ASA Physical Status Classification Quiz

Medical Emergency Management

• Medical Emergencies: A range of situations requiring immediate medical attention. These can vary significantly in severity and cause.

American Society of Anesthesiologists (ASA) Physical Status Classification System

• ASA PS 1: Normal, healthy patient with little to no dental anxiety. No modifications needed for treatment.

• ASA PS 2: Patient with mild systemic disease or extreme dental anxiety. Medical consultation may be required, and sedative or pain control techniques might be utilized during procedures.

• ASA PS 3: Patient experiencing severe systemic disease. Exercise caution during treatment; the patient needs to rest. Sedative/pain control techniques are critical.

• ASA PS 4: Patient with severe systemic disease that poses a constant threat to life. Important to postpone elective dental care; treat emergencies in a hospital setting.

• ASA PS 5: Moribund patient not expected to survive without surgery. Only palliative pain management should be offered.

• ASA PS 6: Declared brain-dead patient whose organs are harvested for transplantation. No treatment is indicated.

Preventing Emergencies

• Five-Point Plan: A strategy to proactively avoid emergencies
  • Employ systematic patient assessment procedures.
  • Document and maintain comprehensive patient records.
  • Implement stress-reduction protocols.
  • Recognize and address early signs of distress.
  • Establish a clearly defined team management plan for preparedness.

BLS Certification

• Essential: Licensed dental hygienists must obtain BLS certification.
• Source: Training provided by American Heart Association (AHA). BLS for Healthcare Providers Manual provides the most current information.

In Every Emergency

• Dental Treatment Termination: Terminate treatment when an emergency arises.
• Removing Items: Remove all dental items from the patient's mouth.
• Patient Awareness: Inform the patient that further dental treatment is suspended.
• Unresponsive Patients: Assess pulse and breathing. Initiate Cardiopulmonary Resuscitation (CPR) if needed.
• Blood Pressure Monitoring: Monitor blood pressure, pulse, and respirations.
• Positioning: Position the patient to optimize circulation (e.g., upright for high blood pressure, semi-supine for low blood pressure).
• EMS Activation: Call Emergency Medical Services (EMS) if situation warrants.
• Identifying Symptoms: Evaluate patient symptoms, including medications, food intake, and pre-existing conditions.

Division of Duties

• Clear Role Definitions: Team members are assigned specific duties to keep the emergency response organized. Each person's role needs to be clearly defined.

Emergency Team

• Team Member 1 Role: Evaluates the patient's condition and stays with them while requesting help.

• Team Member 2 Role: Gets emergency supplies, drugs, oxygen, and records data.

• Team Member 3 Role: Determines if 911 is needed and directs the call.

Calling for Help

• 911: The standard emergency number for West Liberty and most clinics.

Equipment Essentials

• Emergency Cart: A cart stocked with essential medical components, including drugs and tools.

Drug Kit Contents

• Doctor Role: The doctor assembles the kit with appropriate drugs.
• Basic Kit Contents: Includes epinephrine, Benadryl, aspirin, nitroglycerin, bronchodilators, glucose, oxygen, and sometimes naloxone.

Epinephrine

• Use: Injectable bronchodilator (EPI Pen) used for severe allergic reactions (anaphylaxis).
• Dosage: Adult: 0.3 mg IM/Subcutaneous; Child: 0.15 mg IM/Subcutaneous.

Diphenhydramine (Benadryl)

• Action: Histamine blocker/antihistamine used for allergic reactions (especially mild to moderate).
• Form: Injected or in tablet form.

Allergy Signs

• Mild: Skin rash, redness, itching, hives (urticaria).

• Severe: Severe airway constriction, difficulty breathing, possible loss of consciousness, and a significant drop in blood pressure.

Types of Reactions

• Type I: Immediate, often mild or severe, involving skin reactions and rapid swelling of the skin.
• Type IV: Delayed allergic reactions, such as allergic contact dermatitis.

Nitroglycerin

• Use: Vasodilator for angina treatment.
• Important considerations: Patient must have their own prescription (RX). Before administering, check the patient's blood pressure (BP), ensuring it's at or above baseline.
• Administering via Spray: Metered spray is frequently used, providing consistent and quick relief.
• Administering via Tablets: .4 mg tablet, may be used sublingually for angina treatment.

Bronchodilator (Ventolin and Proventil)

• Action: Treats bronchospasm, commonly caused by allergies or exercise in an acute asthma attack.
• Administering: Patients typically use their own inhalers (RX is needed). Relief typically occurs within 30-60 seconds.

Glucose (Sugar)

• Purpose: Used for hypoglycemia (low blood sugar), a common emergency in dental offices.
• Forms: InstaGlucose tubes, orange juice, cake icing, and soft drinks are readily available options.

Aspirin

• Usage: Primarily for suspected heart attacks. Always call 911 first.
• Dosage: Low dose (81 mg) is commonly used; regular dose (325 mg) might be necessary.

Oxygen

• Availability: Cylinder, 3 ft high, green in color.
• Contraindications: Avoid in patients with COPD or emphysema to prevent hyperventilation.

Oxygen Delivery Systems

• Types: Include cannula, face mask, non-rebreather mask, bag-valve mask, demand valve.
• Usage: Based on patient need and condition.

Portable Oxygen Delivery System

• Utility: A portable unit of oxygen delivery.

Masks

• Purpose: Intended to provide oxygen and facilitate CPR.
• Examples: Disposable masks, bag-valve masks, or Ambu bags.

AED (Automated External Defibrillator)

• Function: A small, portable device intended to assess heart rhythm and deliver electric shocks to correct potentially life-threatening arrhythmias.

Additional Supplies

• Glucometer: Utilized to assess blood glucose levels before and after meals (normal levels are crucial).
• Magill Forceps: Used for removing foreign objects from the trachea, ensuring the airway is clear.
• Pulse Oximeter: Measurable oxygen saturation levels in the blood are necessary to assess breathing issues.

Prevention of Medical Emergencies

• Medical History Assessment: Carefully review patient history, focusing on medications, allergies, and prior medical issues.
• Medication Tracking: Document medications currently active.
• Vital Signs Check: Document vital signs before or during treatment.
• Review of potential Reactions/Allergies: Allergies, drug reactions, stress management, and post-treatment care are all essential elements in the prevention strategy.

Syncope

• Definition: Temporary loss of consciousness caused by insufficient blood flow to the brain.
• Prevalence: A frequent emergency in dental clinics.
• Treatment: Supine positioning and addressing potential causes (e.g., postural hypotension).

Symptoms (General)

• Symptom Clusters: Various symptoms might occur, including pallor, dilated pupils, sweaty/clammy skin, lightheadedness, and nausea up to a drop in blood pressure.

Causes of Syncope

• Anxiety/Fear: Anxiety, especially in young women, can be a frequent trigger.
• Postural Hypotension: A sudden drop in blood pressure when changing position.
• Blood Loss: Insufficient blood volume to support normal circulation.
• Cardiac Arrhythmias: Unusual heart rhythms.

Hyperventilation

• Cause: Rapid, uncontrolled breathing, often originating from fear/anxiety.
• Symptoms: Suffocation, panting, shortness of breath, reduced blood-borne carbon dioxide levels.
• Treatment: Have the patient breath into their own cupped hands, advising them to take slow and intentional breaths.
• Oxygen Administration Prohibition: Do not administer oxygen in this condition unless explicitly directed by medical personnel.

Asthma

• Cause: Frequently triggered by allergies, respiratory infections, and exercise.
• Symptoms: Wheezing, coughing, and difficulty breathing.

COPD (Chronic Obstructive Pulmonary Disease)

• Cause: A collection of respiratory disorders including reduced lung elasticity, often associated with smoking and environmental pollutants.
• Symptoms: Breathing problems, chronic coughing, and difficulty expelling air.

Seizures (Epilepsy)

• Definition: Resulting from irregular brain activity.
• Symptoms: Characterized by loss of consciousness, muscle rigidity (tonic phase), and subsequent rhythmic contractions and relaxation (clonic phase).
• Treatment: Ensuring patient safety, letting seizures run their course, observing post-seizure reactions.

Diabetes

• Overview: Hypoglycemia (low blood glucose/sugar) and hyperglycemia (high blood glucose); both are essential factors in treatment. Monitor blood sugar with glucometer before and after meals.
• Types: Type I & Type II diabetes.
• Treatment: Administering glucose promptly for hypoglycemia.

Stroke (CVA)

• Cause: Disruption of blood supply to the brain.
• Symptoms (FAST): Face drooping; arm weakness, speech difficulty; time matters, act quickly.
• Treatment: Immediate 911 call, supporting vital functions, observing further responses.

Angina

• Description: Acute chest pain (often radiating to arm, jaw), frequently caused by reduced blood flow to the heart.
• Treatment: Administering nitroglycerin. If symptoms persist or worsen after two nitroglycerin doses, activate EMS immediately.

Myocardial Infarction (Heart Attack)

• Cause: Coronary artery disease often causes a heart attack.
• Symptoms: Characterized by persistent, potentially severe chest pain, often accompanied by other symptoms.
• Treatment: Essential immediate steps include calling 911, monitoring vital signs, administering oxygen, and aspirin if medically advisable.

Local Anesthesia Reactions

• Type: Reactions can be psychogenic, allergic, or toxic.
• Treatment: Monitoring patients and addressing any reactions appropriately.

Specific Dental Emergencies

• Hemorrhage: Excessive bleeding from the mouth.
• Avulsed Tooth: Dislocated tooth in the socket.
• Broken Instrument: Instrument damage during procedures.
• Foreign Body in the Eye: An object lodged within the eye(s).

Documentation Procedures

• Critical Information: Recording emergency timeline, details of required actions, and essential information about the patient and course of treatment.

Disposal of Drugs

• Important Info: Information regarding appropriate drug/medicine disposal.