Dental Theraputic & Med Emergencies- Ch 31 Test/COMPLETE

What is a medical emergency?

A condition or circumstance that requires immediate action

• Be prepared to respond immediately. Your knowledge and skills could mean the difference between life and death

Preventing a Medical Emergency

Prevent by: Knowing your patient

• open communication about the patient history

• completed or an updated medical history

Front desk assistant is responsible for ensuring that patient Health History is updated

• most emergencies that occur are caused by stress and apprehension of going to the dentist

Emergency Preparedness

The dentist is responsible for the patient’s safety

Be prepared, have prompt recognition, and effective treatment

Ongoing observation of the patient during the emergency

Assigned Roles

Call: Front desk staff will call emergency services and stay on the telephone

Retrieve: A clinical assistant or dental hygienist will retrieve the oxygen unit and emergency drug kit

Remain: The dentist, clinical assistant, or dental hygienist will remain with the patient to assist in assessment or with basic life support

Respond: Additional team members will respond to the needs of other patients in the office

Routine Drills

Training must be always current

A “mock emergency "created monthly so that dental team members can practice their roles, take on additional roles, and refine the office’s emergency plan

Emergency Telephone Numbers

ER Telephone numbers are posted next to each telephone and should include:

911

Local police

Local fire station

Emergency medical services

Recognizing a Medical Emergency

A medical emergency can occur at any time

• Ongoing observation of the patient in the reception area, dental chair, or leaving the office cannot be overemphasized

Note the patient's response to routine questions

• Slow responses and changes in speech patterns from a previous appointment

• Recognition of a problem is critical

Signs and Symptoms

Symptom

• Something that the patient tells you he or she is feeling or experiencing

Sign

• Something that you observe in a patient (e.g., a change in skin color, an increase in respiration rate)

Emergency Care Standards

Every member of the dental team must be current in:

Cardiopulmonary resuscitation (CPR)

Heimlich maneuver

Ability to assess and record vital signs accurately

Basic Life Support

Fundamental details:

Immediate recognition of an emergency

Activation of the emergency response system

Early performance of high-quality CPR

Rapid defibrillation when appropriate

Cardiopulmonary Resuscitation (CPR)

The major change in CPR instruction was from the old sequence of steps, “A-B-C” (Airway, Breathing, Chest compressions)

New sequence of “C-A-B” (Chest compressions, Airway, Breathing)

Automated External Defibrillator (AED)

Used for victims of cardiac arrest

Survival is greater

Functions

Monitors the heart rhythm

Heart rhythm is analyzed for ventricular fibrillation

Automatically defibrillates the patient’s heart

Most victims of sudden cardiac arrest experience Ventricular Fibrillation which is an abnormal chaotic heart rhythm that prevents the heart from pumping blood.

Choking

A sudden coughing spasm or movement by the patient during a dental procedure may cause the accidental aspiration of a foreign object

Measures to prevent airway obstruction:

• High-velocity suction

• Use of dental dam during routine procedures

• Placement of a throat pack

Emergency Equipment and Supplies

In most offices, a standardized emergency kit is equipped and organized with emergency supplies

Maintenance of the kit consists of:

• Routine check of supplies to determine whether they are in working condition

• Weekly examination for expiration of drugs within the emergency kit

• Daily check of oxygen tank or tanks

Oxygen

Most frequently used "drug" in a medical emergency

Ideal agent for resuscitation of a patient who is unconscious but still breathing is 100% oxygen

• If the patient is not breathing, air must be forced into the lungs through rescue breathing or similar emergency measures

A portable unit with tanks of oxygen may be stored where it can be moved quickly into a treatment room if needed

• The oxygen tank is always color-coded green

Emergency Responses

The primary factor in determining the manner of treatment is the physical change of the patient

• Unconsciousness

• Altered consciousness

• Respiratory distress

• Convulsions

• Chest pain

Most emergencies occur during or immediately after the administration of local anesthesia or at the beginning of a procedure

Common Medical Emergencies Experienced in the Dental Office

Syncope

Postural hypotension

The pregnant patient

Cardiac emergencies

Cerebrovascular accident

Hyperventilation

Asthma attack

Allergic reaction

Epileptic seizure

Diabetes mellitus

Syncope

Reduced blood flow to the brain causes the patient to lose consciousness

• Psychological factors: Stress and apprehension, fear, the sight of blood or instruments

• Physiological factors: Remaining in one position for a long time, confinement, missed meals or hunger, fatigue or exhaustion

Fainting is not harmful to the patient as long as someone is there to protect the person during unconsciousness

Postural Hypotension

A level of altered consciousness that may lead to loss of consciousness

This emergency can occur when the patient assumes an upright position too quickly

• It is due to a drop in blood pressure caused by lack of sufficient blood flow

• Patients most affected: receive nitrous oxide or intravenous sedation and pregnant patients

The Pregnant Patient

While in a supine position, the pregnant patient may feel dizzy or lightheaded and may faint

• This reaction results from pressure of the enlarged uterus on the abdominal veins

In contrast to the procedure for postural hypotension, the patient should be turned on her left side

• Change in position relieves pressure on involved blood vessels

Angina

Severe chest pain due to heart muscle deprived of oxygen

The signs and symptoms of angina and those of myocardial infarction are very similar

• Anginal pain usually lasts 3 to 8 minutes

• Pain is relieved or eased promptly by the administration of a commonly prescribed drug, nitroglycerin

• When an attack strikes, patient could be having a heart attack

Acute Myocardial Infarction

Commonly referred to as a heart attack

• The muscles of the heart are damaged because of an insufficient oxygen supply

• If this damage is severe enough, the patient will die.

• Any unexplained chest pain should be treated as a potential acute myocardial infarction

Stroke or Cerebrovascular Accident (CVA)

Stroke is an interruption of blood flow to the brain lasting long enough to damage the brain and cause loss of brain function

Most CVAs occur in older individuals with predisposing diseases such as:

• Arteriosclerosis

• Heart disease

• Uncontrolled high blood pressure

Hyperventilation

Caused by stress and anxiety

• An increase or depth (or both) of respiration that results in the consumption of too much oxygen by the patient

• The patient usually remains conscious

Asthma Attack

A pulmonary disorder characterized by attacks of sudden onset, causing difficulty in breathing along with coughing and a wheezing sound

Patients with asthma usually carry an inhaler that contains medication (bronchodilator) to relieve the first symptoms of an attack

Allergic Reaction

An allergy (hypersensitivity) is response to a foreign substance or allergen.

• Antigen: Substance that causes an immune response through the production of antibodies

• Allergen: An antigen that can trigger an allergic state

Localized allergic response is slow to develop, involving mild symptoms such as itching, erythema, and hives

Anaphylaxis is a life-threatening allergic reaction that can develop very quickly

Epileptic Seizure

Epilepsy is a neurologic disorder characterized by recurrent episodes of seizures

• Seizures or convulsions are controlled with medication

• A seizure can still occur under stressful conditions

Two types of seizures of major concern

• Grand mal seizures

• Petit mal seizures

Grand mal seizure: Involves temporary loss of consciousness accompanied by uncontrollable muscular contractions and relaxation

• Phase 1: Aura

• Phase 2: Loss of consciousness

• Phase 3: Muscle contractions

• Phase 4: Sleep/recovery

Petit mal seizure: A brief lapse of consciousness that may last only a few seconds

Diabetes Mellitus

A metabolic disorder resulting from disturbances in normal insulin mechanics

Hyperglycemia is an abnormal increase in the glucose (sugar) level in the blood resulting in:

• Diabetic ketoacidosis

• Diabetic coma

Hypoglycemia is an abnormal decrease in the glucose level in the blood caused by:

• Missing a meal

• An overdose of insulin

Diabetes Mellitus

Type 1 Diabetes Mellitus: a patient becomes insulin dependent.

Type 2 Diabetes Mellitus: a patient manages a proper diet and takes medication, and/or insulin

Documentation of an Emergency

Full documentation of the details of an emergency is essential

After such an emergency, the dentist will make extensive notes in the patient's record to:

• Explain exactly what happened

• Indicate the treatment provided

• Describe the patient's condition at the time he or she left the office

acute

a sudden onset of a condition, often severe, requiring immediate medical attention.

allergen

a substance that causes an allergic reaction

allergy

an immune response to an allergen that can cause symptoms ranging from mild to severe.

anaphylaxis

a severe, potentially life-threatening allergic reaction that requires immediate medical intervention.

angina

a type of chest pain caused by inadequate oxygen to the heart

antibodies

proteins produced by the immune system that help identify and neutralize foreign objects like bacteria and viruses.

antigens

substances that provoke an immune response, often found on the surface of pathogens or foreign cells.

aspiration

the inhalation of food, liquid, or foreign material into the lungs, which can lead to respiratory complications.

asthma

a chronic condition characterized by inflammation and narrowing of the airways, leading to difficulty in breathing and wheezing.

cardiopulmonary resuscitation

an emergency procedure used to restore breathing and circulation in a person who has stopped breathing or whose heart has stopped.

convulsion

a sudden, violent, and irregular movement of the body, often associated with episodes of uncontrolled electrical activity in the brain.

epilepsy

a neurological disorder characterized by recurring seizures due to abnormal brain activity.

erythema

a reddening of the skin typically caused by increased blood flow due to various conditions, including inflammation or irritation.

gait

the manner or pattern of walking or moving on foot.

hypersensitivity

a heightened immune response to a particular substance, often resulting in allergic reactions or other adverse effects.

hyperventilation

a condition characterized by rapid or deep breathing, often leading to decreased carbon dioxide levels in the blood and causing symptoms like lightheadedness or tingling.

hypotension

a condition marked by abnormally low blood pressure, which can lead to dizziness, fainting, or inadequate blood flow to organs.

hypoxic

A condition in which there is a deficiency of oxygen in the blood, often resulting in symptoms such as confusion, cyanosis, or shortness of breath.

myocardial infraction

A medical condition that occurs when blood flow to a part of the heart is blocked, often resulting in chest pain, shortness of breath, and other symptoms. It is commonly known as a heart attack.

syncope

A temporary loss of consciousness or fainting, typically caused by a decrease in blood flow to the brain.

ventricular fibrillation

A serious heart rhythm disturbance that prevents the heart from pumping effectively, leading to loss of consciousness and requires immediate treatment.