clinic theory II medical emergencies final exam

allergic reactions

• hypersensitivity responses ranging from mild urticaria to life-threatening anaphylaxis

• can be triggered by latex , antibiotics, anesthetics (caines), and dental materials

common triggers of allergic reactions

• latex products

• antibiotics

• local anesthetics

• impression materials

• NSAIDs

• antiseptics

signs and symptoms of allergic reactions

• rash, hives, itching, angioedema, wheezing, hypotension, dizziness, GI upset, tachycardia, possible LOC

anaphylaxis emergency management

• administer Benadryl 25-50 mg orally; continue with 25-50 mg every 6-8 hours for the next 3 days.

• administer epinephrine immediately if Benadryl not successful and airway is compromised

• oxygen

• monitor vitals

• call EMS if symptoms progress (worse and not better)

• position patient supine

office response to allergic reactions

• stop procedure, remove allergens, communicate team roles, prepare emergency, medications, document reaction

prevention of allergic reaction

• thorough allergy history

• avoid known allergens

• stock epinephrine

• train staff

• conduct emergency drills

Benadryl

• not a replacement for epinephrine

• patient will receive a shot of epinephrine if symptoms progressively get worse after administration of oral medication

angina

• chest pain caused by reduced blood flow to the heart

• one of the most common cardiovascular emergencies- precursor to myocardial infarcation

• common cardiovascular emergency in the dental setting

what is angina

• temporary chest pain due to myocardial ischemia

• occurs when heart muscle needs more oxygen

• often triggered by stress or exertion

• usually relieved with nitroglycerin

common triggers of angina in dentistry

• stress of anxiety

• pain during treatment

• long appointments

• epinephrine in local anesthetic

• underlying cardiovascular disease

signs and symptoms of angina

• chest pressure or tightness

• pain radiating to the arm, neck, jaw, or back

• shortness of breath

• sweating

• nausea

• anxiety

• signs and symptoms mimic heart attack and make it difficult to differentiate

angina vs MI

• angina improves with nitroglycerin

• MI pain persists longer

• MI may include severe symptoms

• always treat seriously

• activate EMS if unsure

management steps

• stop dental treatment

• position patient upright

• assess vital signs

• administer oxygen 4-6 L/min

• administer nitroglycerin

• monitor response

nitroglycerin administration for angina

• 0.4 mg sublingual tablet or spray

• repeat every 5 minutes

• maximum 3 doses

• monitor blood pressure

calm

• it is vital during emergency services that the clinician to remain as _ as possible for effectiveness, efficiency, and above all else the well being of the patient

when to activate EMS for angina

• pain lasts more than 10 minutes

• no relief after 3 doses of nitroglycerin

• symptoms worsen

• suspected myocardial infarcation

prevention of angina

• short morning appointments

• stress reduction protocol

• profound anesthesia

• review medical history

  • monitor vital signs

emergency equipment needed for angina

• nitroglycerin tablets or spray

• oxygen tank

• blood pressure cuff

• emergency kit

• trained dental team

asthmas

• chronic inflammatory airway disease with hypersensitivity triggers

  • dental stress

  • aerosols

  • odors

  • allergens may induce attacks

common triggers for asthma in dentristry

• stress/ anxiety

• aerosols

• powders

• dental materials

• strong odors

• cold air

• latex exposure

categories of asthma

• extrinsic (allergic to something and triggered asthma)

• intrinsic (non allergic - the type of pollen or bronchial spams)

• helps predict triggers and severity

early warning signs for asthma

• accessory muscle use

• chest tightness

• panic

• tachycardia

• tachypnea (shallow breathing)

• difficulty speaking in full sentences

signs and symptoms of asthma

• labored breathing

• wheezing

• bronchospastic cough

• shortness of breath

position for patient experiencing asthma attack

• upright or semi-upright

• any comfortable position to optimize breathing

airway and breathing for asthma patients

• maintain open airway

• assist ventilation PRN

• avoid laying patient flat

circulation for asthma patients

• monitor pulse and BP

• initiate CPR if needed

medication for asthma

• Albuterol 2-4 puffs

• may repeat after 20 minutes, use spacer if available

• ensure proper inhaler technique

oxygen therapy

• administer supplemental oxygen during respiratory distress

contraindicated drugs for asthma

• aspirin in nasal polyp patients

• avoid erythromycin

• azithromycin

• clindamycin with certain inhalers ( a lot of people with this condition have reactions to -mycin)

• avoid beta-blockers when possible

prevention strategies for asthma

• have patient bring inhaler to appointment

• pre-med steroid inhaler 1-2 hours prior

• minimize stress

• use rubber dam

• avoid strong odors

• avoid full supine position

oral health considerations for asthmatic patients

• patients may experience xerostomia, candidiasis, enamel defects, increased caries and gingivitis risk

when to call EMS for asthmatic patients

• if no improvement after albuterol

• worsening tachypnea/tachycardia

• patient cannot speak

• cyanosis or decreased responsiveness

documentation of asthamtic patient

• record onset

• triggers

• vitals

• inhaler doses

• oxygen use

• EMS activation

• patient response

cardiac arrest

• sudden loss of heart function resulting in no blood circulation

• life-threatening emergency requiring immediate action

what is caridac arrest

• heart suddenly stops beating effectively

• no blood flow to brain and organs

• loss of consciousness occurs quickly

• can result from myocardial infarction or arrythmia

common causes of cardiac arrest in dentistry

• history of cardiovascular disease

• severe stress or anxiety

• complications from myocardial infarction

• respiratory failure

• drug reactions

• underlying systemic disease

signs and symtpoms of cardiac arrest

• unresponsiveness

• no pulse

• no breathing or gasping

• loss of consciousness

• possible bluish skin

• dilated pupils

immediate response to cardiac arrest

• stop dental treatment

• check responsiveness

• call for help (never leave the patient alone)

• Activate EMS immediately

• begin basic life support (BLS)

CPR steps

• position patient supine on firm surface

• chest compressions 100-120/ min

• compression depth 2-2.4 inches

• allow full chest recoil

• minimize interruptions (found to be the most effective step in life saving treatment)

airway and breathing during CPR

• open airway using head tilt-chin lift

• provide rescue breath

• use barrier device if available

• 30 compressions: 2 breaths

use of AED

• apply AED as soon as available

• follow voice prompts

• deliver shock if advised

• continue CPR immediately after shock

emergency equipment needed for cardiac arrest emergency

• automated external defibrillator (AED)

• oxygen tank

• emergency drug kit

• pocket mask or bag valve mask

• trained dental team

prevention strategies for cardiac arrest

• review medical history thoroughly

• monitor vital signs

• stress reduction protocol

• recognize warning signs of cardiac distress

• be prepared for emergencies

myocardial infarction

• Heart attack caused by blockage of blood flow to heart muscle.
• Life-threatening emergency requiring immediate EMS activation.

what is a myocardial infarction

• occurs when coronary artery becomes blocked

• heart muscle deprived of oxygen

• tissue damage begins quickly

• requires rapid medical treatment

common risk factors for myocardial infarction

• History of cardiovascular disease
• Hypertension
• Smoking
• Diabetes
• High cholesterol
• Obesity
• Stress
• Age

signs and symptoms of myocardial infarcation

• Persistent chest pain or pressure
• Pain radiating to arm, jaw, neck, or back
• Shortness of breath
• Sweating
• Nausea or vomiting
• Anxiety or feeling of doom

angina vs myocardial infarction

• angina relieved by nitroglycerin

• MI pain persists longer than 10 minutes

• MI symptoms often more severe

• always treat chest pain seriously

management steps of myocardial infarction

• Stop dental treatment
• Activate EMS immediately
• Position patient comfortably (usually upright)
• Loosen tight clothing
• Remain calm and reassure patient

medication support for myocardia infarction

• administer oxygen 4-6 L/min

• assist patient with nitroglycerin if prescribed

• administer aspirin if not contraindicated

• monitor vital signs continuously

emergency response for myocardial infarction

• be prepared to initiate CPR if patient loses consciousness

• use AED if cardiac arrest occurs

• monitor airway and breathing

emergency equipment needed for myocardial infarction

• oxygen tank

• nitroglycerin

• aspirin

• AED

• blood pressure cuff

• emergency kit

prevention strategies for myocardial infarction

• Review medical history
• Monitor vital signs
• Reduce stress and anxiety
• Short morning appointments
• Recognize warning signs early

seizures

• sudden, uncontrolled electrical disturbances in the brain causing changes in behaviors, movement, or consciousness

causes and risk factors for seizures

• genetic factors, head trauma, hypoxia, infection, drug withdrawal, sensory triggers, hypoglycemia, circulatory issues, tumors

signs and symptoms of seizures

• aura (visual or hearing auras)

• visual/auditory disturbances

• dizziness

• sudden loss of consciousness

• tonic-clonic activity (act like they are in a dream state, zombie-like. stiffening or jerking motion)

• tongue biting

• salivation

• incontinence (urinate on themselves)

• postictal confusion (posture is not normal)

emergency management for seizures

• protect from injury; do NOT restrain

• guide movements

• suction after seizure

• recovery position

• 4-6 L/min oxygen

• monitor vitals

• call EMS if no recovery

dental office responses to seizures

• stop procedure, remove instruments, recline chair, protect head with padding, team communication, document event, prepare for EMS handoff

prevention of seizures in dentistry

• identify at-risk patients, reduce anxiety, ensure medication compliance, avoid light triggers, schedule rested patients, review medical history

tonic

• stiff

clonic

• jerk

stroke (Cerebrovascular accident CVA)

• interruption of blood flow to the brain causing loss of neurological function

• required immediate emergency response

what is a stroke

• occurs when blood supply to part of the brain is blocked or ruptures

• brain tissue deprived of oxygen

• can cause permanent brain damage

• time-sensitive emergency

ischemic stroke

• blood clot blocks blood vessel

hemorrhagic stroke

• blood vessel ruptures

transient ischemic attack (TIA)

• temporary stroke symptoms

common risk factors for strokes

• hypertension

• History of stroke or TIA

• cardiovascular disease

• smoking

• diabetes

• high cholesterol

• age

signs and symptoms (FAST) of stroke

• face drooping

• arm weakness

• speech difficulty

• time to call EMS immediately

additional signs of stroke

• sudden numbness on one side

• confusion

• difficulty speaking or understanding speech vision problems

• severe headache

• dizziness or loss of balance

management steps of stroke

• stop dental treatment

• activate EMS immediately

• note time symptoms begin

• position patient comfortably (usually semi-supine)

• maintain airway

FAST

• face (droops)

• arm (numb)

• speech (slurred)

• time (to call EMS)

airway and breathing for patient experiencing stroke

• maintain open airway

• administer oxygen 4-6 L/min

• monitor breathing

• be prepared for vomiting

circulation for patient experiencing stroke

• monitor pulse and blood pressure

• be prepared to begin CPR if needed

• DO NOT give food or drink

prevention of stroke in dental setting

Review medical history
• Monitor blood pressure
• Reduce stress
• Short appointments
• Recognize warning signs early

syncope

• fainting

• loss of consciousness due to decreased blood flow to the brain

• most common medical emergency in dental office

what is syncope

• temporary loss of consciousness

• usually caused by stress, anxiety, pain, or fear

• reduced blood flow and oxygen to brain

• often preventable with stress reduction

common causes of syncope in dentistry

• dental anxiety or fear

• pain or anticipation for injection

• long appointment times

• standing quickly after treatment

• hunger or dehydration

• emotional stress

signs and symptoms of syncope

• pallor (pale skin)

• diaphoresis (sweating)

• dizziness or lightheadedness

• nausea

• weakness

• rapid pulse followed by slow pulse

• drop in blood pressure

• loss of consciousness

pre-syncope warning signs

• patient says they feel faint

• yawning

• cold, clammy skin

• blurred vision

• ringing in ears

• restlessness

management of syncope

• stop dental treatments

• position patient in Trendelenburg position (head down feet elevated)

• maintain open airway

• administer oxygen 4-6 L/min

• loosen tight clothing

• apply cold compress

• monitor vital signs

additional management of syncope

• use ammonia inhalant if needed

• monitor pulse and blood pressure

• stay with patient until recovery

• document incident

• determine cause before continuing treatment

prevention strategies for syncope

• review medical history

• short morning appointments

• stress reduction protocol

• ensure patient has eaten

• explain procedures clearly

• use pain control methods

emergency equipment needed for syncope

• oxygen tank

• ammonia inhalants

• blood pressure cuff

• pulse oximeter emergency kit

• trained dental team

when to activate EMS for syncope

• loss of consciousness persists

• patient does not response to management

• abnormal vital signs to continue

• medical history suggest complication

• uncertainty about patient safety

epinephrine injectible

• for anaphylactic reactions, preventing additional release of histamine and other chemical mediators

• rapid onset and short duration

• 0.3 mg of 1;1,000 concentration for intramuscular injections

• pediatric dosage -0.15 mg

• not to be used with ischemic heart disease or severe hypertension

diphenhydramine (benadryl) or chlorpheniramine

• mild, slow onset, non life-threatening allergic reactions

• oral histamine blocker

• 25-50 mg

• 10 mg (C)

albuterol

• critical drug for asthma attack or bronchospasm

• inhaler

• bronchodilator - dilation of bronchioles with minimal cardiovascular effects

• quick onset- peak effect 30 to 60 minutes

• long duration of action 4-6 hours

oxygen

• used for all emergencies expect hyperventilation

nitroglycerine

• vasodilator - dilates coronary blood vessels

• rapid onset

• tablet and spray form

• administer sublingually or onto tongue

• administer at 5 minute intervals - up to 3 doses

• should not administer is systolic BP <90 mmHg or patient has taken ED drugs within 24 hours - sudden decrease in blood pressure

• activate EMS is not effective and assume MI

aspirin

• reduces overall mortality from MI

• inhibitory of platelet aggregation - prevents progression of cardiac ischemia to cardiac injury or cardiac tissue death

• 162 mg - 325 mg: 2-4 tablets (81 mg each)

oral carbohydrate

• for conscious hypoglycemic patient

• not actually a drug, but inclusion necessary

• paste or tablets do not require refridgeration

glucagon

• injectable

• for unconscious hypoglycemic patients

• administers IM

• adult dose- 1 mg

• pediatric dose- 0.5 mg