Medical Emergencies Ch. 3

massachusetts

State that made it mandatory for DDS to maintain a “minimal” emergency kit

state

Most guidelines are developed by ____ boards of dental examiners who certify DDS who administer oral or parenteral sedation

position, circulation, airway, breathing, difinitive care

P – C – A – B - D

supine

Position of an unconscious patient

comfortable

Position of a conscious patient

circulation

Assess & perform chest compressions if needed

airway

Assess & maintain, (head tilt/chin lift) if needed

definitive care

Diagnosis, drugs & defibrillation by doctor

dentist

who bears legal responsibility for the overall management & outcome of the emergency situation

person 1

Initiate BLS as needed

Remain with the patient

Alert office staff members

You, the clinician

familiar

Only use drugs with which one is ____ with and able to use

essential, 2nd degree, ACLS, antidotal drugs

Four levels of emergency kits:

adult dose

Typically 1-ml ampule or vial =

child

would use 1/2 ml or ampule

33-66 pounds

infant

would use 1/4 ml or ampule

33 pounds or less

vastus lateralis and mid deltoid

2 Sites for IM injections

injectable drugs, non-injectable drugs, and equipment

3 things each kit should have

IV

Fastest route for injection of drugs, 20-30 seconds

Not done is most dental offices

10

Intramuscular injection may take up to __ minutes to take effect

vastus lateralis

provides the fastest uptake of most drugs and is anatomically safe

epinephrine and histamine blocker

2 injectables in essential and drug equipment kit

6

How many non-injectable drugs are there in a essential drugs and equipment kit

6

How many equipments are there in a essential drugs and equipment kit

epinephrine

considered the most import drug in emergency management

epinephrine

Exception to the basic rule of therapeutic dose

0.3, 0.15, 0.075

Therapeutic doses for epinephrine

__ ml for adult

__ for child

__ for infant

epinephrine

Indications:

 Acute allergic reaction (anaphylaxis)

 Acute bronchospasm (acute asthma episode)

Side effects:

 Tachydysrhythmias (racing heart)

epinephrine

Contraindications:

 Pregnant patient =>may induce premature labor

 Consider situation & risks involved

 Patients with significant cardiovascular disease (ASA 4)

diphenhydramine

Example of a histamine blocker

1ml ampule

Therapeutic dose for histamine blocker for adults

histamine blocker

Indications:

 Delayed-onset allergic reaction (involving skin only) non-life threatening allergic reactions

Side effects:

 CNS depression, lower BP, thickening of bronchial secretions (drying)

histamine blockers

Contraindications:

 Not for management of acute asthmatic episode due to the drying effect

4-6 L/min

Therapeutic dose of oxygen

oxygen

Indications:

 Any emergency situation with respiratory distress

Side effects:

 None with emergency use

oxygen

Contraindications:

 Not for management of hyperventilation

nitroglycerin and amyl nitrate

2 examples of vasodialators

0.4, 0.3

Therapeutic dose for vasodilators:

__ mg tablet (sublingual) or spray (translingual)

__ ml inhalant

vasodilator

Indications:

 Immediate management of chest pain from angina pectoris or acute myocardial infarct or acute hypertensive episode

vasodilators

Side effects:

 Once container is opened the tablets deteriorate within 12 wks

 It has a bitter taste & sting when it is effective

 Transient headache, facial flushing & hypotension

vasodilators

Contraindications:

 Not for patients with chest pain who exhibit clinical symptoms of hypotension

albuterol

Name for bronchodilator, aka “rescue inhaler"

1-2

Therapeutic dose for bronchodilators:

__ inhalations every 4 – 6 hrs

bronchodilator

Indications:

 Treatment of bronchospasm (acute asthmatic episode)

Side effects:

 May have significant cardiac effects in some patients

bronchodilators

Contraindications:

 Other similar drugs have contraindications with patient with tachydysrhythmias

no

Are hygienists legally allowed to administer any drugs from the kit in the case of an emergency?

glucose

Example of an antihypoglycemic

antihypoglycemic

Indications:

 Management of hypoglycemia or diabetic patients

Side effects:

 None

aspirin

Example of an antiplatelet/thrombolytic

325

Therapeutic dose for aspirin:

__ mg = adult dose

antiplatelet

Indications:

 Suspected myocardial infarction

 Unstable angina

Side effects:

 Increased bleeding

antiplatelet

Contraindications:

 Life-threatening hemorrhage from recent bleeding ulcer

 Allergy to aspirin

narcan

Example of an opioid receptor antagonist

1, 0.4

Therapeutic dose for narcan (naloxone):

_ spray in nostril

__ mg/ml in 1 ml ampule

opioid antagonist

Indication:

 Opioid-induced depression, including respiratory depression

 Primary concern – maintain airway manually

Side effects:

 Possible respiratory depression relapse dependent on administration route

opioid antagonist

Contraindication:

 Acute withdrawal syndrome of known opioid user

pulse oximeter

Observes oxygen saturation and pulse

 Normal range: 95% to 100%

oxygen tank and masks, AED, syringes, suction devices, tourniquets, pulse oximeter

6 essential emergency kit equipments

corticosteroid

Important injectable drug from the 2° noncritical drugs and equipment kit

respiratory stimulant

Important noninjectable drug from the 2° noncritical drugs and equipment kit

aromatic ammonia

Example of a respiratory stimulant

0.3

Therapeutic dose for respiratory stimulant:

 One vaporole: __ml

respiratory stimulants

Indication:

 Syncope (fainting)

Side effects:

 Irritant to mucous membranes of upper respiratory tract may cause bronchospasm

respiratory stimulants

Contraindication:

 Chronic Obstructive Pulmonary Disease & asthma

solu-cortef

Example of a corticosteroid

50

Therapeutic dose for corticosteroids:

__ mg/ml

corticosteroids

Indication:

 Acute allergic rxn – anaphylaxis, acute adrenal insufficiency

Side effects:

 None for management of life- threatening medical emergencies

opioid antagonist

Important injectable drug that falls under the Antidotal drugs kit

oraverse

Anesthetic reversal agent, injected into the site where anesthetic was injected

Vasodilator that does not reverse numbness immediately

dentist

Who is ultimately responsible for emergency kit?

below AED

Where is the emergency kit located at the Cypress clinic

injectable drugs

The upper left corner of the Cypress clinic emergency kit contains:

dosimeters

The Cypress clinic non-critical emergency kit is located at the bottom drawer under the: