Upgrade to remove ads
Only $35.99/year

Office Medical Emergencies Exam I

Terms in this set (159)

In most medical emergencies _____ is the key to success, not the use of _____.
- Basic Life Support (BLS)
- Not the use of medications
BLS involves what four aspects?
- Airway
- Breathing
- Circulation
- Defibrillation
What is the best way to ensure that an emergency handled appropriately?
- Have an office plan & document the training
- Practice, practice, practice
- Have a specific job for each member of the staff
What are the JADA recommendations for success in medical emergencies in the dental office?
- Never treat a stranger: know your patient's medical history
- Never work with a stranger: train staff and document training
- Have a plan and make time to practice
What are the early physical warning signs of medical emergencies?
- Change in HR/regularity
- Change in BP
- Change in respirations
- Change in body temp
- Posture, movement, skin tone
What are the early mental warning signs of medical emergencies?
- Disorientation
- Incoherence
- Loss of Consciousness
- Change in speech
What are the early sensation warning signs of medical emergencies?
- Numbness may be due to stroke
- Nausea may be due to swallowed blood, narcotoics, stroke, or MI
- Light headedness may be due to narcotics or pre-syncopal
What are the early psychological warning signs of medical emergencies?
- Sense of impending doom is a sign of myocardial infarct
What are the early mentation warning signs of medical emergencies?
- Disorientation/Incoherence: hyper/hypoglycemia, stroke
- LOC: oversedation, stroke, hyper/hypoglycemia
- Changes in speech: stroke
List the basic drugs that should be kept on hand for emergencies.
- Vasopressor: epinephrine
- Antihistamine: benadryl
- Anticonvulsant: benzodiazopene (controlled substance) for treating status epilepticus
- Bronchodilator: albuterol
- Chewable aspirin: given early on in a MI event
- Vasodilator: nitroglycerin
- Portable Oxygen
- Sugar
- Reversal agents: flumazenil (reversal after bezo sedation), naloxone (reversal after opoid sedation)
- Other optional drugs: atropine, steroid, aromatic ammonia
According to the Texas Dental Board, what must be in a medical emergency kit?
- Positive pressure O₂
- Equipment and currently dated drugs
- Trained staff
- Adherence to generally accepted protocols
- Current CPR certifications
Why is it important to train staff to be trained and knowledgeable about treating emergencies?
- One day, it may be you (the doctor) to have a medical emergency, and it is important that the staff know how to handle the situation
Define Syncope.
- Loss of Consciousness and Muscle Tone
What are the etiologies of syncope?
- Peripheral vascular or circulatory: vasodepressor, micturation, hypovolemia, autonomic dysfunction, medications
- CNS: seizures, emotional
- Metabolic: hypoglycemia, anemia, hypoxia
- Cardiac: obstructive cardiomyopathy, arrhythmia
_____ is the most common emergency in the dental office. What is it associated with?
- Vasodepressor Syncope (vasovagal syncope)
- Stress, injury, and/or pain (neurocardiogenic reflex)
Describe the process of Vasovagal syncope occurrence.
- Afferent Stimulus (fear or pain) to cerebral cortex & medullary centers
- Catecholamine release → ↓ peripheral resistance and ↑ blood flow to skeletal muscle
- Parasympathetic stimulus to the heart (bradycardia)
- Patient doesn't move → blood remains pooled in the periphery → relative ↓ circulating blood volume → ↓ arterial blood pressure → ↓ cerebral blood flow → syncope
What are the prodromal signs and symptoms of syncope?
- Pale, clammy skin
- Diaphoresis
- Lightheaded
- Tachycardia followed by bradycardia
- Anxiety (often unexpressed)
What is the treatment for syncope?
- Place patient in supine position w/ the feet elevated
- Ensure open airway
- Verify ventilation
- Monitor vital signs
- Consider ammonia vaporole
How do you test for the resolution of the syncopal episode?
- Sit the patient up at 45 degrees and see how they respond
- If the patient's BP is up and HR is up, you can assume you have complete resolution
If a patient has a syncopal episode and completely recovers, when can you resume dental treatment?
- Immediately; there is no physiologic reason not the complete the procedure that day
What are the 3 presentations of Ischemic Heart Disease?
- Angina pectoris (stable vs. unstable)
- Myocardial Infarct
- Sudden cardiac death
T/F
No elective dental treatment should be performed on a patient within 12 months of an MI. Unstable angina patients may undergo elective dental treatments.
- False: 6 months of an MI
- False: only stable angina patients should undergo elective treatment
The 3rd most common emergency event in the dental office is _____. Women are more likely to have _____ pain as the primary symptom.
- Chest pain
- Back pain (often left shoulder or left arm as well)
Chest pain is caused by _______ secondary to _________. Patients with _____ are more likely to have a silent MI.
- Hypoxia to the myocardium secondary to atherosclerotic deposits
- Diabetes
How can you differentiate chest pain from cardiac causes vs. chest pain from non-cardiac causes?
- Cardiac caused chest pain is diffuse, dull, and not changed by respiration
- Non-cardiac chest pain (such as pleuritis) is often localized, sharp, and changes in intensity w/ respiration
How do you differentiate an MI from Acute Angina?
- Pain from a MI is not relieved by nitrates such as nitroglycerin while Acute Angina will be relieved by nitrates
- Weakness/diaphoresis/cyanosis w/ MI
- Fear of impending doom w/ MI
- Nausea & vomiting w/ MI
The timing for the administration of _____________ during an MI has the greatest decrease in mortality in patients.
- Thrombolytics in the Cath Lab w/ angioplasty
How should you manage cardiac chest pain in the dental office?
- Have the patient sit up (not lying down)
- O₂ administered and Vital signs monitored
- Administer Nitroglycerine tab or spray every 3-5 minutes: maximum of 3 times or until pain is relieved
- If there is no pain relief from Nitroglycerin, then it is likely a MI then follow MONA
Why should you have the patient sitting or standing up during a suspected MI?
- By having the patient sit or stand, the amount of blood returned to the heart is decreased, therefore decreasing the amount of work required by the heart
What is the MONA protocol for treating an MI until the EMS arrives?
- Morphine (or nitrous oxide)
- Oxygen
- Nitroglycerin
- Aspirin (chewed w/ transmucosal absorption)
If a patient has used the drug _____ in the last 24 hours, nitroglycerine may cause the patient to be come life threateningly hypotensive.
- Viagra (or other Erectile Dysfunction drug, such as Cialis, etc.)
- Similarly, patients must not take any ED medication in the 24 hours following nitroglycerin administration
What is the normal blood sugar range for patients w/ Diabetes? At what blood sugar level should you not treat a diabetic?
- 90-110: normal
- 80-200: okay to treat
- >200: immunocompromised, defer treatment, or give prophylactic antibiotics
What is the HbA1c? A normal HbA1c value is _____%. A HbA1c of > _____% indicates a poorly controlled diabetic.
- HbA1c lab test looks for the percentage of glycosylated hemoglobin in the patient's blood, providing an indicator of the patient's long-term blood glucose control
- <6%
- 9-12%
What is the etiology of DM?
- Hyperglycemia resulting from an absolute deficiency of insulin secrection, reduction in the biologic effectiveness of insulin, or both
T/F
Type I DM is typically inherited. The administration of corticosteroids can cause iatrogenic diabetes.
- False: Type II DM has a genetic predisposition
- True
T/F
Type I DM is less common than Type II DM. Type I DM patient's have an excess of insulin in their bloodstream.
- True: IDDM accounts for 8% of of diabetics
- False: they essential lack all insulin
Without exogenous insulin, IDDM patients will go into ___________. What may cause Type I DM?
- Ketoacidosis
- AI responses, such as auto-antibodies to beta-cells, or may be the result of infections in genetically predisposed individuals
T/F
NIDDM (Type II) patients have tissues which lack insulin sensitivity. Most diabetics taking insulin take a long-acting agent for basal insulin and short-acting agents for post-prandial spikes.
- True
- True
What oral agents are used for diabetes maintenance?
- Sulfonylureas: stimulates insulin secretion and inhibits hepatic gluconeogensis (glyburide, glipizide, glimeperide)
- Biguanides: ↓ hepatic glucose output and reduces hyperlipidemia (metforminn*)
What is the drug of choice for new Type II patients?
- Metformin
What are the symptoms of hypoglycemia? Below what glucose level does unconsciousness occur? Below what glucose level do symptoms occur?
- Weak, dizzy, pale, diaphoresis, headache, mental confusion
- Possible unconsciousness <50mg/dL
- Symptoms at <70
What is the treatment for Hypoglycemic episodes?
- BLS basics
- Fingerstick glucometer test
- Sugar: simple carbohydrates, 24-25 grams and wait 15 min for a response
- Conscious: use oral gel or sugary drinks
- Unconscious: IV D₅₀W, glucagon; oral form (viscous gel) for transmucosal absorption
What is the classification of Hypoglycemia?
- Drug induced: insulin, alcohol, sulfonylureas
- Fasting hypoglycemia
- Reactive: stress, exercise, infection
What factors may precipitate Hyperglycemia?
- Insufficient insulin
- Weight gain
- Reduced exercise
- Fever
- Corticsteriod therapy
- Acute infection
- Pregnancy
Giving patients with hyperglycemia insulin causes ____________ to flow into cells, leading to heart __________.
- Potassium in
- Heart arrhythmias
What are the signs/symptoms of hyperglycemia?
- Fruity odor to breath due to ketoacidosis
- Hyperventilation (patient is in metabolic acidosis, responds w/ respiratory alkalosis)
- LOC
- Dehydration
What is the treatment for hyperglycemia?
- Insulin (though shouldn't be administered in the dental office)
- BLS
- IV if possible
- Supplemental O2
- EMS
Congestive Heart Failure is due to _____. _____% of patients diagnosed with CHF die within 5 years.
- Inability of the heart to function as a pump
- 50%
What are the clinical presentations of CHF?
- Rapid shallow breaths
- Neck vein distension
- Peripheral edema (pitting edema)
- Dyspnea (difficulty breathing)
- Orthopnea
What drug from the emergency drug kit is used to treat acute episodes of CHF in the dental office? How is are acute episodes of CHF managed in the dental office?
- No drug for CHF in the emergency drug kit
- Basic BLS, Supplemental O₂, Call 911
What drugs are commonly used to control CHF long term?
- ACE inhibitors
- Thiazide diuretics
- Potassium-sparing diuretics
- Loop diuretics
- Digitalis glycosides
- Long acting nitrates
- Vasodilators
What are the AHA classifications for CHF?
- Class I: no limitation of physical activity
- Class II: slight limitation of physical activity w/ fatigue, palpitations, dyspnea w/ ordinary physical activity
- Class III: significant limitation but comfortable at rest (no elective treatment)
- Class IV: symptoms at rest (no elective treatment)
Class I and II CHF patients may be treated in the dental office provided ______________.
- Vital signs are WNL
- Procedures are short & stress-free
- Chair is upright
What is hypertension? What organs does it affect the most?
- Abnormal elevation of arterial pressure which precedes the onset of vascular changes
- Kidneys, heart, & eyes
What are the first 2 stages of Hypertension?
- Stage I: 140-159 / 90-99
- Stage II: >160 / >100
Define Concordant and Discordant hypertension.
- Concordant: ↑ Systolic andd* Diastolic BP (most lethal)
- Discordant: ↑ Systolic orr* Diastolic BP (systolic only more lethal than diastolic only)
What is the difference between Secondary and Essential hypertension? Which is more common?
- Secondary: hypertension is due to a systemic disease, often from kidney disease such as renal artery stenosis
- Essential: hypertension due to increased peripheral resistance, 95% of cases (more common)
Describe the difference in hypertensive emergency and hypertensive urgency.
- Hypertensive urgency and emergency are differentiated by the patient's symptoms
- For example, if a patient is 170/110 w/ no visual changes, no SOB, no angina, no headaches, then this is hypertensive urgency
- If the patient is 160/100 with w/ visual changes, SOB, angina, or headaches, then this is hypertensive emergency
At what BP should you not treat a patient in the dental office?
- >180 / >110 (Stages III and IV HTN)
What are the signs and symptoms that would indicate a Hypertensive emergency?
- Chest pain
- Headache
- Visual disturbances
- Shortness of breath (SOB)
How is HTN treated by a physician?
- In a stepwise manner w/ the goal to keep BP <140/90
- Step 1: begin w/ single agent such as diuretic or Beta-blocker
- Step 2: increase dosage of first medication, add drug from another class
- Step 3: add third drug and/or diuretic if not already prescribed
How is hypertension managed in the dental office?
- Good medical history
- ↓ Stress and anxiety
- Avoid long appointments
- Premedicate, IV, or Nitrous oxide
- Gradual positional changes
- Avoid stimulating gag reflex
- Dismiss patient if overstressed
- Limit use of vasoconstrictors to 2 carpules
What are the 5 drug interactions w/ Local anesthetic?
- Non-Cardioselective β-blockers*: ↑ BP w/ reflexive bradycardia
- TCA: ↑ BP w/ dysrhythmias (blocked amine neurotransmitters)
- Cocaine: ↑ BP w/ dysrhythmias (blocked amine neurotransmitters)
- α-blockers*: hypotension, epi becomes β₂ agonist
- General anesthesia: dysrhythmias
What are the signs and symptoms of minor allergic reactions?
- Urticaria on trunk and may spread to the face
- Pruritis: specific or generalized itching
- Angioedema: localized skin swelling often of lips and eyes
- Erythema: generalized or localized hives and flushing
How do you differentiate Minor from Major allergic reactions?
- Minor reactions have no cardio or pulmonary affects
- Major allergic reactions have cardio or pulmonary symptoms
An immune-complex mediated immunologic reaction is a Type _____ reaction. Cell-mediated or Delayed immunologic reactions are Type ______ reactions.
- Type III: SLE
- Type IV: contact dermatitis, infectious TB, graft rejection, GVHD
How are Minor IgE (Type I) allergic reactions treated?
- Benadryl, 50mg: antihistamine
- If patient responds well to Benadryl, continue antihistamine dose q 6-8 hours for 72 hours
What are the signs and symptoms of Major Anaphylactic allergic reactions?
- Skin lesions: flushing, generalized urticaria, angioedema, pruritis
- Respiratory: respiratory distress, bronchospasm, airway obstruction
- Cardiovascular: hypotension, tachycardia, dizziness, syncope
How are Anaphylactic reactions treated?
- BLS, O₂, vital signs, EMS activation
- Epinephrine: 0.3-0.5mg IV (1:10,000 epi) or IM/SQ (1:1,000 epi). May repeat every 3-5 minutes to eliminate bronchospasm and hypotension
- Diphenhydramine (50mg IV) may be administered after positive response from epi
- Hydrocortisone (200mg IV) but is usually not administered until at the hospital
What is Epilepsy?
- Group of disorders characterized by chronic, recurrent, paroxysmal changes in neurologic function (seizures) that are caused by abnormal and spontaneous activity in the brain
Which type of Epilepsy is most common in the dental office? What are the characteristics of an epileptic patient that you don't want to treat?
- Tonic-clonic (Grand Mal seizure)
- Poorly controlled w/ medications, patients who don't visit physician frequently for epilepsy, recent seizure
What are the classifications of Epilepsy?
- Partial Seizures: simple and complex
- Generalized Seizures: absence, myoclonic, tonic, tonic-clonic
What stages of a Grand Mal seizure?
- Prodromal aura: aware seizure about to occur
- Outcry: diaphragmatic contraction
- Tonic: muscle rigidity, pupil dilation, eye rolling, breathing irregularities
- Clonic: uncoordinated beating movements of limbs and head. incontinence
- Post-ictal: deep sleep, HA, muscle soreness
What is the most dangerous phase of a Grand Mal seizure for a patient?
- Tonic-Clonic phase due to chest wall rigidity, trouble breathing, and heavy salivation all leading to the patient becoming cyanotic
How do you treat a Grand Mal seizure?
- Protect the patient
- Usually resolves in 3-5 minutes
- Do Not stick tongue blade in mouth
- >4 minutes → Status Epilepticus (emergency, anoxic brain injury)
- Administer benzodiazepines in case of status epilepticus: Diazepam or Midazolam (Versed)
What are the signs of a stroke?
- Facial droop: ask patient to smile; asymmetrical animation points to stroke
- Arm drift: ask patient to extend arms w/ eyes closed; uneven movement is suspect
- Speech difficulties: ask patient to enunciate a phrase
How can Stroke be treated?
- Thrombolytics administered within 3 hours of onset
- TPA or streptokinase
T/F
Oxygen should be given to conscious patients who are having a stroke.
- False: oxygen is a mild vasoconstrictor and may worsen the stroke. However, oxygen should be given to an unconscious stroke patient
What are the clinical features of Asthma?
- Inflammatory respiratory disease causing dyspnea, coughing, wheezing
- Caused by bronchial spasm and mucous hypersecretion
What are the 2 main etiologies of asthma? Which one is more common?
- Extrinsic, allergic/atopic asthma (more common)
- Intrinsic, non-allergenic & idiosyncratic
Patients with Intrinsic asthma are usually taking a _____ drug.
- Systemic Steroid
How is asthma classified?
- Mild: symptoms following exposure to allergen, lasts less than 1 hr and occurs less than 2x per week
- Moderate: symptoms are greater than 2x per week, may affect sleep and daily activities w/ multiple ER visits
- Severe: ongoing symptoms that limit daily activities
What are the controller drugs used in asthma? Reliever drugs?
- Controller: steroids, beta-2 agonists, anticholinergics, cromolyn sodium, anti-leukotrienes
- Reliever: short acting beta-2 agonists
What should you do in the event of an asthmatic attack in the dental office?
- Allow patient to sit up
- Administer β₂ agonist Inhaler (albuterol)
- Re-administer as necessary (up to 3 times)
- Supplemental O₂
- EMS if symptoms don't resolve
- (Epinephrine may be give if β₂ agonist fails and patient is cyanotic)
The disease state in COPD is due to airflow obstruction due to __________________.What should be done in the event of an acute COPD emergency?
- Chronic bronchitis or emphysema (usually features of both)
- Supplemental O₂
- EMS activation
How does chronic bronchitis differ from emphysema in terms of the patient's stats?
- Chronic bronchitis patients have elevated PCO2 and erythrocytosis (blue bloaters)
- Emphysema patients have normal PCO2 and normal hematocrit (pink puffers)
How do you manage a patient w/ COPD in the dental office?
- Good Medical History
- Avoid further depressing respirations, supine or upright chair position, enteral sedation only w/ extreme care, and low flows of N₂O sedation
- Short treatment times
_____ hyperventilation is the primary type of hyperventilation seen in the dental office.
- Stress-induced
What are the Initial clinical presentations of Hyperventilation syndrome?
- Lightheadedness and dizziness
- Chest discomfort
- Dysphagia
- Nausea
- Positive feedback of symptoms: patient notices discomfort and further increases ventilation
Hyperventilation leads to _____________.
- Respiratory alkalosis
What are the Physiologic signs of Hyperventilation?
- Coronary artery vasoconstriction (chest pain)
- Release of adrenaline
- Neurologic symptoms: ↓CNS perfusion
- Paresthesias: around mouth & extremities (numb and tingly)
- Tetany: carpopedal spasms
How is Hyperventilation syndrome managed in the dental office?
- Ask patient to breath slowly
- Breathe into paper bag or cupped hands
- O₂ is contraindicated (only emergency where O₂ is contraindicated)
What are the 3 main causes of Loss of Airway during medical emergencies?
- Loss of drive, typically due to over sedation
- Obstruction, either foreign body or positional
- Laryngospasm
How do you distinguish between Loss of Airway due to loss of drive vs. obstruction?
- Jaw thrust: fingers behind ramus of mandible and pull outward
- If patient responds it is obstruction. No response signifies loss of drive
T/F
Immediate signs and symptoms are always present when an object is aspirated. Immediate signs and symptoms are not always present when an object is Swallowed.
- False: not always present
- True
How should a patient be positioned after aspiration of a foreign body?
- Don't let them sit up
- Place the patient in a lateral decubitis position (on side) w/ head down: patient may cough and expel the foreign body
Foreign body obstruction typically presents with _____________ within 1 hour of aspiration.
- Coughing, choking, wheezing, and SOB
The most common cause of Airway obstruction in unconscious patients is due to the _____. The airway is opened using _____.
- Tongue and/or Epiglottis
- Jaw thrust or Head tilt-chin lift procedures
What equipment is used for positive pressure ventilation?
- Ambu bag w/ a demand valve to push oxygen into the patient's lungs
With an E cylinder, how many L of oxygen is held? At 10L per minute, how long will this tank last?
- 682 L
- About 1 hour or 68 minutes
Summarize the ASA Classifications.
- ASA I: normal, healthy patient
- ASA II: patient with mild systemic disease that doesn't interfere w/ daily life
- ASA III: patient with moderate to severe systemic disease that alters day to day life (labile HTN, IDDM, MI w/in 6 months, COPD, CHF)
- ASA IV: patient with sever systemic disease that is constant threat to life (ESRD, liver failure)
- ASA V: moribund patient not expected to survive for 24 hours with or without operation
- ASA VI: patient who is declared braindead
- E can be added to any of these for emergency situations
List all the different routes of Drug Administration. Which one is the fastest route of drug administration?
- Intravenous (IV)
- Intramuscular (IM)
- Sub-cutaneous
- Endotracheal (w/ intubated patient)
- Intra-nasal
- Oral
When starting an IV, the ____________ vein is typically used.
- An antecubital vein, such as the median cephalic or basilic vein
Where are the common locations for giving a Intramuscular (IM) injection?
- Into a tissue with excellent vascular supply for absorption
- Deltoid
- Vastas lateralis
- Gluteal
- Sublingual (almost as fast as IV injections, goes extraorally through floor of mouth)
What drugs are used w/ the IM technique?
- Sedative agents
- Analgesics
- Emergency drugs
What are the disadvantages to giving an IM injection?
- Bolus administration based on size a weight
- Variable sedative effects
- Not recommended for the very young due to small muscle mass
How is an IM given?
- 20-22 gauge needle w/ 1-1.5" needle
- Clean skin & hold tissue taut & insert needle
- Aspirate & inject slowly
- Hold pressure on site to control bleeding and swelling
Where is the Vastus Lateralis injection site?
- Mid-lateral thigh on the side about a hands breadth above the knee into the bulk of the vastus lateralis muscle
What are the Superior and Inferior boundaries for the Mid-Deltoid injection site?
- Superior: acromion of the scapula
- Inferior: the point that corresponds w/ the axilla
Describe the injection site for the Gluteal region.
- Divide the area into quadrants & inject into the Upper-Outer quadrant
- Superior border is the posterior superior Iliac Spine
Should Sublingual injections be given Intraorally or Extraorally? Why?
- Extraoral injection for better access, no intraoral bleeding, to avoid floor of mouth structures
- Avoid through-and-through injections
What are the advantages and disadvantages of the intra-nasal route of drug administration?
- Advantages: fast absorption, compatible w/ many drugs
- Disadvantages: many drugs cause nasal mucosa irritation, drug may be swallowed, leak out, or blown back out → ↓ drug absorption
Why is the Oral drug administration usually not for an emergency situation?
- Time is required for absorption: emergencies require rapid drug absorption
- Oral administration requires a conscious, cooperative patient: not always possible in an emergency
Oral drugs can be used in what medical emergencies?
- Hypoglycemic episodes: carbohydrates
- Mild allergic reactions: Benadryl
- Infarction: chewable aspirin, oral sublingual nitroglycerin
What are the advantages to using an IV line?
- Fastest route of drug administration
- Fluids also given to hydrate patient
- Some drugs can only be given as IV
You set up an IV line on a patient and notice multiple small bubbles in the line before beginning drug administration.
How should you proceed?
- Continue to administer the drug
- Small air bubbles are of no concern: RBCs will absorb the air
What are the seven drugs that you should have in your emergency kit?
- Vasopressor
- Antihistamine
- Sugar/antihypoglycemic
- Bronchodilator
- Chewable aspirin
- Vasodilator
- Oxygen
_____ is the #1 drug for the prevention and treatment of medical emergencies. Most emergencies occur following ____________ in a dental setting.
- Oxygen
- Following anesthetic injection (55%)
The E-tank of oxygen has a _____ valve and is capable of _____ L/min flow rate. E-tanks are checked on a _____ basis
- Double-gauge reduction valve
- 10-15 L/min
- Weekly
At a flow rate of 10L/min, a full E-tank will last about _____ min.
- 60 min
_____% of emergencies are related to stress and anxiety. Oxygen supplementation is contraindicated in _____________ emergency patients.
- 76%
- Hyperventilation patients
Oxygen delivery should be at a rate of ________L per minute for unconscious and apneic patients. Positive pressure flow rates should not exceed __________L per minute.
- 10-15 L/min
- 35 L/min
The Drug of Choice for generalized anaphylaxis is ______________. What forms does this come in?
- Epinephrine (catecholamine)
- Ampule or pre-loaded EpiPen (delivers 0.33mg in each increment)
What properties of epinephrine make it ideal for treating anaphylaxis?
- Rapid onset
- Bronchial smooth muscle dilator
- Histamine blocker
- Vasopressor
- Increases HR, SBP, CO, and Coronary blood flow
What are some disadvantages of epinephrine?
- Predisposes heart to dysrhythmias
- Short DOA
Initial doses of epinephrine for anaphylaxis are _______________mg IM or _________ mg IV.
- 0.3-0.5mg IM
- 0.1 mg IV
The drug of choice for vasodilation is ____________. How is it adminsitered?
- Nitroglycerin
- Sprayed under the tongue
Why is the nitroglycerin spray superior to the nitroglycerin tablets? What patients are these contraindicated in?
- Tablets have a short shelf-life at 8-12 weeks after opening the bottle
- Hypotensive patients (systolic below 90mmHg)
What forms & dosages does nitroglycerin come in? Which is recommended?
- 0.3, 0.4, and 0.6mg sublingual tablets
- 0.4 and 0.8mg/dose translingual spray
How should nitroglycerin spray be administered? What symptoms will the patient complain of if the nitroglycerin is working?
- One dose sublingual every five minutes for maximum of 3 doses or until pain subsides
- Severe headache
With additional thrombolytic therapy, chewing an aspirin during an MI reduces mortality by _______%.
- 42%
What are the clinical features of hypoglycemia (blood glucose <70mg/mL)?
- Sweating, tremor, plapitations
- Oral paresthesias
- Slurred speech
- Behavioral disturbances
For severe hypoglycemia, what should be done? Which is the ideal management protocol?
- Call EMS
- IV D50W (50mL of 50% glucose)
- Glucagon (1mg)
What role do corticosteroids play in emergencies? Describe the onset of action.
- Role in recurrent anaphylaxis and adrenal crisis
- Slow onset, 1 hour when administered IV
What is considered the best form of corticosteroid for dental emergencies, such as adrenal crisis?
- Hydrocortisone 100mg (Solu Cortef)
When adminstered by an inhaler, what effects does Albuterol have on the CV system? If the inhaler fails to rescue an asthmatic, what should be used?
- Minimal systemic CV effects
- Other bronchodilators, such as epinephrine or aminophylline via IM or SC
What is the drug of choice for allergic reactions? How do these drugs work?
- Chlorpheniramine or diphenhydramine
- Block histamine's response at target cells
T/F
Antihistamines are more potent in preventing the action of histamine than reversing the actions after they occur. Antihistamines, particularly diphenhydramine, are potent analgesics.
- True
- False: anesthetics, causing sedation
How should anti-histamines be used for mild and life-threatening allergic reactions?
- Mild, non-lifethreatening reactions: PO administration
- Life-threatening: parenteral administration
What are side effects of diphenhydramine?
- CNS depression
- Decreased BP
- Thickening of bronchial secretions
- Contraindicated in acute asthmatic episodes
What emergency drugs are used during status epilepticus?
- Midazolam, diazepam, lorazepam
After the seizure has stopped, what is important to monitor during the post-ictal phase?
- Airway and breathing due to CNS depression plus respiratory depression secondary to midazolam (or other benzo if given)
- May require oxygen w/ positive pressure
What does administration of morphine cause?
- Decrease in BP and respiratory depression
What is the reversal agent for benzodiazapines? Opioids?
- Flumazenil: titrated in 0.1 to 0.2mg increments
- Naloxone: titrated in 0.1mg increments
The best treatment for emergencies is ________________.
- Preventing them from occurring by taking a good medical history
If you have an E cylinder that is 1/2 full, how long will it last at 10L per minute flow?
- About 30 minutes
If the EMS response time in your city is 15 minutes, how often should you refill your oxygen cylinders?
- At 1/2 full to give you full 30 minutes of peak flow
What are additional pieces of equipment that should be present in office for emergencies?
- Suction tips (tonsillar)
- Syringes and needles, both IV and IM
- Tourniquet
- Stethoscope & sphygmomanometer
- Tape
- Flashlight
Each minute, there is a _____% decrease in success rate of defibrillation by an AED. What is the rationale for early defibrillation?
- 7-10% decrease/minute
- Most frequent initial rhythm in cardiac arrest is ventricular fibrillation & the most effective treatment for this is defibrillation
The out of hospital survival rate without defibrillation after 2 minutes is _____%. Survival rates with defibrillation within 2 mintues is _________%.
- 8%
- 30-89%
What type of AED is better, monophasic or biphasic? Why?
- Biphasic: this passes 150 joules of energy in two directions through the heart (double pass through cardiac tissue)
What are the contraindications for using AEDs?
- Children less than 8 years or under 90 pounds (use Pedi Pads)
- Not used unless patient has no pulse
- Not used in moving vehicle or in water
What is more lethal, hypo or hyperthyroid when combined with dental treatment? Why?
- Hyperthyroid: increased BP, cardiac dysrhythmias, tachycardia, & potential for thyroid storm which is caused by infection, trauma, or surgery
What is Cushing's Syndrome?
- Hypersecretion of cortisol - rarely an emergency
- Elevated BP, increased fat to face & back (moon face & buffalo hump)
How do you prevent an Acute Adrenal Insufficiency?
- Take thorough medical history
- Consultation w/ MD prescribing the steroid
- Supplementation: depending upon procedure, double oral dosage the day before, day of, and day following procedure
What is a primary insufficiency in adrenal output called? What causes secondary insufficiency?
- Addison's Disease
- Results from exogenous corticosteroid therapy which suppresses the adrenal glands
What is the normal cortisol production per day?
- 20mg/day
How do you manage an adrenal crisis?
- BLS
- Activate EMS
- Administration of corticosteroid (100mg of hydrocortisone via IV)
What emergencies are seen with pregnancy?
- Syncope due to obstructive hypovolemia: prevent by turning patient onto the left side
- Pre-eclampsia: HTN w/ albuminuria around 20th week of pregnancy
- Eclampsia: coma and/or seizures in 20th week
Sets found in the same folder