List 5 components of an adequate medical history review.
- thorough interpreting of all info provided
- asking appropriate questions related to risks for conditions
- evaluating responses to follow-up questions
- considering drug history and indications for each drug
- verifying necessary medical consultations before initiating tx.
How are vital signs used to assess sytemic health?
compare pts vitals to values and qualities of normal limits
Define basic life support and consider its use in medical emergency management
- assuring open airway, breathing, and circulation
- if a medical emergency develops, this is the first step in management
Describe the roles of each member of the team in the dental office emergency management protocol.
- Dental hygienist: assist pt in retrieving personal meds or O2 in emergency
- Someone: monitor vitals every 5 minutes
- Someone: bringing emergency kit in area
- Someone: Assure that equipment is functioning properly
Identify situations that limit the effectiveness of an emergency drug.
If circulation and respiration have stopped
Identify the information to provide to EMS personnel
- signs and symptoms
- related health history info and recent hospitilizations
- vital sign info
- resuscitative procedures and meds administered
Identify the source of most medical emergencies in the dental office.
- Stress response due to: fear
Describe the relationship between stress, hypoxia, and altered consciousness as a response of the autonomic nervous system.
- during stress response, BP may drop to the point that hypoxia may develop and consciousness is lost; usually occurs when pt is upright
- during this BP initially rises, and vasodilation in muscles causes blood to move from thoracic area to arms and legs, and pool in extremities, then BP drops, this results in cerebral eschemia responsible for loss of consciousness
- When this occurs, the CNS stimulates heart to pump, vasodilation to occur, and blood pressure to continue to drop
Describe the resolution of hypoxia.
- moving pt to a supine position
- an ammonia capsule may be needed to stimulate respiration, but problem is usually solved by lowering pts head
List the primary emergency drugs and describe the use of each.
- E cylinder: oxygen, for hypoxia
- EpiPen: epinepherine, for anaphylaxis
- Metered dose inhaler: albuterol, for bronchospasm
- tablet or metered spray: nitroglycerin, angina pectoris
- solution (intensol): diazepam, for seizure
- Aromatic spirit inhalant: ammonia, for syncope
- Tablet: aspirin, for MI
- solution: glucagon, for hypoglycemia
List accessory items in the emergency kit and identify the purpose of each.
- Pillow: comfort
- blanket: temperature
- portable light source: to see better
- blucometer: measure blood sugar levels
- portable sphygmomanometer: measure BP
Describe the equipment needed to reverse cerebral hypoxia.
oxygen administered as a gas, portable E cylinder oxygen tank with face mask and nasal cannula
Identify contraindications for use of oxygen.
What actions of epinepherine are useful in the management of anaphylaxis? What additional drug is used, and why?
- It increases blood pressure, and dilates bronchiolar muscle
- Oxygen is used because it helps with the hypoxic conditions and lowers the threshold for arrhythmia
Describe the action of nitroglycerin in the management of angina.
It has a strong vasodilation effect
What pt instruction is essential for the pt who uses nitroglycerin?
- That it must be carried at all times, and that they should bring it to all dental appointments
- also, spray form has shelf life of 3 yrs, tablet has shelf life of 3-6 months
What are precautions when it is used for anginal pain?
They should not use drugs for erectile dysfunction
When anginal pain occurs in an individual with no history of cardiovascular disease, how is the management procedure changed?
EMS should be called immediately, and the dentist should administer nitroglycerin from the emergency kit
Describe the number of doses of nitroglycerin, and the timing of dose administration for angina.
- one spray or one SL tablet placed sublingually
- dose form administered aevery 5 minutes
- maximum of 3 doses in a 10 minute period
Identify the drugs that interact with nitroglycerin. How does this affect emergency care?
- drugs for erectile dysfunction: phosphdiesterase type 5 inhibitors
- sildenafil (viagra)
- tadalafil (cialis)
- vardenafil hydrochloride (levitral)
- pts with heart problems will not be given these drugs
How is angina differentiated from MI?
- nitroglycerin will not resolve chest pain from MI, but it can resolve angina pain
- Angina is when cardiac muscle recieves too little oxygenated blood
- MI is most often caused by a blood clot that occludes a blood vessel within the heart
Identify the most likely behavior preceding hypoglycemia in the pt with diabetes.
taking insulin and not eating a meal
List situations that can lead to breathing difficulties during dental hygiene care.
- acute asthma attack
- chronic obstructive pulmonary disease
- allergy causing asthma
- stress-induced asthma
What pt instruction is recommended for the individual with respiratory disease?
they should be required to bring personal bronchodilator inhaler to all dental appointments
Describe management of an acute asthma attack.
- Sit pt upright
- use rescue inhaler: albuterol or pirbuterol
- some pts may use aerosolized epinepherine
- 2 inhalers taken over a 4-5 min period followed by 100% oxygen at 2-4 L/min by nasal cannula
Identify the type of seizure that causes a medical emergency during oral health care.
tonic-clonic convulsive, or grand mal seizure
What type of seizure is managed with a drug? What is the drug of choice to stop uncontrolled convulsive seizures?
- uncontrolled or severe seizures
- benzodiazepines; diazepam
Identify possible causes for uncontrolled seizures.
- local anesthetic overdose
- prolonged syncope
- alcohol withdrawal
Identify 2 antagonists used in emergency management and specify when each is used.
- Naloxone (Narcan): opioid antagonist, in case of life-threatening opioid-induced respiratory depression
- Flumazenil (Romazicon): reverse actions of benzodiazepines, overdose of benzodiazepines resulting in bizarre behavior, hyperexciteable, and pts trying to leave the office
Describe duties that could be delegated to the dental hygienist in the emergency mamagement protocol.
- recognize emergency or most likely cause
- position pt to open airway
- assess airwy, breathing, and circulation
- activate 911 system if needed and not time called
- notify dentist of emergency
- gring emergency kit to emergency area
- monitor vitals and record time
- provide 100% oxygen