partial seizure
    - complex (focal) partial seizure
  2. Generalized seizures
    - generalized tonic-clonic or grand seizures GTCS GRAND MAL
    - Generalized Non-convulsive/absence seizures
  3. Status Epilepticus
    - Continuous seizure or repetitive recurrence of any seizure without recovery between seizures (LASTS LONGER THAN 5 min
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10
Q

Simple Focal partial seizure is under what type of seizure and what does it include

A

Partial focal seizure

  • Motor, sensory, psychomotor changes with NO LOSS OF CONSCIOUSNESS (AWARENESS) OCCIPITAL LOBE
  • tingling sensation
  • bad odor
  • flashing lights
  • unintelligible speech
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11
Q

Complex focal partial seizure is under what type and what does it include

A

Partial focal seizures

  • may involve one or both sides of brain, automatic behavior with impaired consiousness, begin in temporal lobe
  • repetitive nonpurposeful activity such as lip smacking or wandering in circles
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12
Q

Generalized Tonic-Clonic or Grand Seizures GTCS or GRAND MAL

IS UNDER WHAT TYPE AND WHAT DOES IT CONSIST OF

A

Generalized Seizures

  • ictus or ictal= seziure
    1. Aura or prodromal phase
  • subjective sensation, mood change
    2. Pre-ictal phase
  • patient loses consciousness
    3. Ictal Phase
  • tonic - sustained muscle contraction
  • clonic- muscular spasms/contractions and relaxation- rhythmic jerking motions
    4. Post-ictal
  • Movement has stopped, pt still unconsious
  • muscle flaccidity, incontinence
  • pt may awake and confused, fatigued and no recollection of event
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13
Q

Generalized Non- Convulsive/Absence Seizures

is what Type and what does it consists of

A
  • Blank Stare- Day dreaming
  • Minor facial movements blinking or eye rolling
  • brief change in level of consiousness awareness
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14
Q

Status Epilepticus S/S 5 answers

A
  • Continuous seizure or repetitive recurrence of any seizure without recovery between
    seizures (lasts longer than 5 minutes).
  • Most commonly associated with tonic-clonic or grand mal seizures - Life threatening and can last for hours or even days
  • Signs and symptoms
    1. Unconscious
    2. Generalized clonic contractions
    3. Fever- may rise to 106 or higher
    4. Elevated BP/ Tachycardia
    5.Arrhythmia/dysrhythmia
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15
Q

What are some oral maifestations for patients with seizure disorders

A
  1. laceration on tongue from biting
  2. Gingival overgrowth from medciaton
  3. Fractured teeth
  4. pitichae
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16
Q

Tx of Generalized Absence/ Petit mal seizures

A
  • Stop dental tx for duration of episode
  • protect airway
  • remove instruments from mouth
  • monitor vital signs
  • continue tx following cessation of seizure if patient has no ill effects
17
Q

Management of GTCS or grand mal

A
  • Protect patient from injury
  • Place patient in supine position- leave in dental chair
  • place one person at head of pt and one at foot
  • contact ems if first episode ever**
  • Administer 02 4-6 L**
  • Postictal phase: BLS as needed CAB, vital signs muscle flaccidity, increase saliva, blood from tongue trauma common, airway protection position on their side in recovery mode
18
Q

POST ICTAL Treatment of GTCS

A
  • monitor vital signs to insure return to baseline
  • patient may have headache and muscle soreness
  • patient should never drive themselves home - should be released to responsible adult
19
Q

Status Epilepticus

A
  • *>5min
    • Immediate medical intervention required to prevent death
  • death occurs due to cardiac arrest irreversible brain damage to cerebral hypoxia
  • IV anticonvulsant drug therapy as needed
20
Q

Drug therapy of STATus epilepticus

A
  • Tx usually begins with one AED (anti-epiletic drug /anti convulsant) and if the patient does not respond well, another drug or combination is tried
  • common AED:
    barbiturates (phenobarbitol)
    hydantoins (phenytoin)
    succinimides (ethosuximide)
    valproic acids (depakote)
    **benzodiazepines (diazepam)
    carbamezepine (tegretol)
    felbamate (felbatol)
    gabapentin (neurontin)

Spring 2020 Applied Dental Hygiene (6 decks)

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