Patient Centered Care and Dental Emergencies Flashcards
What is the basic Life support flow chart?
Follow DRSABCD!
Dangers?
Responsive?
Send for help
Airway
Breathing (normal?)
CPR (30 compressions, 2 breaths)
Defibrillator
What are the standard drugs and equipment that should be available at every dental surgery?
- Transportable oxygen tank
- Plastic airways
- Pulse oximeter
- Adrenaline
- Glyceryl Trinitrate spray
- Salbutamol (or other short acting bronchodilators)
- Aspirin
- Blood pressure monitor
- Glucose monitor and some glucose
- Automated external defibrilator
What is urticaria?
It is a condition, characterised by transient erythematous lesions that very in size. Usually a good indicator that subsequent exposure will result in acute angiodema or event can occur together with angiodema and anaphylaxis.
What is the management of mild urticaria or angiodema?
- Stop dental treatment
- Remove or stop administration of the allergen
- Recommend an oral antihistamine
What is the management of extensive urticaria or angiodema or swelling involving eyelids, lips or tongue?
- Stop dental treatment
- Remove or stop administration of the allergen
- Refer to urgent medical attention
What are the signs of anaphylaxis?
- Labored breath
- Swelling of tongue or throat
- Hives
- Loss of consciousness or dizziness
What is the management for urticaria or angioedema with associated hypotension and evidence of anaphylaxis?
- Stop dental treatment
2, Remove or stop administration of the allergen
- Call 000
- Give intramuscular injection of adrenaline into anterolateral thigh:
For adults or children over 20 kg - 300 micrograms
For 10-20 kg child: 150 micrograms
- Start supplemental oxygen
- Be prepared to start CPR
- Repeat adrenaline every 5 minutes
Follow up: update records and request a copy of medical report of the allergic reaction
What are the signs of syuncope?
Presyncope is a good indicator. Signs and symptoms are light-headedness, nausea, anxiety, sweating and tinnitus.
What are two major types of syncope?
Vasovagal syncope - as a reaction to pain, anxiety and fear
Orthostatic hypotension - reduction in venous return during standing up right, reducing MAP thus reducing oxygen perfusion to the brain
What is management of a syncope if a patient just feels like fainting?
- Stop dental treatment
- If the patient is in the dental chair, tilt the chair back to a horizontal position. If not, ask them to lie down
- Raise patient’s legs
- Measure patients heart rate
- assess consciousness by talking to the patient
What is management of a syncope if a patient loses consciousness?
- Stop dental treatment
- Raise the patient’s legs and try to achieve a position where the head is lower than the heart. If in chair, tilt the chair back to a horizontal position
- Measure the patient’s blood pressure and heart rate
Consciousness usually return rapidly
What is management of a syncope if a patient loses consciousness and does not regain consciousness?
- Call 000
- Start basic life support
- Place the patient on their side
- Continue treatment until the patient regains consciousness or assistance arrives
What do coronary ischaemic syndrome include?
- Stable angina
- Acute coronary syndromes ( ST evelation myocardial infarction and non-ST elevation acute coronary syndrome)
What are the typical symptoms of acute coronary syndrome?
- Crushing or heavy chest pain that may radiate to the arms, neck, back or jaw
- Shortness of breath
- Nausea
- Sweating
What are signs of symptoms of stable angina?
Retrosternal chest discomfort that lasts 10 minutes or less that is commonly triggered by physical activity or stress.
What is the management of the patient that has pain occurring in the chest area with history of angina?
- Stop dental treatment
- Measure blood pressure, heart rate and pulse oximetry
- Assess consciousness
- Sit the patient down (or up) and use GTN spray:
a. GTN spray 400 micrograms sublingually, every 5 minutes upto 3 doses
b. GTN tablet 300 to 600 micrograms sublingually, every 5 minutes upto 3 doses
After 2 doses, administer 3 dose and treat as sever chest pain
What is the management of the patient that has severe or new chest pain?
- Call 000
- For patient with angina, follow the initial angina protocol
- For all patient give:
300mg aspirin orally, chewed or dissolved prior to swallowing
- Measure blood pressure, hear rate and pulse oximetry
- Start supplemental oxygen if saturation is less than 90% and titatrate to around 90-96%
- Provide assurances
- If patient lsoes consciousness, start basic life support
How to manage cardiac arrest in dental practice?
- Stop dental treatment
- Call 000
- Start basic life support, including CPR
- Maintain treatment until the patient regains consciousness or assistance arrives
What is the definition of hypoglycemia?
The textbook definition is blood glucose concentration below 4.0 mmo/L however, symptoms of hypoglycaemia may occur at a higher blood glucose concentration and can occur without symptoms and signs particularly in patient who have had diabetes for more than 10 years.
What are some factors that increase hypoglycaemia in diabetic patients?
- Inappropriate high doses of insulin or sulfonylureas
- Forgotten or delayed meals
- Insufficient carbohydrate intake
- Rigorous or prologned exercise
What is the management of hypoglycaemia in dental practice if patient is conscious and cooperative?
- Stop dental treatment
- Give glucose if available:
a. adult - 15g
b. child 6 years or older (or more than 25 kilos) - 10g
c. child 5 years or younger (or upto 25 kilos) - 5g
(if glucose not available, give a fast acting glucose food or drink)
- If after 15 minutes, glucose levels did not return to normal, repeat the dose
- If after 3 or more portions the glucose does not come back to normal, seek medical advice
- If the glucose levels have returned to normal, give patient a longer-acting carbohydrate and abserve the patient until they recovered. Do not allow them to drive home.
What is the management of hypoglycaemia in dental practice if patient is drowsy, uncooperative or unconscious?
- Stop treatment
- Call 000
- If the patient is unconscious, star basic life support
