Medical Emergencies - Pt History and Neuro Emergencies (Part 1)

what are the 5 ways to prepare for management of life-threatening emergencies

1. update medical history and take vital signs

2. alert faculty of special needs patient

3. DH faculty will alert other faculty in DH clinic if needed

4. if possible, do not leave patient alone

5. know medical emergency protocol

what are the steps in emergency management

Recognize, evaluate, position, activate, implement, refer

what is the acronym for emergency management

REPAIR

what does the first R in REPAIR mean (emergency management)

recognize signs and symptoms of emergency

what does the E in REPAIR mean (emergency management)

evaluate patient (level of consciousness etc)

what does the P in REPAIR mean (emergency management)

Position patient

what does the A in REPAIR mean (emergency management)

activate CAB's of CPR and monitor vitals (BLS as needed)

what does the second R in REPAIR mean (emergency management)

Refer patient to healthcare professionals (code blue, EMS, physician/allergist consultation)

Unconsciousness can be caused by a variety of ______

emergencies

what is the most common cause of unconsciousness in the dental setting

vasodepressor syncope

what are some predisposing factors of unconsciousness

stress (most common), special needs (medically compromised) patient, drug administration

What are the signs and symptoms of unconsciousness

-no response to stimuli (shake, shout, pain)

-no protective reflexes (swallowing, coughing)

-Lose ability to keep airway open

What should you do during the recognize step of management for an unconscious patient

stop treatment and remove objects from the mouth

What should you do during the evaluate step of management for an unconscious patient

shake and shout

What should you do during the position step of management for an unconscious patient

Put the patient in supine with their feet slightly higher (10-15 degrees) than their head (unless otherwise noted). If they are pregnant, you want to turn them on their side first

What should you do during the activate step of management for an unconscious patient

-Check the carotid pulse (10 sec only)

-Check the airway (head tilt chin lift)

-Check for breathing (chest rising? listen and feel for breaths)

What are the CAB's of CPR

C-circulation

A-Airway

B-Breathing

What should you do during the refer step of management for an unconscious patient

depends on the cause/ condition that led to unconsciousness

what is the definition of syncope

loss of consciousness caused by decreased blood flow to the brain (fainting)

What are the types of syncope

vasodepressor syncope, orthostatic hypotension

The number one cause of unconsciousness ini the dental setting and the #1 type of syncope is

vasodepressor syncope

what is the major cause of vasodepressor syncope

anxiety

What are the steps that lead to vasodepressor syncope

1. patient becomes excited/nervous/anxious

2. heart rate increases

3. blood pressure decreases

4. blood pools in arms and legs

5. decreased blood to heart and brain

6. leads to further decrease in BP and pulse

7. patient goes unconscious

What are the types predisposing factors

psychogenic factors, non-psychogenic factors

What are psychogenic factors

fear, pain, bad news, poor prognosis, stress

What are non-psychogenic factors

hunger, poor health, upright position/ standing long periods, fatigue, temperature (heat)/crowded environment

What are ways to prevent vasodepressor syncope

- observation and anticipation

- decrease stressful situations

- honest, open approach

- take time to visit with patient

- look at medical patient (fainting spells, dizziness, medications, anxiety)

what are signs and symptoms of pre-syncope

- Pale

- Cold sweats

- Dizziness

- Nausea

- Warm feeling

- Rapid pulse initially

- BP and pulse drop right before consciousness is lost

What are signs and symptoms of syncope

- "deathlike" appearance

- shallow, gasping breaths

- dilated pupils

- convulsive movements

- low BP

- Slow pulse

what are signs and symptoms of post-syncope

- pale, nausea, sweating

- confusion

- BP returns to normal

- heart rate (pulse) returns to normal

- patient can easily faint again (do not leave along, make sure fully recovered)

What is the position you want the patient to be put in for vasodepressor syncope

supine, feet higher than head

How do you implement appropriate action for emergency for vasodepressor syncope

- loosen tight clothing

- cold compress

- administer oxygen

- ammonia capsule/towelette (use caution- not recommended)

After patient recovers from vasodepressor syncope, what should you do

- raise up slowly

- check vitals

- get patient a ride home

define orthostatic hypotension

syncope due to sudden drop in blood pressure when a patient is raised from a supine to vertical position

what is the second leading cause of unconsciousness in dental settings

orthostatic hypotension

what are the predisposing factors of orthostatic hypotension

1. drug therapy (most common)

2. prolonged recumbency

3. pregnancy

4. geriatric population

5. Venous defects in legs

orthostatic hypotension seldom affects _____ and is not related to ____ or ____

children, fear, anxiety

How to prevent orthostatic hypotension

1. Review medical history

2. bring patient up slowly in dental chair and let them sit a while

What is important to note when reviewing medical history to help prevent orthostatic hypotension

1. high or low BP

2. Fainting spells

3. Medications

4. Pregnancy

What are the signs and symptoms of orthostatic hypotension

-prodromal symptoms of vasodepressor syncope typically not present

- Drop in BP -> patient unconscious

What is the management for orthostatic hypotension

- managed much the same as vasodepressor syncope

- exception: patient typically recovers more quickly, patient with history of episodes: if fully recovered as determined by doctor -> may drive themselves home, if no history: get patient a ride and consult physician

What are the terms relating to hyperventilation

respiration, hyperpnea, tachypnea

what is respiration

process of gas exchange- oxygen is gained and carbon dioxide is lost

what is hyperpnea

abnormal increase in depth and rate of respirations

what is tachypnea

rapid respirations, greater than normal

what is the definition of hyperventilation

respiratory condition in which the patient breathes faster and/or deeper than the metabolic needs of the body, resulting in a change in the blood chemistry as the body eliminates more carbon dioxide than it produces (too much oxygen, not enough carbon dioxide)

What are predisposing factors of hyperventilation

anxiety, emotional upset, stress, certain physical conditions

what is the most common predisposing factor of hyperventilation

anxiety

anxiety causing hyperventilation is most common in ____ and not common in ___

adults, children

What are the ways to prevent hyperventilation

1. keep anxiety levels down

2. determine fears of patient

3. try to eliminate fears

what are the signs and symptoms of hyperventilation

1. abnormal increase in rate and depth of respirations

2. nervousness

3. feeling of suffocation

4. tightness/pain in chest

5. dizziness/lightheadedness

6. tingling in extremities

7. carpopedal spasm

What is the position you want the patient in if they are hyperventilating

upright

how would you implement appropriate action if a parent was hyperventilating

- no oxygen

- help pt. control respirations