Medical and dental emergencies: Med history, risk assessment, vitals

Risk assessment

Assessing risk of treatment

The standards define assessment as

the systemic collection, analysis, and documentation of oral and general health status and patient needs

Risk assessment

determining whether a patient can safely tolerate planned procedures

Risk assessment process requires ongoing collection and interpretation of relevant data through a variety of methods including:

medical history, radiographs, diagnostic tools, and instruments.

What is a normal healthy patient classified as?

ASA I

What is someone who is healthy, a non-smoker, and minimal alcohol use classified as?

ASA I

ASA II classification:

a patient with mild systemic disease

current smoker, social alcohol drinker, pregnancy, obesity, well controlled diabetes mellitus, well controlled hypertension, mild lung disease are examples of what classification

ASA II

A person with severe systemic disease is classified as

ASA III

Poorly controlled DM or HTN, COPD, morbid obesity, active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, ESRD undergoing regularly scheduled dialysis, premature infant, history of (>3 months) of MI, CVA, TIA, OR CAD/stents are examples of what classification

ASA III

ASA IV:

a patient with severe systemic disease that is a constant threat to life

what are examples of ASA IV

MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis

a moribund pt who is not expected to survive without the operation is classified as

ASA V

ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction are examples of which classification

ASA V

a declared brain dead pt whose organs are being removed for donor purposes is classified as

ASA VI

what are the three core components to the assessment process

patient history, comprehensive clinical exam, risk assessment

what kind of approach is used when treating a patient

patient centered approach

why should you update medical information

to ensure the current and accurate status of health

you should follow up all positive responses on a medical history with further __________, and recording an accurate summary of the additional information on the history form

questioning

when observing the patient for signs of stress you should coordinate those signs with

the patients' vital signs

how long should someone not be treated in the dental chair for after having a heart attack, stroke, or MI

6 months

what is type 1 diabetes treated with

insulin

what is type 2 diabetes treated with

metformin

uncontrolled diabetes:

pt doesn't know they have it or they are noncompliant with medication

Hep. ______ or recreational ____________ use can impact pts care and/or oral health; it is important we know everything

Hep. C , drugs

what might abnormal vital signs indicate

undetected systemic problems

the recording of _________ _________ contributes to the proper systemic evaluation of a pt in conjunction with the complete medical history

vital signs

determination of the body temp, pulse, respiratory rate, and blood pressure is considered _________ ____________ in pt care.

standard procedure

what is blood pressure

the force in the arteries when the heart beats, and when the heart is at rest

hypertension is another term for

high blood pressure

the higher the bp, the risk is greater for a...

heart attack or stroke to occur for the pt

what is systolic

the top number/reading which measures the ventricular contraction of the heart

diastolic

bottom number/reading which measures the ventricular relaxation of the heart or the heart at rest

what is the normal body temperature for adults

97-99 F

What is the normal pulse rate for adults

60-100 per minute

what is the normal respiration rate for adults

12-20 per minute

what is the normal systolic

<120

what is the normal diastolic

<80

what is considered elevated systolic

120-129

what is considered systolic hypertension stage I

130-139

systolic hypertension stage II

140-179

systolic hypertensive crisis

greater than or equal to 180

diastolic hypertension stage I

80-89

diastolic hypertension stage II

90-119

diastolic hypertensive crisis

greater than or equal to 120

how many times can you retake bp

3x

when retaking bp, what should you alternate

arms

is a manual or digital bp monitor more accurate

manual

what happens if a pt is considered hypertension stage II, (whether systolic or diastolic or both)

the dentist makes decision for tx or signs off

what are you to avoid when taking the bp of a pt who has had a vasectomy

avoid taking blood pressure on the affected side after surgery.

how should you take bp on a pt who has had a double mastectomy

-position bp cuff on lower arm using digital bp monitor

-take bp on popliteal artery (behind the knee)

for those who had a mastectomy w/o lymph node dissection (prophylactic mastectomy) where can bp be obtained?

in either arm

what is given to pts with hypertension to reduce to normal readings

medications

what is hypotension

low blood pressure

who is hypotension normal for

athletes

what can hypotension cause

fainting or dizziness due to the brain not receiving enough blood

what causes hypotension

side effects of meds or family history

what systolic reading is considered hypotension

<90

what diastolic reading is considered hypotension

<60

what sounds are we listening for when reading bp

korotkoff

which disease conditions are associated with hypertension

-stroke

-myocardial infarction

-heart failure or congestive heart failure

-hyperthyroidism

-diabetes

what is pulse

the result of the alternate expansion and contraction of an artery; count of heart beats per minute

what is the normal pulse rate

60-100 bpm for an adult

what is tachycardia

fast heart beat, over 100 bpm`

what is bradycardia

slow heart rate; below 50 bpm

where is the radial pulse taken

wrist, thumb sideanatomy of the arm

what is the technique for taking pulse

the tips of the first two fingers are placed over the radial pulse

what is the function of respiration

to supply o2 to the tissues to eliminate carbon dioxide

what is normal respiration

12-20 breaths per minute

what is respiration

one breath taken in and let out; count the number times the chest rises in one clocked minute

what are factors to observe during respiration

-depth

-rhythm

-quality

-sounds

-the position of the patient

what is temperature

the sensible intensity of the heat of the body.

what is normal temp.

97.0-99 F

when may fever be present?

abscess, NUG, NUP, pericoronitis

what is an abscess

due to an infection which has developed along the root length of the tooth.

what does NUG stand for

Necrotizing ulcerative gingivitis

what does NUP stand for

Necrotizing ulcerative periodontitis

what is NUP and NUG

a distinct, recurrent periodontal disease that primarily affects the interdental papillae, causing necrosis and ulceration of the gingiva

what causes NG

pt not following dental protocol, stress, alcoholism, use of recreational drugs etc

which has bone loss NG or NP

NP

what is pericoronitis (operculum)

an inflammation of the gingival flap around the crown of the tooth/usually associated with the eruption of a third molar

will a fever always be present with abscess, NUG, NUP, and pericoronitis? why or why not?

no not always because the body can become acclimated

what is syncope

a temporary loss of consciousness or fainting

vasodepressor syncope is also due to the emotional stress of _____ or ______

fear or pain

what are some signs/symptoms of vasodepressor syncope

pale, nauseated, sweaty, and weak

vasodepressor syncope is caused by what reflex

vasovagal reaction

what does the vasovagal reaction lead to?

bradycardia, leads the nerve to the blood vessels in the legs to permit those vessels to dilate.

This results in the heart putting out less blood, bp drops and circulating blood goes to legs rather than the head

what causes syncope

fright, anxiety, emotional stress

what is syncope most commonly precipitated by

a decrease in cerebral blood flow below a critical level and is usually characterized by a sudden drop in bp and a slowing of the heart rate

what is recovery for syncope usually hastened by..

positioning the victim supine with their legs elevated slightly

what does positioning the victim supine with their legs elevated slightly improve?

it improves venous return to the heart and increases blood flow to the brain, so that cerebral blood flow once again exceeds the critical level necessary for maintenance of consciousness

what can you administer if needed in syncope

oxygen

who is orthostatic (postural) hypotension common in

the elderly due to a number of underlying problems with BP control

what is orthostatic hypotension

a drop in BP (usually >20/10 mm Hg) within 3 mins of standing; normal pooling of the blood in the lower limbs is not correctly regulated by the cardiovascular system on moving to a vertical position

what is orthostatic hypotension a common cause of

unconsciousness in the dental setting

when does orthostatic hypotension occur

when the pt is changed from the supine position to the upright position and the physiological response to increase the bp is delayed

how can postural hypotension be prevented

-raising the dental chair back slowly

-remain in upright position for 2-3 mins before dismissing pt

-measure bp before leaving dental chair

how to manage postural hypotension

-place in supine position

-assure airway is open, breathing and circulation are present

-observe for signs of recovery while measuring bp

-when bp is above 80/60 mm Hg pt can stand

what is prevention based on

the pts medical history and physical exam

postural hypotension is often a side effect with some…

prescription medication