COMMON EMERGENCIES

COLLAPSE

clinical condition that occurs insidiously, and does not attain its maximum degree of severity for several hours

P or U

management (for cases of collapse with uncertain causes; __________ in the AVPU scale)

A

patient regains consciousness in < 2 minutes; ______ in the AVPU scale

SEIZURES / FITS / CONVULSIONS

- involuntary, physical movements caused by the sudden surge of electrical activity in the brain

SEIZURES / FITS / CONVULSIONS

- twitching or jerky movements can involve almost the entire body or just a part of the body, and can occur with or without disturbed consciousness

SEIZURES / FITS / CONVULSIONS

- unconsciousness may be prolonged or momentary (form of a stare or staring episodes)

SEIZURES / FITS / CONVULSIONS

- can occur in patients with no history of epilepsy (recurrent seizures that have a sudden onset)

SEIZURES / FITS / CONVULSIONS

- causes: traumatic brain/head injury, high fever or serious illness, abnormal sodium & glucose levels, genetic or developmental disorders, withdrawal from alcohol consumption, withdrawal from the use of illicit drugs or from certain medications (e.g., analgesics & sleep aid drugs)

SEIZURES / FITS / CONVULSIONS

- signs & symptoms: tremors; brief blackouts (staring episodes) or periods of confusion; rapid eye movement (REM), suddenly falling for no apparent reason; and any changes in mood, personality, or behavior

CHEST PAIN

- refers to a severe pain just behind the breastbone (angina pectoris), excruciating pain that radiates to other parts of the body (myocardial infarction), or sudden pain that worsens when taking a deep breath (pulmonary embolism)

CHEST PAIN

- causes: heart-related problems (i.e., angina pectoris, myocardial infarction, etc.); lung-related problems (i.e., pulmonary embolism, collapsed lung, etc.); muscle & bone causes (i.e., sore muscles, injured ribs, etc.); digestive causes (i.e., heartbum, swallowing disorders, etc.); and other causes (i.e., panic attack, shingles etc.)

CHEST PAIN

signs & symptoms: central chest pain (squeezing/crushing sensation), pulse rate (PR) is <40 or >120 bpm, breathlessness, cyanosis, sweating, nausea or vomiting, & loss of consciousness with a weak or irregular pulse that indicates an infarct

angina pectoris

clinical syndrome marked by severe chest pain

myocardial infarction

excruciating & radiating pain due to complete blockage of blood supply to the heart muscle

pulmonary embolism

blood clot in the lungs

glyceryl nitrates (nitroglycerin)

gives a profound vasodilator effect to the systemic vasculature which can worsen ischemia (inadequate blood flow)

pulmonary embolism

presence of cyanosis that does not resolve with the administration of oxygen therapy suggests

ASTHMA

pertains to widespread narrowing of the bronchial airways resulting to difficulty in breathing

ASTHMA

patients with asthma (both adults & children) may have an attack during dental surgery

high-risk asthmatics:

patients taking oral medications in addition to beta-2 agonists & corticosteroids, uses a nebulizer at home, required corticosteroid therapy within the last year, & those who were admitted to the hospital due to asthma within the last year

ASTHMA

- causes: anxiety, infection, or exposure to an allergen/drug/substance can trigger an asthma attack

ASTHMA

sign & symptoms: breathlessness, wheezing, use of accessory muscles with each respiratory cycle in increased severity (e.g., shrugging of the shoulders), unusually quiet or inability to speak full sentences, cyanosis (around the lips or extremities), pulse rate is <50 or >110 bpm, and respiratory rate is >25 breaths per min

FOREIGN BODY AIRWAY OBSTRUCTION (FBAO)

- refers to the act of inhaling or breathing in a foreign object into the respiratory tract

choking

the physiologic response to sudden obstruction of the airways

hands clutched to the throat

universal sign of choking:

FOREIGN BODY AIRWAY OBSTRUCTION (FBAO)

causes asphyxia / suffocation / respiratory depression or arrest (serious condition in which oxygen is prevented from reaching the tissues)

mild airway obstruction (effective cough) or severe airway obstruction (ineffective cough)

severity of FBAO:

loss of consciousness and death

severe asphyxia may result to _________ if initial treatment is not done quickly

dental items

the 2nd most commonly ingested/aspirated foreign object

FOREIGN BODY AIRWAY OBSTRUCTION (FBAO)

- signs & symptoms: irregular breathing with crowing or croaking during inhalation, violent respiratory efforts using accessory muscles, and cyanosis

HYPERVENTILATION SYNDROME (HVS)

- pertains to breathing at a rapid rate while at rest resulting in COz reduction of arterial blood

dizziness, paresthesia of the lips & limbs, tetany (spasm/twitching of the muscles) of the hands, and chest pain (tightness)

- sequence of HVS:

HYPERVENTILATION SYNDROME (HVS)

-causes: anxiety or neurosis; pain; cardiovascular disease; neurological disorder; acidosis (metabolic or drug-associated); & poor respiratory exchange (but in this case, it is a compensatory psychological response)

HYPERVENTILATION SYNDROME (HVS)

- signs & symptoms: anxiety; weakness, light-headedness; dizziness; tetany; muscle pain or or stiffness; disturbed consciousness; perioral & peripheral paresthesia; and features of cardiovascular & respiratory disease (such as chest pain, palpitations, breathlessness, etc.)

DISTURBED OR AGGRESSIVE BEHAVIOR

- causes: results from annoyance or underlying psychiatric disorder drugs (such as barbiturates, alcohol, illicit drugs, or drug withdrawal); corticosteroid pain or discomfort from infections (particularly in the elderly with hypoglycemia or other endocrine disorders); temporal lobe epilepsy; and cerebral tumors

DISTURBED OR AGGRESSIVE BEHAVIOR

- signs (varies depending on severity: defiance, belligerence, or combativeness (verbal or physical) which may be directed towards objects, people, or oneself

INTRAVASCULAR INJECTION OF A LOCAL ANESTHETIC AGENT

- signs & symptoms: agitation, confusion, drowsiness, convulsions or seizures, and eventually loss of consciousness

TEMPORARY FACIAL PALSY, DIPLOPIA, OR LOCALIZED FACIAL PALLOR

- rarely occurs as a result of the action of an anesthetic agent on the facial nerve or orbital components

TEMPORARY FACIAL PALSY, DIPLOPIA, OR LOCALIZED FACIAL PALLOR

transient effects will resolve

TEMPORARY FACIAL PALSY, DIPLOPIA, OR LOCALIZED FACIAL PALLOR

- if the patient is unable to blink: tape the eyelids closed until the anesthetic abates

CARDIOVASCULAR REACTIONS TO THE LOCAL ANESTHETIC

- usually experienced as palpitations by the patients

HYPOTENSION RESULTING FROM INTERACTION WITH HYPERTENSIVE DRUGS

- refers to the risk of developing low blood pressure that is exhibited with the use of certain medications which aim to treat hypertension

HYPOTENSION RESULTING FROM INTERACTION WITH HYPERTENSIVE DRUGS

- causes: alpha blockers (prazosin, terazosin, doxazosin); vasodilators (nitrates, hydralazine); antihypertensive drugs (diltiazem, nifedipine, clonidine, reserpine, methyldopa, thiazide diuretics, loop diuretics, angiotensin-converting-enzyme/ACE inhibitors)

hypotension

considered as a side effect or "first-dose effect" of alpha blockers

HYPOTENSION RESULTING FROM INTERACTION WITH HYPERTENSIVE DRUGS

- signs & symptoms: dizziness, light-headedness, weakness or fatigue, nausea, palpitations, orthostatic/postural hypotension (dizziness or fainting with ≥ 20mmHg systolic & ≥10mmHg diastolic drop in blood pressure when rising from a sitting or lying position)

BLEEDING

- refers to the escape (external or internal) of blood from a ruptured blood vessel

BLEEDING

- causes: secondary to local trauma and hemorrhagic disease (uncommon occurrence, but it must always be considered)

BLEEDING

- signs & symptoms of extemal bleeding: clearly visible & can easily be recognized

internal bleeding

pain, pallor, dizziness, cold or clammy skin, low blood pressure, rapid pulse rate, and shortness of breath (extreme cases may lead to shock)