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dental/medical Emer test 1
Test one
89
Other
Professional
09/18/2008

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Term
what is the best way to prevent a medical emergency in the dental office?
Definition
Take a good health history
Term
How should allergies be noted in the chart?
Definition
in red pen on the top of the page
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
Term
What is the ASA Physical Classification system?
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
Term
Describe an ASA 1
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
Term
Describe an ASA 2
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
Term
name some examples of ASA 2 patients
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
Term
Describe ASA 3
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
Term
Is an ASA 2 patient a yellow or green light patient?
Definition
yellow, no contraindications to treatment but may need treatment plan modifications such as pre-med
Term
Is an ASA 3 patient a green, yellow, or red light?
Definition
Yellow- no contraindications to elective treatment but risk to patient is increased. Needs treatment modifications and serious consideration when treating these pts
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
Term
Describe ASA 4
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
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
Term
Describe ASA 5
Definition
terminally ill, not expected to survive more than 24 hours
might be DNR
no treatable in dental setting
Term
what are the 6 vital signs you should note?
Definition
BP, HR, resp, (every time)
temp, height, weight (for anesthetics)
Term
Define blood pressure
Definition
force exerted by blood on the walls of blood vessels during heart contractions
Term
define hypertension
Definition
abnormally high BP (above 140/90)
Term
define hypotension
Definition
abnormally low BP, often associated with shock (under 90/60 I think)
Term
define systolic pressure
Definition
the force exerted during ventricular contration
Term
define diastolic
Definition
the lowest pressure exerted against the arteries, ventricular relaxation
Term
define pulse
Definition
pressure waves with each beat causing surge in BP within the artery.
Term
tachycardia
Definition
the heart beating too fast, above 100 bpm
Term
define bradycardia
Definition
the heart beating too slow, below 60 bpm
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
Term
how could you describe a normal pulse?
Definition
strong
Term
how could you describe a stronger than normal pulse?
Definition
bounding
Term
how would you describe a weak or difficult to feel pulse?
Definition
thready or weak
Term
What is a normal pulse range for adults?
Definition
60-100 bpm
Term
what is a normal pulse range for children?
Definition
100-160 bpm
Term
what is a normal pulse range for infants?
Definition
80-120 bpm
Term
what is a normal rpm for adults?
Definition
12-20 rpm
Term
what is a normal respiration rate for children?
Definition
around 20 rpm
Term
what is a normal temperature for adults?
Definition
96-99.5 above this indicates infection or disease
Term
why do we ask patients if they have taken appetite suppressants?
Definition
these types of drugs can cause heart problems, which could be complicated by anesthetic
Term
why do we ask pts if they have taken coke in the last 12 hours?
Definition
If given anesthetic will coke (or coke derived drug) is in their system they could die.
Term
what is the role of a dental auxiliary in preparing for medical emergencies?
Definition
familiarize self with office policy
identify emer equipment
familiarize self with contents of emer kit
practice routines
maintain professional CPR status
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
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
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.
Term
where are the O2 tanks and AED stored in the clinic?
Definition
Both are right outside the dispensery
Term
What do you assess before using the AED?
Definition
Verify the patient unconscious, not breathing, no pulse
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
Term
define allergic response
Definition
hypersensitive response to an allergen to which an individual has previously been exposed and to which that individual has developed antibodies.
Term
what is anaphylaxis?
Definition
result of rapid activation of several inflammation pathways. An extreme allergic reaction that often involves multiple organ systems. Can be life threatening.
Term
what are some causes of anaphylaxis?
Definition
drugs, pollens, foods, chemicals, insect bites etc
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)
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
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.
Term
define antibody
Definition
those substances found in blood or tissues that respond to the administration of or react to antigens
Term
define antigen
Definition
any substance foreign to the host that is capable of activating an immune (allergic) response by stimulating the development of a specific antibody
Term
define pruritus
Definition
itching
Term
define angioedema
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
Term
define allergen
Definition
an antigen that can elicit allergic symptoms
Term
define urticaria
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.
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
Term
what are the two most common reactions in the dental office?
Definition
Fluoride and anesthetic related
Term
what is the most common adverse reaction in the dental office?
Definition
vasodepressor syncope
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
Term
what are signs of anesthetic overdose?
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.
Term
what are some symptoms of anesthetic overdose?
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
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
Term
what are some signs and symptoms of anesthetic ALLERGIC reaction?
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
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
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
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
hyperglycemia
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
describe syncope
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
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
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
Term
name some clinical manifestations postsyncope
Definition
recovery should be very rapid, less than a few seconds, pt may feel off for next 24 hours
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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