Medical Emergencies Ch.3

chief complaint

The patient’s concern stated during the initial HHx preparation

The reason for seeking care

every appointment

When should we ask the patient if they have pain concerns or dental concerns or their reason for coming in

medications and drug history

Obtain as much information from the patient as possible

Ask questions about medications they are taking

Document everything

medications

Ask at each and every appointment if there are any changes to the list of:

supplements and herbal products

What are two things that must be included in the medical or drug history if the patient is taking them

medical consult

If a patient has premedication with antibiotic, diabetes, premedication with steroid, high blood pressure, or other medically compromised conditions, they may need a:

postpone treatment

Premedication with antibiotic, diabetes, premedication with steroid, high blood pressure, or other medically compromised conditions are all reasons to:

clindamycin

This antibiotic will no longer be used if a patient is allergic to amoxicillin

1,2

If antibiotic prophylaxis is not taken _ hour prior to appointment the guidelines state it may be administered up to _ hours after the procedure

wait 10 days after course is completed or administer a different antibiotic

If a patient is taking a short course of antibiotics for an infection elsewhere in the body, what are the 2 options?

antibiotic prophylaxis

preventative medications given before a potential infection risk to stop bacteria from multiplying and causing severe illness

infective endocarditis

An infection of the lining of the heart chambers and heart valves that is caused by bacteria, fungi, or other infectious substances

infective endocarditis

An infected blood clot caused by bacteria that can break off and travel to other organs of the body

medical and dental

What 2 procedures can cause infective endocarditis

prosthetic heart valve, previous endocarditis, congenital heart disease, cardiac valvular disease

What are the 4 heart conditions that puts a patient at risk of infective endocarditis

exploring, probing, SRPs

3 examples of manipulation of gingival tissue

manipulation of gingival tissues, treatment of periapical region, perforation of mucosa

For these 3 procedures premedication is recommended to prevent infective endocarditis

1

Premed patients must take antibiotic _ hour prior to treatment

2 grams

Adult oral dosage for amoxicillin

4

How many 500mg tabs of amoxicillin is equal to the standard adult oral dosage

cephalexin (keflex)

If a patient is allergic to amoxicillin and ampicillin they must take:

2 grams

Adult dosage for cephalexin

ampicillin, cefazolin, and ceftriaxone

What are 3 types of IV antibiotics that are available to patients who can’t take oral meds

10

AHA states: “waiting _ days after an antibiotic has been taken to allow sufficient time for the usual oral flora to be reestablished

different antibiotic

If the patient can’t wait 10 days between appointments, Another option is to use ______ ______ for each appointment

half mouth

In order to minimize the number of times a patient needs to premed you can schedule them for a ___ ___ SRP

no

In general, for patients with prosthetic joint implants, are prophylactic antibiotics recommended prior to dental procedures to prevent prosthetic joint infection

prosthetic joints

prophylactic antibiotics should only be considered after consultation with the patient and orthopedic surgeon

no

Can we treat a patient with not well-controlled diabetes

type 2

Non-insulin dependent diabetic

A1C blood test

This blood test provides the average level of blood glucose over the past 3 months. It is the primary test used in diabetes management

A1C blood test

Does not require fasting before blood work which makes it more convenient

below 5.7

Normal A1C blood level

5.7-6.4

Prediabetes A1C blood level

6.5 and above

Diabetes A1C blood level

below 7

Well managed diabetic A1C blood level

adrenal insufficiency

cortisol deficiency, enough for daily living, not enough for an extremely stressful situation

extreme weakness, low bp, and unconsciousness

3 symptoms of Adrenal Crisis

adrenal insufficiency

taking corticosteroids for a condition at high does for a long time can lead to:

eye drops and topical creams

These 2 items are not included as a cause of adrenal insufficiency

rule of twos

adrenal suppression may occur if a patient is taking 20 mg of cortisone or its equivalent daily, for 2 weeks within 2 years of dental treatment

medical clearance

Patient with adrenal suppression or insufficiency needs ____ ____ before being treated here at cypress

normal BP

Routine dental care, Recheck in 6 months, Monitor unless treatment dictates

<120/<80

ASA 1 blood pressure

elevated BP

Routine dental care

Recheck BP, after 3 consecutive dental visits with elevated numbers the patient needs a medical consult

120-129/<80

ASA 2 blood pressure

hypertension stage 1

Recheck BP in 5 min w/ manual unit

If still elevated may need consult

Routine dental care

130-139/80-89

ASA 3 blood pressure

normal

What BP category is associated with ASA 1

elevated

What BP category is associated with ASA 2

hypertension stage 2

Recheck in 5 min with manual unit

If still elevated med consult needed before treatment

No dental care until HBP corrected

>140/>90

ASA 4 blood pressure

>180/>120

hypertensive crisis, call 911

influence BP

Nervousness, How hard the heart is working, Exercises, eating, stimulants, Full bladder, Medications, Fasting, resting, quiet emotion, fainting or blood loss

99.8

If patient’s temperature is above ___° F they must be reappointed

97-99

Normal temperature range

>99.5

Pyrexia (fever)

>104

Hyperthermia

<96

Hypothermia

50

If a student has herpes they must wear a mask and change mask every __ min

completely healed

If a patient still has an oozing herpes sore they will not be seen until it is:

6

Must wait at least _ months post heart attack before dental treatment can occur

6

Must wait at least _ months post accident/stroke before dental treatment can occur

MRSA

All wounds must be healed

Carriers must wear over gloves to sign forms

BP must be taken over sleeves

AIDS

Will need CD+4 counts before treatment

myocardial infarction

Another name for heart attack

medical history, vital signs, and dialogue history

3 components of physical evaluation

open-ended

You must ask ________ questions and get as much information as possible to safely treat the patient

emergency

Prior knowledge of the patient’s physical & psychological conditions permits the DHCP to modify treatment to prevent an:

medical history form

Provides a baseline history.

Provides information on past & current medical/dental conditions.

Provides list of medications

limitations to medical history form

Patient unaware of health status

Patient not revealing information on health status

Patient does not understand the value or need for DHCP to have this information

vital signs and visual inspection

Because of the medical history limitations, DHCP must do use these 2 things as additional sources of information about the health status of a patient

ASA classification and medical consult

2 things that help determine medical risks

ASA 1

Normal health patient w/o systemic disease

ASA 2

Patient with mild systemic disease well controlled, extreme dental fear, ASA1 pregnant woman, ASA 1 patient with allergies to drugs

ASA 3

Patient with severe systemic disease, angina, 6 mo post heart attack, post cerebrovascular accident, type 1 diabetes

Will need medical consult

ASA 4

Patient w/ incapacitating systemic disease that is constant threat to life, unstable conditions

ASA 5

Patient not expected to survive 24 hrs w/o planned surgery, end- stage diseases

ASA 6

Patient declared brain-dead, donor

document

Consult PCP or Specialist that is treating patient’s condition and always _____ phone calls

anxiety

Heightened _____ of dentistry can lead to acute exacerbation of medical problems and will need treatment modification

clinical signs of stress in the reception area

Nervous conversations, Pacing, History of cancellations or emergency care only

Sweating, cold & clammy palms

clinical signs of stress in the dental chair

Unnatural stiff position

Avoidance , unwillingness to cooperate or communicate

Wring of hands, white knuckle syndrome

Beads of sweat on forehead and above lip

stress reduction protocol

Premedication, Early appointments, Minimize wait time, pain control or sedation, shorter appointments

iatrogenic

Stress reduction protocol that involves talking to your patient and getting them comfortable