sudden and temporary appearance of large areas of painless swelling in the subcutaneous tissue or submucosa: a sympton related to allergy; also called angioedema
variation from normal rythym, especially the heart beat
dry crackling sound, such as that produced by the grating of the ends of a fractured bone
incision through the skin and the cricothyroid membrane to secure a patent airway for emergency relief of upper airway obstruction
labored or difficult breathing; indication of inadequate ventilation or of insufficient oxygen in the circulating blood
a cardiac arrhythmia marked by fibrillary contractions of the ventricular muscle caused by rapid repetitive exication of myocardial fibers.
Deficient oxygenation of the blood; insufficient oxygenation of the blood eventually leads to hypoxia.
loud, slow, labored breathing common to patients in diabetic coma
a drop in systolic and diastolic blood pressure due to change in the body position, usually from lying back or sitting to a standing position. The resulting reduction in blood flow can cause temporary shortage of oxygen to the brain and a feeling of light-headedness or syncope
not through the alimentary canal, administered by subcutaneous, intramuscular, or intravenous injection.
temporary loss of consciousnes caused by a sudden fall in blood pressure resulting in generalized cerebral ischemia; can have serious consequences, particularly in patients with a cardiovascular disease, commonly referred to as fainting.
patient is placed on one side with the top leg bent at the hip and knee to form a right angle. the arm closest to the floor is outstretched above the head so that it will stabilize the upper body, while at the bent knee stabilizes the lower body.
patient is supine with the heart higher than the head on a surface inclined downward about 45 degrees.
vascular reaction of the skin with the transient appearance of slightly elevated patches (wheals) that are redder or paler than the surrounding skin; may be accompanied by severe itching; also called hives.
How to increase Emergency Preparedness?
- Review drills periodically
- Keep equipment in convenient place
- Keep quick reference available
The best way to prevent an emergency is to employ proper patient assessment techniques is
–Medical history review
–Vital signs documentation
–Findings on medical alert tags
–Completion of physical assessment
Factors Contributing to Emergencies are :
- Older patient population
- Patients taking multiple medications
- More complex dental procedures
- –Requiring longer appointments
- Increased use of drugs in dentistry
- -Anesthesia: local, general, conscious sedation. Tranquilizers. Pain medications (CNS depressants). Antibiotics
Assessment for routine treatment:
- –First contact:first interaction with the patient. Note abnormalities of patient’s voice
- –Parts of the assessment:Physical assessment (signs and symptoms). Comprehensive medical history. Vital signs. Extraoral and intraoral examination. Comprehensive documentation of findings
- –Emergency indicators:Changes in a patient’s appearance on the day of an appointment may suggest indicators that encourage preparation for emergencies.
The six vital signs:
pulse, blood pressure, respirations, temperature, height, weight, med alert tag
Baseline vital signs:
the vital signs taken at a routine appointment are considered baseline.
“fight or flight” reaction, during which time they are said to be compensating. The vital signs are elevated above the baseline findings
The vital signs have fallen below baseline, and the patient could be going into a state of shock
A state of lack of perfusion (saturation) of oxygenated blood to all cells of the brain and body. When brain cells are deprived of oxygenated blood, they cease to provide respiratory and circulatory function.
–blood disorders and endocrine disorders may be discovered from extraoral palpation, skin color changes, abnormalities of the eyes, and asymmetry of the face or neck
–oral manifestations and lesions can be indications of many disease states, such as diabetes, anemia, leukemia, lupus, or HIV/AIDS
Recognition of Increased Risk Factors
- Updated medical/personal histories
- Special needs as noted
–Diseases (under care of physician)
–Allergies or drug reactions or interactions
- Recognize patient with stress problems
- Suggestions for effective communication
- –Actively listen to patient’s fears
- –Effects of fear
Reduction of Stress
- Appointment scheduling
- Posttreatment care
Emergency Materials and Preparation
- –Telephone numbers for medical aid
- Equipment for use in an emergency
- Care of drugs
- -Identification:familiar with the emergency drugs
- -Record of drugs
Basic Life Support
- Patient in emergency distress–Sudden cessation of effective respiration and circulation
- Assess:the cause of collapse, respiratory arrest, or cardiac arrest cannot always be determined at the outset.
- Determine state of consciousness –No response: call 911
Length of Treatment
- Signs of recovery
- Patient transport to hospital
- Do not leave patient
- Recovery position
- Sequelae–cardiopulmonary resuscitation must be continued until medical assistance arrives or the patient begins to recover.
- Clear the mouth
- Open airway
- Rescue breathing procedure:place resuscitation mask on patient. Hold with thumbs (on sides of mask) and place fingers on the border of the ramus to obtain a seal. Apply modified jaw thrust to open airway if necessary. Deliver two breaths (1 second each breath). Avoid giving full, deep breaths. For child or infant, use only enough breath volume for chest to rise.
- Repeat the breaths (ventilations):provide 2 breaths following each cycle of 30 chest compressions. Rescue breathing is considered effective when the patient’s chest rises with each breath.
Defibrillation with the AED
- Automatic external defibrillator (AED)
- Indications: patients who are in cardiac arrest have an initial rhythm of ventricular fibrillation (VF), which is an erratic rhythm that is ineffective at producing normal contractile force of the ventricles. Purpose: electrical defibrillation interrupts VF, establishing a normal sinus rhythm. Without defibrillation intervention, VF shifts to asystole (no rhythm) in a matter of minutes. For every minute that defibrillation is delayed, survival from cardiac arrest declines by as much as 10%.
- Procedure:adhesive electrode pads are placed on the patient. AED will advise the rescuer to press the “shock” button to defibrillate the heart, or the AED voice prompt will say “shock not indicated.” The AED analyzes the ECG signals to determine if the patient’s heart is in VF, in ventricular tachycardia (VT), or pulseless. If the heart has a normal rhythm, the AED will advise the rescuer. After each single shock, continue with CPR for 2 minutes before pressing shock button again.
- Types of AEDs:many commercial AEDs are available for dental offices, physician’s offices, airlines, and public health centers. Training on the specific AED purchased is of great importance. Being familiar with the emergency equipment available increases confidence and accuracy in managing any medical emergency. A defibrillator may be used only by dental professionals who are trained in a special program on how to use the defibrillation equipment.
- Contraindications:: the patient is less than 1 year old. The patient is in or near some type of standing water. The patient has an implanted pacemaker or defibrillator. The patient has a transdermal patch in the place where the electrode pads must be placed. The patient has hair on the area where the electrode pads must be placed and the hair interferes with the adhesion of the pads. The patient is perspiring so much that the skin is too wet for the electrode pads to properly adhere to the skin.
Signs and symptoms of “mild” obstruction:
good air exchange. Coughing and irregular breathing.
Signs of “severe” obstruction:
poor air exchange. Breathing difficulty, or inability to speak or breathe. Silent cough. Cyanosis.
–Using supplemental oxygen
Patient not breathing
–Using positive pressure
Documentation in emergency:
- Comprehensive record keeping
- New entries
- –Response to treatment
- –Previous appointment review
- –Current information
- –Emergency doc. & progress notes
Factors to Teach the Patient
- Stress minimization
- Emergency prevention
- Appointment scheduling
- Taking medications as prescribed
- Medications for prevention of emergency episodes
Oxygen Delivery System – review pg.123
Amoxicillin dose for standard general prophylaxis
- Adult:2.0g orally
- Child: 50mg/kg orally