Medical Emergencies Ch.16-18

altered consciousness

may be the first clinical sign of a serious medical problem

Dealing with the “brain” or CNS

altered consciousness

a conscious patient acting “strangely

May lead to loss of consciousness.

drugs

Most common cause of altered consciousness in dental setting

hyperventilation

Most common non-drug cause of altered consciousness in dental setting

diabetes mellitus

Most common systemic causes of altered consciousness in dental setting

cva and thyroid gladn disfunction

2 other systemic causes of altered consciousness in dental setting

prevention

MDHx review, vitals, physical exam, dialogue history

Recognition of high levels of anxiety/stress

Proper use of pharmacosedation

cerebrovascular accident

For this emergency, non-supine position is important

modified supine position – head and thorax elevated slightly

diabetes

A group of diseases marked by high levels of blood glucose resulting from defects in

insulin production, insulin action or both

diabetes

Associated with: Blindness, renal disease, amputations, increase risk of cardiac, cerebral and vascular disease, HBP, nervous system disease and periodontal disease

200

Diabetes is defined by the American Diabetes Assoc. as follows:

A blood glucose level of ___ mg/dL or greater with symptoms of diabetes

polyuria, polydipsia, and polyphagia

The 3 P symptoms of diabetes

type 1 diabetes

Predominantly genetic, circulating insulin is absent and pancreatic beta cells do not respond to insulinogenic stimuli

Requires exogenous insulin – often diagnosed in adolescents

type 2 diabetes

Milder & more common form of diabetes with circulating endogenous insulin adequate to prevent ketoacidosis

high incidence of obesity, most don’t require exogenous insulin

genetic, environment, autoimmune

3 predisposing factors of type 1 diabetes

genetic, demographic, lifestyle, metabolic

4 predisposing factors of type 2 diabetes

gestational diabetes

Abnormal glucose tolerance test during pregnancy and either reverts back to normal after pregnancy or remains abnormal

gestational diabetes

If undiagnosed & untreated it carries significant risk of perinatal illness & death in all levels of disease

impaired glucose tolerance

Found in 10 – 15% of adults, at risk of becoming Type II

It is an intermediate condition in the transition between normal and diabetes

200, 6.5

Hyperglycemia is blood glucose levels above ___ mg/1dL or A1c ___% level or above

hyperglycemia

High blood sugar caused by a deficiency of insulin secretion or a reduction of its effectiveness

Does not have an acute onset but will eventually lead to diabetic coma

50

Hypoglycemia is blood glucose levels below __ mg/dL

hypoglycemia

Occurs in diabetic and nondiabetic individuals

Has a rapid onset that leads to loss of consciousness

hypoglycemia

Which type of complication of diabetes has more acute, life-threatening complications

clinical manifestations of hyperglycemia

Fruity or acetone smell to breath

Appear flushed and skin is dry & hot

clinical manifestations of hypoglycemia

Pale skin, cold & clammy

Weak or dizzy, Headache, Bizarre behavior, Diminished cerebral function

management for hyperglycemia

Test blood glucose level if available

Administration of insulin by patient

hypoglycemia

If you do not know which type of diabetic emergency is occurring - treat as if patient had:

management of hypoglycemia

Administration of oral carbohydrates if conscious (every 5 – 10 min)

Instaglucose, Orange juice, Regular soda, Candy

management of hypoglycemia

Administration of parenteral carbohydrates if unresponsive or unconscious (we do not administer)

type 2

Non-insulin dependent diabetic

type 1 or 2

Insulin controlled diabetic

thyroid gland

produces 3 hormones that regulate the level of of biochemical activity of most of the body tissues

thyroxine, triiodothyronine, and calcitonin

3 hormones produced by thyroid gland

thyroid gland dysfunction

A slow, insidious process. Signs & symptoms develop over months

It is relatively uncommon and emergencies are rare

thyrotoxicosis

Overproduction of thyroid hormones

Overdrive

hypothyroidism

Underproduction of thyroid hormones

Slow

cretinism

Hypothyroidism seen in infants and children

myxedema

Hypothyroidism seen in adults

grave’s disease

Most common thyrotoxicosis dysfunction

thyrotoxicosis

Autoimmune disease

Seen more in females, 20-40 years of age, may lead to thyroid storm

goiter

Enlarged thyroid =

hypothyroidism

Disease of thyroid gland (1°), pituitary gland (2°), hypothalamus (3°)

Seen more in females, 70 years of age

clinical signs of hypothyroidism

Large thick tongue w/ atrophic papillae, scalloped boarders, thick edematous skin, puffy hands & face

exophthalmos

abnormal forward bulging or protrusion of one or both eyeballs out of the eye socket

clinical sign of hyperthyroidism

asa 3

What ASA classification are hypothyroid and hyperthyroid patients

euthyroid

Patients who are receiving treatment for hypo/hyper and have normal levels of circulating hormones

Considered ASA 2

management for thyroid gland dysfunction

Acute emergency is highly unlikely – if the pt becomes unconscious usually due to fear.

Position supine, BLS as needed, Oxygen, call 911

polyuria

increase urination

polydipsia

increased thirst

polyphagia

increased apetite

synthroid

Medication that is a sign a patient might have thyroid gland dysfunction

epinephrine

When giving anesthesia to a hyperthyroid patient, we want to use the least concentration of:

aspirate

When giving anesthesia to a hyperthyroid patient, it must have the smallest amount of: