Term
| what is the best way to prevent a medical emergency in the dental office? |
|
Definition
| Take a good health history |
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Term
| How should allergies be noted in the chart? |
|
Definition
| in red pen on the top of the page |
|
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Term
| name some methods of reducing the likelihood of a medical emergency in the dental office |
|
Definition
get a thorough HH and vitals
modify TX based on HH and vitals
use stress reducing methods
pay attention to allergy/drug interactions
maintain a medical emer kit and be trained on how to use it
have an emer plan for your office |
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Term
| What is the ASA Physical Classification system? |
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Definition
| A system developed in 1962 by the American Society of Anesthesiologist to estimate risk to a patient who is scheduled to receive "anesthesia" of any type |
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Term
|
Definition
*considered normal and healthy
*able to walk up 1 flight of stairs or two city blocks without distress
*can tolerate stress associated with planned dental treatment without serious complications
*no dental anxiety |
|
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Term
|
Definition
*mild systemic disease or is a healthy ASA 1 with extreme dental anxiety
*can walk 1 flight of stairs or two city blocks before distress causes them to stop
*less tolerant of dental treatment but are still at minimum risk during dental care.
*might need treatment modifications or considerations (sedation, pre-med etc)
*able to perform normal activities without distress |
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Term
| name some examples of ASA 2 patients |
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Definition
*type 2 diabetes- controlled
*epilepsy- controlled
*asthma- controlled
*thyroid disorders- controlled
*healthy ASA 1 pregnant patients
*adults with BP between 140-159S and/or 90-94D
*healthy patients over 60
*healthy pts with high dental anxiety
*healthy pts with allergies, especially to drugs
*ASA 1s presenting with upper respiratory tract infections |
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|
Term
|
Definition
*severe systemic disease that limits activity but not incapacitating
*no signs or symptoms of distress at rest
*distress exhibited when encountering physiologic or psychologic stress
*can walk 1 flight of stairs or 2 city blocks but has to stop and rest in route |
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Term
| Is an ASA 2 patient a yellow or green light patient? |
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Definition
| yellow, no contraindications to treatment but may need treatment plan modifications such as pre-med |
|
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Term
| Is an ASA 3 patient a green, yellow, or red light? |
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Definition
| Yellow- no contraindications to elective treatment but risk to patient is increased. Needs treatment modifications and serious consideration when treating these pts |
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Term
| Name some examples of an ASA 3 patient |
|
Definition
*stable angina
*type 1 diabetic (controlled)
*hearth failure with ankle edema
*COPD
*exercise induced asthma
*epilepsy (controlled)
*BP 160/95- 199/114
*post-myocardial infaction more than 6 months prior to dental tx w no significant residual signs or symptoms
*post cerebral vascular accident (stroke) more than 6months w/ no sig residuals
*might need to stop and rest during normal activities |
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Term
|
Definition
pt have incapacitating systemic disease that is a constant threat to their lives. No elective dental treatment unless they improve to ASA 3.
Unable to walk 1 flight of stairs or 2 city blocks
distress at rest
RED LIGHT |
|
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Term
| name some examples of ASA 4 |
|
Definition
*unstable angina
*MI (myocardial infarction) in past 6 mos
*CVA (cerebral vascular accident, stroke) in past 6 mos
*BP over 200/115
*severe heart failure or COPD needing 02and confinement to wheel chair
*uncontrolled epilepsy
*uncontrolled type one diabetes with hx of hospitalization |
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|
Term
|
Definition
terminally ill, not expected to survive more than 24 hours
might be DNR
no treatable in dental setting |
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Term
| what are the 6 vital signs you should note? |
|
Definition
BP, HR, resp, (every time)
temp, height, weight (for anesthetics) |
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Term
|
Definition
| force exerted by blood on the walls of blood vessels during heart contractions |
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Term
|
Definition
| abnormally high BP (above 140/90) |
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Term
|
Definition
| abnormally low BP, often associated with shock (under 90/60 I think) |
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Term
|
Definition
| the force exerted during ventricular contration |
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Term
|
Definition
| the lowest pressure exerted against the arteries, ventricular relaxation |
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Term
|
Definition
| pressure waves with each beat causing surge in BP within the artery. |
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Term
|
Definition
| the heart beating too fast, above 100 bpm |
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|
Term
|
Definition
| the heart beating too slow, below 60 bpm |
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Term
| Name the places on the body where you can feel a pulse, and state what site you would use for which situation |
|
Definition
radial/upper wrist: all patients over 1 year
carotid in the neck: unresponsive patients
brachial, underside of upper arm: infants under 1 year |
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Term
| how could you describe a normal pulse? |
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Definition
|
|
Term
| how could you describe a stronger than normal pulse? |
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Definition
|
|
Term
| how would you describe a weak or difficult to feel pulse? |
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Definition
|
|
Term
| What is a normal pulse range for adults? |
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Definition
|
|
Term
| what is a normal pulse range for children? |
|
Definition
|
|
Term
| what is a normal pulse range for infants? |
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Definition
|
|
Term
| what is a normal rpm for adults? |
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Definition
|
|
Term
| what is a normal respiration rate for children? |
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Definition
|
|
Term
| what is a normal temperature for adults? |
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Definition
| 96-99.5 above this indicates infection or disease |
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Term
| why do we ask patients if they have taken appetite suppressants? |
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Definition
| these types of drugs can cause heart problems, which could be complicated by anesthetic |
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Term
| why do we ask pts if they have taken coke in the last 12 hours? |
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Definition
| If given anesthetic will coke (or coke derived drug) is in their system they could die. |
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Term
| what is the role of a dental auxiliary in preparing for medical emergencies? |
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Definition
familiarize self with office policy
identify emer equipment
familiarize self with contents of emer kit
practice routines
maintain professional CPR status |
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Term
| what is the medical emergency management plan at CCD? |
|
Definition
student must remain with pt at all times
notify nearest clinic faculty
begin assessment of situation and rend aid until help arrives
clinic faculty will assess the situation and determine if additional support is required
if assistance is necessary the following will happen in this order
1)notify attending DDS
2)call 911, state your name, the emergency team needed, type of emergency and location of the clinic
3)do not hang up until the operator says so, then call lowery campus security and inform the of the emer
4)go outside and direct EMS to emer
5)have current HH available to EMS |
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Term
| What is inside the CCD emergency kit? |
|
Definition
albuterol
epi 1:1000
nitrolingual spray
chlorpheniramine histamine blocker (benadryl 50mg/ml)
apple juice
glucose (small tubes of frosting)
tourniquets
disposable syringes
high volume suction tips
pocket mask for CPR
spare defibrillator pads
BP cuff and stethoscope
razors |
|
|
Term
| what is the nitroglycerin spray for? |
|
Definition
| used for treatment of angina pectoris |
|
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Term
| what is the ammonia in our rooms for? |
|
Definition
respiratory stimulation, crush and place under pts nose.
noxious odor, and irritates the mucous membranes of the URT, stimulating the respiratory and vasomotor sensors in the medulla. Use for fainting. |
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Term
| where are the O2 tanks and AED stored in the clinic? |
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Definition
| Both are right outside the dispensery |
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Term
| What do you assess before using the AED? |
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Definition
| Verify the patient unconscious, not breathing, no pulse |
|
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Term
| What safety precautions must we use in the dental materials lab? |
|
Definition
neat hairstyle worn up off collar and away from face
no jewelry
wear goggles
use mask and glove any time contact with pathogenic organisms is possible.
use mask when there is potential for vapors/airborne particles |
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Term
|
Definition
| hypersensitive response to an allergen to which an individual has previously been exposed and to which that individual has developed antibodies. |
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Term
|
Definition
| result of rapid activation of several inflammation pathways. An extreme allergic reaction that often involves multiple organ systems. Can be life threatening. |
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Term
| what are some causes of anaphylaxis? |
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Definition
| drugs, pollens, foods, chemicals, insect bites etc |
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Term
| name symptoms of immediate allergic reaction |
|
Definition
*urticaria (hives
* nausea
*angioedema (rapid swelling)
*respiratory distress
*cardiovascular collapse
* drop in BP
*weak thready pulse
*heart palpitations
*GI distress
*itching
*syncope
*hypotenion
*cyanosis
*dyspnea (difficult/labored breathing) |
|
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Term
| how do you treat an immediate allergic reaction? |
|
Definition
this can be life threatening so activate ems- you may need to perform BLS until help arrives
place pt in supine position
administer 02 and ventilate
monitor vitals
administer epi .3-.5 ml (1:1000) iv or IM
administer additional drug if needed (histamine blocker, coricosteriod (IV) bronchodilator |
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|
Term
| describe a delayed onset allergic reaction |
|
Definition
usually mild and needs to tx
appears after a time lapse greater than 1 hr
involves the cell mediated immune system |
|
|
Term
| name symptoms of a delayed allergic reaction |
|
Definition
skin manifestations
flushed skin
edema
minor respiratory upset
GI upset |
|
|
Term
| how do you treat a delayed allergic reaction? |
|
Definition
terminate dental procedure
place pt in semi supine or upright position
montor vitals
administer benadryl orally.
pt might need follow up w benadryl every 6-8 hours for 3 days (consult w md)
activate EMS if patient declines. |
|
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Term
|
Definition
| those substances found in blood or tissues that respond to the administration of or react to antigens |
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|
Term
|
Definition
| any substance foreign to the host that is capable of activating an immune (allergic) response by stimulating the development of a specific antibody |
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|
Term
|
Definition
|
|
Term
|
Definition
| mmon-inflammatory edema involving the skin, subcutaneous tissue, underlying muscle and mucous membranes, especially those of the GI and respiratory tracts. Occurs in response to exposure to allergens, the most critical area of involvement is the larynx |
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Term
|
Definition
| an antigen that can elicit allergic symptoms |
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Term
|
Definition
| hives. a vascular reaction of the skim marked by the transient appearance of smooth, slightly elevated patches that are redder or paler than the surrounding skin and are often accompanied by severe itching. |
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Term
| name some drug related emergencies |
|
Definition
| overdose, allergic reactions, chemical intoxication, psychogenic response (syncope or hyperventilation) |
|
|
Term
| what type of anesthetics do allergic reactions more often occur with? |
|
Definition
| Ester-type (procaine). Not used much any more but dental topical anesthetic (benzocaine) is an ester-type |
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Term
| what are the two most common reactions in the dental office? |
|
Definition
| Fluoride and anesthetic related |
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|
Term
| what is the most common adverse reaction in the dental office? |
|
Definition
|
|
Term
| when might a toxic overdose of anesthetic occur? |
|
Definition
| if the pt is slow to metabolize the drug, given an excess, or has an IV injection of the drug |
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|
Term
| what are signs of anesthetic overdose? |
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Definition
| confusion, talkativeness, apprehension, excitedness, slurred speech/stutter, muscular twitching and tremor of face and extremities, nystagmus (rapid involuntary eye movement), increased BP, HR, resp. |
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|
Term
| what are some symptoms of anesthetic overdose? |
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Definition
| headache, light headedness, dizziness, blurred vision, ringing in ears, numbness of tongue/perioral tissues, drowsiness, disorientation, loss of consciousness. In rare cases tonic-clonic seizure followed by CNS depressoin, decreased HR, BP and resp |
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Term
| what are signs and symptoms of epi overdose? |
|
Definition
| increased bp, hr, fear, anxiety, tenseness, restlessness, tremor, perspiration, weakness, dizziness, palpitations, possible cardiac dysrhythmias |
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|
Term
| what are some signs and symptoms of anesthetic ALLERGIC reaction? |
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Definition
usually will apear after drug is administered, not related to dosage of drug, symptoms can extend for long duration
most often presents as skin reaction
pt complains of feeling terrible
anaphylaxis
bp can fall due to massive vasodiliation
weak and thready pulse, cardio collapse can result |
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Term
| most anesthetic allergies are related to what component? |
|
Definition
methylparaben (preservative)
soduim metabisulfate (antioxidant) |
|
|
Term
| signs and symptoms of anesthetic vasodepressor syncope |
|
Definition
most common in adults 18-40
more common in males
occurs most often prior to administration
usually self limiting when pt placed in supine position
pallor, cold and clammy skin, perspiration
pt feels faint and lightheaded
HR increases right before fainting, then decreases dramatically with loss of consciousness , bp decreases w loss of consciousness |
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|
Term
| describe a fluoride overdose |
|
Definition
can be accute or chronic
nausea, abdominal pain, excessive salivation, thirst, vomiting, diarrhea.
severe cases- muscle cramping, cardiac arrest, broncospasm |
|
|
Term
| what fluoride containing products and how much of them can be fatal to a small child? |
|
Definition
8 oz tube of fluoridated tooth paste
1 oz of topical F gel |
|
|
Term
| how do you treat an acute toxic fluoride reaction? |
|
Definition
| induce vomiting, administer milk or 1% calcium chloride, activate ems |
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|
Term
| what are signs and symptoms of altered consciousness? |
|
Definition
sweaty, dry, cold or clammy skin
paresthesia (pins and needles)
headaches (CVA?)
drunk appearance- could be hypoglycemic
breath smells of alchol or fruit |
|
|
Term
| what are the 4 most likely altered consciousness pts you may see, besides those who are drunk? |
|
Definition
1)Hyperventilation
2)hypoglycemic
3)hyperglyemic
4)CVA |
|
|
Term
| what are signs and symptoms of hyperventilation? |
|
Definition
rapid respirations
anxiety
bp and hr raised
occurs most often in 15-40 year olds
seldom results in unconsciousness |
|
|
Term
| what are signs and symptoms of hypoglycemia? |
|
Definition
hx of type 1 diabetes
lack of ingested food
pt can appear drunk
skin is cold and clammy
rapid hr
symptoms and appear rapidly and result in unconsciousness |
|
|
Term
|
Definition
hx of uncontrolled diabetes
skin is hot and dry
breath may smell of acetone
breathing is rapid and deep
rarely lose consciousness and symptoms appear gradually |
|
|
Term
| what are some signs of CVA? |
|
Definition
worse head ache ever
speech defects and paralysis
unconsciousness may occur |
|
|
Term
|
Definition
a transient loss of consciousness
is only a symptom
any loss of consciousness, however brief, represents a potentially life threatening situation and |
|
|
Term
| what are some predisposing factors leading to unconsciousness? |
|
Definition
| stress, impaired physical status (asa classes 3 and 4), administration of drugs. |
|
|
Term
| describe an unconscious pt |
|
Definition
| one who does not respond to sensory stimulation and has lost protective reflexes, accompanied by the inability to maintain a patent airway |
|
|
Term
| describe the trendelumburg position |
|
Definition
pt supine with feet slightly elevated (10-15 degrees)
gets blood to the brain |
|
|
Term
| can pregnant women be put in the trendelumburg position? |
|
Definition
| no, place them on their right side and tuck a blanket/pillow under their left to keep the baby off their vena cava |
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|
Term
| is airway an issue in unconscious patients? |
|
Definition
| yes, some degree of airway obstruction will be present in all unconscious pts bc they cannot hold their head up |
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|
Term
| describe some clinical manifestations of presyncope |
|
Definition
| pt feels warm, looses color, has tingly finger tips, sweaty, tachycardia, then bradycardia, cold feet and hands, pupils dilated, feels sick |
|
|
Term
| describe some clinical manifestations of syncope |
|
Definition
| irregular shallow breathing, pupils dilated, pt looks dead, bradycardia, weak thready pulse |
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|
Term
| name some clinical manifestations postsyncope |
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Definition
| recovery should be very rapid, less than a few seconds, pt may feel off for next 24 hours |
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|
Term
| describe postural hypotension |
|
Definition
drop in systolic pressure of 30mm Hg or more
or a greater than 30 mm Hg drop in diastolic pressure that occurs on standing
second leading cause of syncope in the dental office
happens when pt assumes an upright postion |
|
|
Term
| name some predisposing factors to postural hypotension |
|
Definition
administering/ingesting drugs
prolonged recumbency or convalescence (in hospital long time)
inadequate postural reflex
late state pregnancy
advanced age
venus defects in legs
recovery from sympathectomy
addisons disease (low cortisol)
physical exhaustion/starvation
chronic postural hypotension |
|
|
Term
| define postural hypotension |
|
Definition
| disorder of the autonomic nervous system where syncope occurs when pt sits up |
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