Medical Emergencies Ch.10-15

tongue

Primary cause of airway obstruction with loss of consciousness

hyperventilation, syncope, asthma, heart failure, hypoglycemia

most common potentital causes of acute respiratory distress

stress

major predisposing factor of acute respiratory distress that exacerbates underlying medical condition

prevention

Pretreatment Medical/Dental Evaluation and Modifications in patient management

clinical manifestations

Most cases patient remains conscious throughout episode

Difficulty breathing, gasping for air; sounds according to problem

management

Recognition of respiratory distress types

Discontinue dental treatment

PCABD and BLS if needed

bronchospasms

Wheezing

pulmonary edema

Coughing & crackling respirations

hyperventilation

Signs of acute anxiety & tachypnea

foreign body airway obstruction

No sounds at all

definitive care

Management of respiratory distress with emergency kit drugs or equipment

Activate EMS if needed

90

What percentage of deaths from FBAO are children under 5 yrs. of age

FBAO

With adults typically occurs while eating – drinking alcohol, laughing & talking while eating, not chewing food well

Or patients who are undergoing sedation

trendelenburg

What postion should we put patients who have a FBAO

ER

If FBAO object is swallowed should have patient sent to the:

complete airway obstruction

Universal sign grasping at throat, no sound or voice produced

 In 2 – 5 minutes patient will pass out

 In 4 - 5 minutes will have cardiorespiratory arrest

partial airway obstruction

Patient will be forcefully coughing

Have air exchange & wheezing in between coughing air

chin lift

What maneuver should be done once patient is unconscious and the most common cause of obstruction is tongue

forceps

What can be used to remove an object that is visibly obstructing the airway

heimlich

Noninvasive maneuver used on a patient who is choking or has a FBAO

hyperventilation

Produced by increase in frequency or depth of respiration or both

Complains of feeling of suffocation but unaware of rapid breathing

hyperventilation

Rarely occurs in older adults and children

Most often occurs in 15 – 40 yr olds

hyperventilation

Prevention: physical evaluation – nervousness, shaking hands, flushed or pale, beads of sweat, restless, uncomfortable

Management: stress reduction and drugs

clinical manifestations of hyperventilation

Chest tightness and feeling of suffocation

Numbness & tingling of extremities

Carpopedal tetany

management of hyperventilation

Rarely require BLS

Reassure patient & try to calm them. Have patient hold breath for 10 second intervals

Have patient breath into hand to “warm up” to enrich CO2 levels and correct respiratory alkalosis

oxygen

DO NOT ADMINISTER THIS IF PATIENT IS HYPERVENTILATING

Continue treatment if both patient & DDS agree and plan for alteration in future treatment

asthma

A chronic inflammatory disorder that is characterized by reversible obstruction of the airways

asthma

Primarily a disease of young people.

 Half of all cases develop before age 10

extrinsic

allergic asthma

intrinsic

non-allergic or idiosyncratic asthma

status asthmaticus

true emergency, most severe form of asthma

extrinsic

50% of patients have this type of asthma

Bronchospasms develop within minutes of exposure to allergen

intrinsic

Asthma that usually develops in adults over 35 years of age

Most common factor is a viral infection

2

Status asthmaticus is resistant to _ doses of rescue inhaler

Secondary factors to respiratory distress may lead to fatality

albuterol

What drug must be kept in hand to prevent an asthma emergency

clinical manifestations of asthma

Signs & symptoms - triad

 Coughing, Wheezing, Shortness of breath - dyspnea

management for asthma

Definitive care

 Oxygen – 5 – 7 L/min

 Use patient’s bronchodilator or albuterol in medical emergency kit

heart failure

The inability of the heart to supply sufficient oxygenated blood for the body’s metabolic needs

Fluid accumulates in the pulmonary circulation, &/or systemic circulation

acute pulmonary edema

A life-threatening condition caused by an excess of serous fluid in the alveolar spaces or interstitial tissues of the lungs, causes extreme difficulty breathing, respiratory distress

predisposing factors of heart failure

Increasing workload of the heart: HBP and stress

Damage to the heart muscle

Valvular deficiencies and increase in body’s requirement for oxygen

prevention of heart failure

Determine ASA classification

MDHx: Swollen ankles, shortness of breath, heart disease

diuretics

most commonly used drug for heart failure

heart failure

Weight gain (3+lbs in 7 days) is a predisposing factor or:

clinical manifestations of heart failure

Edema or pitting of ankles and Prominent jugular vein

Orthopnea and paroxysmal nocturnal dyspnea

asa 3

should have medical consult, use stress reduction protocol, treatment modifications

asa 4

treat dental emergencies as non-invasively as possible. No elective procedures until cardiovascular condition controlled

cyanosis

a bluish or purplish discoloration of the skin and mucous membranes caused by a low level of oxygen in the blood

clinical manifestations of acute pulmonary edema

Cyanosis

Moist rale sounds in the lungs

Frothy pink sputum (saliva)

acute pulmonary edema

a true medical emergency that requires immediate attention

call 911 and administer oxygen

consciousness

Patient usually retain __________ during respiratory distress

heart failure

Between 50 – 70 years, what is the most common condition that leads to respiratory distress

comfortable

Position of the patient during asthma episode or hyperventilation

upright

Position of the patient during heart failure to help alleviate symptoms

increase

Vitals _____ during periods of respiratory distress