Lec 4: Respiratory Distress

***Respiratory distress can be caused by a variety of conditions, including ….

Asthma, Hyperventilation, Aspiration, Fainting, Heart failure, Hypoglycemia, Drug Overdose, Anaphylaxis (allergic reaction), COPD/Emphysema

troubled or labored breathing; gen remain conscious

Respiratory distress

most asthmatics dont have issues (asymptomatic) until …. ****

put into a stressful situation

Shortness of breath

Rapid breathing (tachypnea)

Wheezing while breathing due to turbulent airflow through narrowed bronchioles Frequent coughing

Chest tightness

Fatigue

Bluish lips/fingertips (due to cyanosis)

are all gen SYMPTOMS of ****

Respiratory distress

if pt becomes unconscious ___ should be quickly activated and ___ implemented

EMS; BLS

characteristic sounds such as wheezing and frequent coughing is

Recognition of respiratory distress

dental tx should cease as soon as ___ ____ is observed because ___ is a primary precipitating factor for exacerbating the symptoms

respiratory distress; stress

pts feel more comfortable and in control of their breathing in an upright/laid back position

upright

Circulation, ___, and breathing should all be monitored closely

airway

BP, pulse, and respiratory rate can be monitored every ___ min

5 min

a chronic condition that inflames and narrows the airways in the lungs causing difficulty breathing and respiratory distress***

asthma

***Pt’s in respiratory distress do/don’t often fall unconscious (at least not immediately)

dont

The severity of someones asthma can even change throughout a person's life: T or F ****

T

Asthma is rare, fairly common, common ***

fairly common with about 8% of the population having at least a mild form (in the U.S.)

Though often/ rarely life-threatening, asthma attacks represent a medical emergency in a dental setting and need to be managed (and hopefully prevented) ****

rarely

____ narrow in response to something (trigger) ***

bronchioles of the lungs

Genetic predisposition

Allergies & allergic reactions

Respiratory infections

Exercise induced

Cold weather

Smoking

Air pollution

Stressful situation

are all pot CAUSES of

asthma

talk to pt and ask what their ___ are to avoid an asthma attack; could have physician prescribe nitrous

triggers

Rescue inhalers, typically comprised of the drug _____, is a bronchodilator and is used to help relieve symptoms from asthma attacks ***

Albuterol

Pts should be asked to bring a rescue inhaler to all appts and it should be ________________ *****

readily available for use

a condition where a person breathes rapidly and deeply, exceeding their body's physiological needs for oxygen ***

Hyperventilation

Hyperventilation tends to ___ ____, meaning the pt begins hyperventilating, which causes them to panic, which leads to further and more rapid breathing

compound itself (a vicious loop)

in the dental office is almost always caused by fear or anxiety (can be underlying med conditions ex) such as ****

hyperventilation

metabolic acidosis or drug intoxication

Hyperventilation is more likely seen in pts aged ___-___ years and has a predilection for females/males ***

15-40 years

females

The normal respiratory rate for adults is 12-18 breaths per minute. During hyperventilation, this value can easily exceed ___-___ or more

25-30

symptoms include chest tightness and a feeling of suffocation

onset of a hyperventilation attack

Once hyperventilation is detected, dental tx should CEASE and pt put in an ____ position*** (this is usally due to fear so check w/ pt to make sure theyre ok)

upright

Instruct the pt to hold their breath for 20-30 sec. This may___ ____ to more normal levels

"reset" breathing

In order to correct blood CO2 levels, breathing in more ____ rich air can be beneficial. A paper bag (if available) or having the pt breath into _______________ can help regulate proper O2/CO2 levels ****

CO2

their own cupped hands

paying close attention to any ___ and ____ involving dental tx can be incredibly beneficial in identifying pts that may be prone to hyperventilation

fears; anxieties

____ drugs, such as benzodiazepines, may be beneficial in some pts to help control anxiety

Anxiolytic; prescribed by dr

In a conscious dental pt, it is more likely that any foreign object lost in the oropharynx is _____ and passed into the esophagus, where it will either be ___ __ or continue on into the GI tract **** this is more likely than being aspirated

swallowed

coughed up

objects may enter the _____ and become lodged either in the larynx, or further down into a bronchiole tube

trachea

Extracted teeth

Crowns

Dental prosthetics

Burs

Endodontic/Implant instruments

are ex of common

dental tools and materials may be lost into the oropharynx

what is the ages that ppl are most under risk of FBAO?

young kids, elders, those undergoing procedures while under sedation

Whenever small objects are being used by the operator, or may occur as a consequence of a dental procedure (such as during an extraction), the use of a ___ ___ or an __ ___ ___ is highly encouraged****

rubber dam

oral throat pack (roll up pack of gauze)

Bite blocks

Rubber dam clamps

Fixed bridges (when trying in)

are ex of that that should be…

ligated (tie it w/ something) and secured with dental floss prior to introduction into the pt's mouth (floss can aid in retrieval)

Once an object is dropped and it can be seen, attempt to retrieve it using ___ ___ ___ should be performed****

high speed suction

if dropped something check for what 2 possibilities

1) swallowed it

2) aspirated it

coughing are typically signs for

swallowing something

feeling something at the bottom of the chest, wheezing and shortness of breath is typical a sign for

aspirating something

if someone aspirated something should they be seated upright or laid back? why? Still call EMS

laid back; more facilitates the airway to remain open

If the object was ingested, the pt will likely confirm that they swallowed the foreign body, in which case the pt should be escorted to the to obtain a ___ ___ , to confirm the objects presence and ensure it was not aspirated***

ER

chest x-ray

If the object has completely blocked the airway, EMS should be immediately contacted and ___ begun; the _____ ______ should be attempted***

BLS; Heimlich maneuver

During Heimlich maneuver****

• If the pt is still conscious, they should be asked to sit or stand up, while the rescuer placed his/her arms around the pt's ____ while delivering sharp, upward thrusts in an attempt to dislodge the object

• Once the pt lapses into unconsciousness, ___ should be initiated until EMS arrives

• abdomen

• CPR

Oxygen tanks will be (color) while nitrous tanks will be (color) ***

Green -universal

Blue

Oxygen alone can also be given in emergency situations when a pt is in respiratory distress and is hypoxic such as…

Fainting

Asthma attacks

Allergic reactions

Shock

Heart attack