DH 111 - Quiz #2

Syncope

Defined as an abrupt, transient loss of consciousness (TLoC) and postural tone with spontaneous recovery most often caused by loss of cerebral oxygenation and perfusion referred to as cerebral ischemia.

Name the situation/condition that is most often associated with syncope.

Stressful situation

Which age groups are particularly susceptible to syncope?

- Children

- Pregnant mothers

- Elderly

Signs and symptoms of syncope

- Pallor (paleness)

- Unconsciousness

- Weak, slow pulse

Which type of syncope is most serious?

Cardiac syncope

5 ways syncope can be caused in children

- Missed meal

- Heat

- Dehydration

- Crying ( holding breath)

- Exertion activity

What is the time frame for a possible recurrent syncopal event?

Within the first 24 hours of initial event

Valsalva maneuver

Forced expiratory effort against a closed airway

- Example: clearing of ears

What are the three types of syncope?

- Cardiac

- Noncardiac

- Neurocardiac/vasodepressor

What are the 2 etiologies of cardiac syncope?

- Arrhythmic

- Obstructive

What are the 5 etiologies of noncardiac syncope?

- Seizures

- Orthostatic hypotension

- Situational occurrences

- Hyperventilation

- Metabolic disease

What are the 2 etiologies of neurocardic/vasodepressor syncope?

- Noxious stimuli

- Activation of the sympathetic division of the autonomic nervous system

Describe the treatment position of a patient in syncope

Trendelenburg

- Supine with feet and heart above the head

What is the most common form of syncope to dental offices ?

Neurocardiac/vasodepressor syncope

- Noxious stimuli

What noxious stimuli is neurocardiac syncope associated with?

- Pain

- Fear

- Exhaustion

- Illness

What happens the longer the patient is in syncope?

More likely seizure will occur

Shock

Condition produced when the cardiovascular pulmonary system fails to deliver enough oxygenated blood to body tissues to support the metabolic needs of those tissues and leads to abnormal cellular and tissue function; results in a reduction of metabolism for those tissues.

What are the 4 stages of shock?

- Initial

- Compensatory

- Progressive

- Refractory

Initial stage of shock

- First stage of shock

- Cells deprived of oxygen

- Inhibition of energy production

Compensatory stage of shock

- Second stage of shock

- The body performs physiological adaptations in an attempt to overcome the shock (i.e. increased RR, increased BP, reduced blood supply to peripheral organs, oliguria)

Progressive stage of shock

- Third stage of shock

- Compensatory mechanisms start to fail

- Vital organs compromised

- Systolic hypotension

Refractory stage of shock

- Fourth and final stage of shock

- Failure of vital organs

- Irreversibility of the shock condition

- Cell death and brain damage, followed by death

What do all forms of shock have in common regarding blood pressure?

Reduction of BP

What is the first form of action when dealing with a patient in shock?

Recognize the signs and symptoms of the particular type of shock

What treatment do all forms of shock need?

Contacting EMS

How should a patient be positioned if they are in shock?

Supine

What is the most important step in treating hypovolemic shock?

Stop the fluid loss

- Find where blood is occurring, arrest hemorrhage or dehydration.

Which stage of shock is irreversible and characterized by failure of the vital organs?

Refractory stage

What is the respiration rate of a patient experiencing hyperventilation?

22-40 respirations/min

What is lacking in the patient in order to produce hyperventilation?

Carbon dioxide

What is the most common cause of hyperventilation?

Fear and anxiety (psychological event)

Hyperventilation is most common in what gender and age group?

- Females

- Ages 30-40

What is the pH in a hyperventilated patient?

Above 7.5

Symptoms of hyperventilation

- Deep, rapid respirations

- Suffocating (air hunger)

- Heart palpitations

- Dizziness

- Diaphoresis (sweating)

- Circumoral paresthesia (tingling around mouth)

- Seizures

Hypocalcemia

Decrease in calcium levels in blood

Tetany

twitch spasms

Carpopedal spasms

Sharp flexion if wrist and ankles

Diaphoresis

Excessive sweating

Circumoral paresthesia

Tingling around the mouth

What condition's symptoms can mimic hyperventilation?

Pulmonary embolism

What symptoms can differentiate hyperventilation from pulmonary embolism?

Pulmonary embolism will not have spasms of hands and ankles or circumoral paresthesia (tingling around the mouth)

What is the treatment for hyperventilation?

Work with patient to calmly control breathing

What are the effect of a hyperventilating person breathing into a paper bag?

Can cause suffocation and cardiac arrest

Seizure

Temporary episode of behavior alteration due to massive abnormal electrical discharges in the brain

How are all seizures classified?

- Causes

- Symptoms

- Duration

- Precipitating factors

- Aura

What are some causes of seizures in the dental setting?

- Congenital: developmental malformations

- Genetic: inherited syndromes, family history

- CNS Infections: meningitis, herpetic viruses, encephalitis

- Neoplasms: benign and malignant tumors

- Trauma: closed head wounds, perinatal trauma, surgery

- Metabolic and toxic: hypoglycemia, pyrexia, hypoxia, drug withdrawl

- Cerebrovascular and degenerative: hemorrhage, infarctions, vessel malformation, Alzheimer's

Half of all seizures are _____.

Idiopathic (unknown cause)

- CNS dysfunction

What is the most common type of seizure disorder?

Tonic-clonic

Seizures most common are neurological disorders in _____.

Pediatrics

Tonic

Sudden stiffening and muscle contraction

Clonic

Rhythmic twitching and jerking

Photosensitive epilepsy

Children and adults exposed to flickering lights or geometric patterns

- Video games

Sequence of generalized seizures

- Aura: few seconds, same one, amnesia after

- Pre-ictal: loses consciousness

- Ictal: tonic-clonic; cry, jerky, froth, 2-5 min, with final flexor jerk

- Post-ictal: stops but unconscious, CNS/CVS and respiratory depression; death is most likely

What is the clinician's primary task in the treatment of GTCS?

- Contact EMS

- Protect patient and try to prevent injury before, during, and after seizure

-Supine

- Lower dental chair, do not move patient to floor

- Airway protection essential

Describe the use of a mouth prop during a seizure

Do not use a mouth prop, and the removal of dentures and other appliances is recommended.

What are the first courses of action if your patient starts to seize while in treatment?

- All instruments should be removed from the mouth (even dentures)

- Monitor vital signs

Stratus epilepticus

Continuation of tonic-clonic or repetitive recurrence of any type of seizure without recovery in between.

- Life-threatening

- Temp may increase to 106 F

- May persist for hours or days

- Mortality is 3-23%

- Immediate medical intervention required to prevent death.

What is the treatment for generalized absense seizure?

Continue treatment following cessation of seizure if patient has no ill effects.

What are some oral signs and symptoms often present in a patient with a history of seizures?

- Scars on the oral soft tissues

- Fractured teeth

- Infections resulting from pupal exposure

- Gingival overgrowth

- Bone marrow suppression

- Bleeding problems

What is the pharmaceutical classification of anti-epileptic drugs?

Anticonvulsants