ODH medical emergencies (syncope, seizures, CVA, angina, MI)

_________ is a common emergency drug used for anaphylaxis. Its actions include rapid onset, short duration, reduces hypotension, bronchospasm, and laryngeal edema. Prevents histamine release and other chemical mediators. This drug should be avoided in use of patients with _______________ unless immediately life-threatening.

Epinephrine, severe hypertension or heart disease

__________ is a common emergency drug used for angina (chest pain), heart failure or myocardial infarction (heart attack). The action of this drug includes dilating coronary blood vessels to provide additional oxygen to the heart muscle. Rapid, onset. Use is contraindicated if systolic pressure falls below ___ or if a patient is taking __________ medication.

Nitroglycerin, 90, erectile dysfunction

____________ is a common emergency drug used for mild to moderate allergic reactions. Its actions include being a histamine blocker.

Diphenhydramine (benadryl)

___________ is a common emergency drug used for mild allergy in children. It is a histamine blocker.

Chloropheniramine

________ is a common emergency drug used for asthma attacks. Its actions include bronchodilator, quick onset, and long duration.

Albuterol

________ is a common emergency drug used for myocardial infarction. It reduces overall mortality from myocardial infarction if administered early. Use of this drug is contraindicated with an _______ allergy.

Aspirin

An _________ is a common emergency drug used for hypoglycemia. It increases blood sugar.

oral carbohydrate

________ is an ABRUPT, TRANSIENT LOSS OF CONSCIOUSNESS (TLOC) AND POSTURAL TONE WITH SPONTANEOUS RECOVERY.

Syncope

_________ is the most common medical emergency in the dental office.

Syncope

__________ syncope is a stress-induced fainting episode—commonly triggered by _________ in the dental office—where the body’s fight-or-flight response causes blood to pool in the extremities, leading to a sudden drop in blood pressure and loss of consciousness.

Vasovagal, fear or pain

_________ syncope can occur from conditions like seizures, orthostatic hypotension, or hyperventilation, and in dentistry this often results from a significant drop in blood pressure when a reclined patient is brought upright too quickly. This can lead to syncope with no __________.

Non-cardiac, prodromal symptoms

___________ IS A DROP BY 20 MILLIMETERS OF MERCURY IN THE SYSTOLIC PRESSURE OR 10 MILLIMETERS OF MERCURY IN THE DIASTOLIC PRESSURE UPON RAISING A PATIENT TO THE UPRIGHT POSITION.

POSTURAL/ORTHOSTATIC HYPOTENSION

_______ syncope may occur as a result of an underlying heart disorder such as arrhythmia, tachyarrhythmia (fast heart rate), bradyarrhythmia (slow heart rate) or pacemaker malfunction, which could be potentially fatal.

Cardiac

If a patient is experiencing vasovagal syncope and consciousness is lost, place patient in a _______ position with legs slightly elevated so that blood may return to the brain.

supine

After syncope, WHEN PATIENT REGAINS ___________, THEY SHOULD REMAIN IN A SUPINE POSITION UNTIL THEY FEEL WELL. THEY SHOULD BE REPOSITIONED SLOWLY AND PULSE MONITORED UNTIL IT RETURNS TO NORMAL. ATTEMPT TO IDENTIFY ANY ________ TO AVOID IN THE FUTURE.

CONSCIOUSNESS, TRIGGERS

_________ is a condition that OCCURS WHEN THERE IS NOT ENOUGH OXYGENATED BLOOD DELIVERED TO BODY TISSUES TO SUPPORT THEIR METABOLIC NEEDS. 

Shock

___________ means the body is in shock because it has lost too much fluid or blood, resulting in not enough volume for the heart to pump to vital organs. It is the most common type of shock.

Hypovolemic shock

_________ shock occurs when there is a heart problem and the heart cannot pump effectively, while the blood volume is fine, the pump is failing.

Cardiogenic

___________ shock is a type of distributive shock that has huge histamine release and massive vasodilation.

Anaphylactic

_______ shock is a type of distributive shock caused by infection in the bloodstream that causes vasodilation.

Septic

__________ shock occurs because of a physical blockage that prevents normal circulation whcih causes severe hypotension. ex pulmonaary embolism

Obstructive

___________ includes stopping dental treatment immediately and placing patient in a supine position, monitoring vital signs, activate EMS response. Further treatment depends on the type.

Treatment of shock

____________ OCCURS WHEN THE PATIENT BREATHES FASTER AND/OR DEEPER THAN THE BODY NEEDS, WHICH EXPELS AN EXCESS OF CARBON DIOXIDE AND INCREASES THE OXYGEN SATURATION OF BLOOD.

Hyperventilation

When a patient is experiencing hyperventilation their RR will be between ____ and _____ RR per min.

22, 40

Hyperventilation INCREASING RESPIRATIONS AND EXPELLING CARBON DIOXIDE, THE PH OF THE BLOOD RISES TO _____ OR HIGHER WHICH CAUSES PHYSIOLOGICAL EFFECTS SUCH AS ___________ REDUCING CARDIAC OUTPUT, LEADING TO HEART PALPITATIONS AND CHEST PAIN.

7.5, VASOCONSTRICTION

Hyperventilation can lead to COORDINATION BALANCE AND PERCEPTIVE TASKS ARE IMPAIRED. ____________ IN THE BRAIN CAN LEAD TO DIZZINESS, IMPAIRED VISION, AND LIGHTHEADEDNESS. __________, LOW CALCIUM LEVELS IN THE BLOOD CAN CAUSE SPASMS IN THE MUSCLES.

VASOCONSTRICTION, HYPOCALCEMIA

When a patient is experiencing hyperventilation DO NOT administer ________.

oxygen

A _________ is TEMPORARY CHANGES IN BEHAVIOR DUE TO ABNORMAL ELECTRICAL DISCHARGES IN THE BRAIN.

seizure

SEIZURES ARE USUALLY NOT ____________. MANAGING THE SITUATION TO PREVENT INJURY IS GENERALLY INDICATED.

LIFE THREATENING

__________ are BRIEF, NON-MOTOR EVENTS OCCURRING IN CHILDREN AND YOUNG PEOPLE. THESE SEIZURES CAUSE A LAPSE IN AWARENESS AND ACTIVITY, AND TYPICALLY LAST ONLY A FEW SECONDS. Someone might even mistake this for __________.

Absence seizures, day dreaming

Treatment of ___________, all DENTAL TREATMENT SHOULD STOP DURING THE DURATION OF THE EPISODE ALL INSTRUMENTS SHOULD BE MADE SAFE VITAL SIGNS SHOULD BE MONITORED, TREATMENT MAY CONTINUE AT THE CONCLUSION OF THE SEIZURE IF PATIENT HAS NO ILL EFFECTS.

absence seizures

_____________ seizures may have a beginning (prodrome and aura), middle (ictal), and end (post ictal) phases.

Generalized tonic clonic

During the _________ stage of GTCS some people can tell when a seizure is on its way. Some symptoms may include mood changes, anxiety, lightheaded, sleeplessness, difficulty focusing, and behavior changes.

prodromal

______ are generally considered part of the prodrome stage of the GTCS. Symptoms include, deja vu, dizziness, nausea, headache, panic, numbness.

Auras

The _________ stage of a seizure the “tonic phase” si when the seizure is occuring.  During this MUSCLES SUSTAINED __________, PATIENT APPEARS STIFF OR RIGID, USUALLY LAST 10 TO 20 SECONDS. CLONIC PHASE, THE PATIENT EXPERIENCES MUSCULAR CONTRACTIONS AND RELAXATION PRODUCING CONVULSIONS. This phase usually lasts _____ minutes.

middle (ictal), CONTRACTION, 2 to 5

The __________ phase is the final stage that occurs after the ictal part of the seizure. CNS DEPRESSION OCCURS, URINARY AND OR FECAL INCONTINENCE MAY OCCUR, THE PATIENT MAY AWAKE CONFUSED FATIGUED AND MAY OR MAY NOT REMEMBER HAVING A SEIZURE. THIS PHASE MAY LAST FOR MINUTES TO HOURS.

ending (post-ictal)

TREATMENT for ___________: CLINICIAN SHOULD BE ALERT FOR IMPENDING SEIZURES SUCH AS MOOD CHANGES REPORTS OF AURAS OR SUDDEN LOSSES OF CONSCIOUSNESS. AT THE FIRST SIGN OF A SEIZURE, IMMEDIATELY STOP DENTAL TREATMENT AND MAKE INSTRUMENTS SAFE, MOVE HAZARDS AWAY FROM THE PATIENT. NOTE THE _______ OF THE BEGINNING OF THE SEIZURE .

GENERALIZED TONIC CLONIC SEIZURES, TIME

Do not place anything in the patient’s _______ during a GTCS or move them from the chair. If the patient becomes cyanotic or there seizure lasts more than 3 minutes, contact EMS.

mouth

The difference between a GTCS and a serious Static Epilepticus (grand mal) is the _______ of the seizure. The normal duratic of GTCS is ______ minutes. While a SE can persist for hours, days, and may result in ________.

length, 2 to 5, death

_______ STROKES ARE OCCLUSIVE, MEANING THERE IS A BLOCKAGE IN A ___________. THE BLOCKAGE DEPRIVES SURROUNDING TISSUE (CALLED THE PENUMBRA) OF OXYGEN AND GLUCOSE AND MUST BE TREATED QUICKLY TO AVOID LASTING COMPLICATIONS.

ischemic, CEREBRAL BLOOD VESSEL

__________ STROKES OCCUR AS A RESULT OF RUPTURING OF BLOOD VESSELS IN THE BRAIN. THIS TYPE IS LESS COMMON, ABOUT _____ OF THE TIME. HYPERTENSION ANTICOAGULATION MEDICATIONS, TUMORS, SUBSTANCE ABUSE, CAN CAUSE this type of STROKE. These strokes have _______ rates.

HEMMORAGIC, 15% , higher mortality

Symptoms of an ________ stroke include DEVIATION OF THE TONGUE TO THE SIDE, DROOLING, WEAKNESS ON ONE SIDE OF THE BODY OR FACE, NAUSEA, VOMITING, SEVERE HEADACHE.

ischemic (occlusive)

Symptoms of the _______ are similar to ischemic but they come on more suddently are, ACUTE HEADACHE HIGH BLOOD PRESSURE, MAY HAVE NECK PAIN OR STIFFNESS, PUPILLARY MALALIGNMENT, NAUSEA VOMITING, ALTERED CONSCIOUSNESS.

hemorrhagic

IF YOU SUSPECT A PATIENT MAY BE HAVING A ______, ASK THE PATIENT TO SMILE AND LOOK FOR WEAKNESS ON ONE SIDE OF THE FACE. ASK THE PATIENT TO HOLD THEIR ______ OUT TO THE SIDE WITH PALMS UP AND EYES CLOSED FOR 10 SECONDS, CHECK FOR DROOPING IN ONE ARM. ASK THE PATIENT TO REPEAT A SENTENCE AN LOOK FOR DIFFICULTY IN SPEECH (DYSPHASIA).

STROKE, ARMS

If you suspect a patient is having a stroke CONTACT _____ IMMEDIATELY AND NOTE ________ AND SYMPTOMS.

EMS, TIME OF ONSET

___________ IS CHEST PAIN THAT MAY BE THE RESULT OF AN INADEQUATE SUPPLY OF OXYGEN TO THE MYOCARDIUM OF THE HEART. IS OFTEN A SYMPTOM OF _____________ WHICH IS THE LEADING CAUSE OF DEATH IN THE US.

ANGINA PECTORIS, CORONARY ARTERY DISEASE (CAD)

_________ PRESENTS AS A DULL CONSTANT PRESSURE LASTING FROM 1 TO 15 MINUTES AND RESPONDS POSITIVELY TO REST AND OR _________. IT IS STABLE IF THE PATIENT HAS HAD NO INCREASE IN FREQUENCY OF SYMPTOMS WITHIN THE LAST ___ DAYS AND NO CHANGES TO WHAT PRECIPITATES THE ATTACK.

STABLE ANGINA, NITROGLYCERIN, 60

__________ occurs at rest or with minimal exertion and lasts _____ mins or more. Nitroglycerin may or may not relieve the pain. Patients with this are at high risk for actue myocardial infarction (heart attack). These patients should recieve minimal dental care with medical clearance and no _________ in local anesthesia.

unstable angina, 20, vasoconstrictors

IF THE PATIENT HAS A HISTORY OF ANGINA, TREAT AS AN ___________ FIRST, IF THE PATIENT HAS NO HISTORY OF ANGINA, TREAT THE SITUATION AS IF THE PAIN IS CONSISTENT WITH A ____________ UNLESS OTHER CAUSES ARE EVIDENT.

ANGINAL EPISODE, MYOCARDIAL INFARCTION

After a heart attack the BP is taken at every visit, and do not treat the patient in the first ________ following myocardial infarction.

6 months