Dental Anesthesia and Patient Classification Quiz
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Questions and Answers

A patient with well-controlled Type 2 diabetes and mild hypertension would be classified as which ASA Physical Status?

  • ASA PS 3
  • ASA PS 1
  • ASA PS 2 (correct)
  • ASA PS 4

    • Which of the following is the recommended treatment modification for an ASA PS 3 patient?

  • Only provide palliative treatment.
  • No modifications are necessary.
  • Postpone elective dental care.
  • Exercise caution during treatment and monitor the patient closely. (correct)

    • According to the American Society of Anesthesiologists Physical Status Classification System, what is the most suitable course of action for providing dental treatment for a patient who is categorized as ASA PS 4?

  • Provide palliative treatment only.
  • Provide emergency dental care in a hospital setting and postpone elective treatments. (correct)
  • Treat the patient as usual with no modifications.
  • Postpone all dental treatment until their health status improves.

    • What is the primary focus of treatment for a patient categorized as ASA PS 5?

    <p>Offering palliative care for pain management (D)</p> Signup and view all the answers

    For which ASA Physical Status classification is treatment not indicated?

    <p>ASA PS 6 (A)</p> Signup and view all the answers

    What is the primary purpose of dental hygienists having BLS certification?

    <p>To respond effectively to medical emergencies (B)</p> Signup and view all the answers

    According to the provided content, where can most current information regarding BLS guidelines be found?

    <p>The AHA BLS for Healthcare Providers Manual (B)</p> Signup and view all the answers

    What is the main emphasis of the 'Prevention of Emergencies' section in the content?

    <p>Paying attention to factors that may contribute to emergencies. (B)</p> Signup and view all the answers

    During a medical emergency in the clinic, which team member is primarily responsible for documenting vital signs?

    <p>Team Member #2 (B)</p> Signup and view all the answers

    What is the correct way to dial 911 from a West Liberty phone during an emergency?

    <p>Dial 9-911 (A)</p> Signup and view all the answers

    Which medication is NOT typically included in a basic emergency drug kit, according to the provided information?

    <p>Ibuprofen (B)</p> Signup and view all the answers

    For an adult experiencing a severe allergic reaction (anaphylaxis), what is the recommended intramuscular dose of epinephrine?

    <p>0.3 mg (D)</p> Signup and view all the answers

    Which of the following best describes a Type IV allergic reaction?

    <p>Delayed allergic reaction (C)</p> Signup and view all the answers

    Under what condition should nitroglycerin NOT be administered?

    <p>If the patient's systolic blood pressure is below 100 (A)</p> Signup and view all the answers

    If a patient's angina pain is NOT relieved after two doses of nitroglycerin, what should the team do?

    <p>Call 911 (D)</p> Signup and view all the answers

    What is the primary purpose of administering diphenhydramine (Benadryl)?

    <p>To block histamines during mild allergic reactions (D)</p> Signup and view all the answers

    What is a primary concern when administering certain medications to a patient who has recently taken Viagra or Cialis?

    <p>Unsafe drop in blood pressure (D)</p> Signup and view all the answers

    Which medication is most commonly used to treat bronchospasm during an acute asthma attack?

    <p>Albuterol (C)</p> Signup and view all the answers

    A patient in the dental office is experiencing hypoglycemia. Which of the following would be most appropriate to administer?

    <p>Glucose (B)</p> Signup and view all the answers

    What is the recommended pre-hospital treatment for a patient experiencing a suspected heart attack?

    <p>Call 911 first, then administer a low dose (81mg) of aspirin (A)</p> Signup and view all the answers

    Which of the following is generally NOT a contraindication for administering aspirin?

    <p>Suspected stroke (B)</p> Signup and view all the answers

    When is it most appropriate to use a non-rebreather mask for oxygen delivery?

    <p>When a patient is breathing and needs high levels of oxygen. (B)</p> Signup and view all the answers

    A patient requires oxygen, and the dental team is using a cannula device, what would be the appropriate flow rate?

    <p>2-6 L/min (B)</p> Signup and view all the answers

    In which situation would the use of oxygen be contraindicated in a patient?

    <p>When the patient is hyperventilating (A)</p> Signup and view all the answers

    Which device is used to assess a patient's heart rhythm and deliver an electrical current if necessary?

    <p>Automated External Defibrillator (AED) (C)</p> Signup and view all the answers

    A patient's pulse oximeter reading shows 91%. According to the guidelines, what is the appropriate course of action?

    <p>Consult a healthcare provider to determine appropriate next steps. (B)</p> Signup and view all the answers

    What is the primary purpose of using Magill Forceps during a medical emergency?

    <p>To remove objects from the trachea under direct vision (A)</p> Signup and view all the answers

    What is the recommended blood glucose range before meals for a typical patient?

    <p>80-130 mg/dl (C)</p> Signup and view all the answers

    Which of the following is NOT a typical symptom of syncope?

    <p>Tingling in hands and feet (A)</p> Signup and view all the answers

    What is the correct treatment for hyperventilation?

    <p>Have the patient breathe into their cupped hands (D)</p> Signup and view all the answers

    What is the most common cause of medical emergencies reported in the dental office?

    <p>Syncope (B)</p> Signup and view all the answers

    What should be done if a patient is experiencing syncope?

    <p>Lower the patient into the Trendelenburg position (B)</p> Signup and view all the answers

    In which medical emergency is oxygen administration contraindicated?

    <p>A severe asthma exacerbation (B)</p> Signup and view all the answers

    What is a common trigger for bronchospasms in asthma?

    <p>Exposure to heavy fragrances (B)</p> Signup and view all the answers

    What is the recommended course of action when a patient experiences a seizure in the dental office?

    <p>Maintain a safe environment and protect their head. (D)</p> Signup and view all the answers

    What is the primary cause of hypoglycemia in a diabetic patient?

    <p>Too much insulin and not enough glucose (D)</p> Signup and view all the answers

    Which of the following symptoms is most indicative of an asthma attack?

    <p>Wheezing (A)</p> Signup and view all the answers

    What is the initial treatment for a patient experiencing a COPD exacerbation in the dental office?

    <p>Sit the patient upright and have them take their medication. (B)</p> Signup and view all the answers

    What is a key difference between Type I and Type II diabetes?

    <p>Type I is insulin-dependent, whereas Type II is not always so. (D)</p> Signup and view all the answers

    What does the term 'AURA' refer to in the context of seizure management?

    <p>A warning sign or sensation that precedes a seizure. (C)</p> Signup and view all the answers

    Study Notes

    Medical Emergency Management

    • Medical Emergencies: A variety of conditions can lead to a medical emergency.

    ASA Physical Status Classification System

    • This system classifies patients based on their health status for anesthetic procedures.
    • ASA PS 1: Normal, healthy patient with little to no dental anxiety. No modifications needed.
    • ASA PS 2: Patient with mild systemic disease or extreme dental anxiety. Medical consultation, possible sedative, and pain control may be necessary.
    • ASA PS 3: Patient with severe systemic disease. Requires exercise caution, rest, careful monitoring, and possible sedative and pain control during treatment.
    • ASA PS 4: Patient with severe systemic disease that is a constant threat to life. Postpone elective dental care; emergency dental care is indicated in a hospital setting.
    • ASA PS 5: Moribund patient unlikely to survive without surgery. Palliative treatment for pain management only.
    • ASA PS 6: Declared brain-dead patient whose organs are removed for donation. Treatment is not indicated.

    Prevention of Emergencies

    • Box 9-2 Five-Point Plan: A plan to prevent emergencies.
      • Use systematic patient assessment procedures.
      • Document and update accurate, comprehensive patient records.
      • Implement stress reduction protocols.
      • Recognize early signs of distress.
      • Organize team management plans for emergency preparedness.

    BLS Certification

    • BLS certification is required for licensed dental hygienists.
    • Guidelines and training are provided by the American Heart Association (AHA).
    • Current information is available in the AHA BLS for Healthcare Providers Manual.

    In Every Emergency

    • Dental Treatment Termination: Immediate action in case of an emergency.
      • Terminate dental work.
      • Remove all items from the patient's mouth.
      • Inform the patient that treatment is over for the day.
    • Unconscious Patient Assessment: Assess the patient's condition immediately.
      • Check for breathing and pulse.
    • Pulse and Breathing: Position patient to improve circulation.
      • High Blood Pressure (BP): Upright position
      • Low BP: Semi-supine position
    • No Pulse and Breathing: Initiate cardiopulmonary resuscitation (CPR).
    • Vital Sign Monitoring: Continuous monitoring is essential.
    • Oxygen Administration: Administer oxygen in cases needing supplemental oxygen, except hyperventilation.
    • Symptom Assessment: Assess patient for symptoms, such as allergies and illnesses.
    • EMS Activation: Call emergency medical services (EMS) immediately and accurately.

    Division of Duties

    • Team Leader 1: Provides basic life support, evaluates vital signs, initiates CPR, positions patient, manages airway, directs emergency care, and administers oxygen.
    • Team Member 2: Starts the stopwatch, brings the emergency kit, assists with oxygen delivery, medication preparation, and CPR assistance.
    • Team Member 3: Calls for medical aid, monitors vital signs, records data, loosens tight-fitting clothing, and relieves other team members in CPR or other tasks.

    Emergency Team

    • Team roles for emergency situations.
      • Member 1: Assesses patient and calls for help.
      • Member 2: Collects equipment, documents vital signs.
      • Member 3: Determines the need for 911.

    Call for Help

    • Dial 9–911 from a West Liberty phone.
    • Send a staff member to the front desk for a non-emergency phone call.
    • Use cell phones.

    Equipment Kit or Cart

    • The kit should contain essential equipment and medication to address possible emergencies.
    • List contents of the cart.

    Drug Kit

    • The doctor assembles the drug kit which contains necessary medications.
    • Essential Medications: Epinephrine (EpiPen), Benadryl, Aspirin, nitroglycerin, bronchodilator (e.g., Albuterol), glucose, and oxygen. Some doctors may include naloxone.

    Epinephrine

    • Injectable bronchodilator, commonly known as an EpiPen, administered for severe allergic reactions and bronchospasm.
    • Anaphylaxis treatment: Life-threatening allergic reaction.
      • Adult dosage: 0.3 mg intramuscular (IM) or subcutaneously (SQ).
      • Pediatric dosage: 0.15 mg IM or SQ.

    Diphenhydramine (Benadryl)

    • Treatment for allergic reactions, more common for non-life-threatening reactions.
    • Injectable or tablet form.
    • Histamine blocker.

    Signs of Allergy

    • Mild: skin rash, redness, itching (hives)
    • Severe: Bronchospasm, asphyxiation, dyspnea, drop in blood pressure, cardiovascular collapse

    Types of Reactions

    • Type I: Immediate, may be mild or severe, and can include angioedema (rapid swelling of the skin and mucosal tissues).
    • Type IV: Delayed, allergic dermatitis (e.g., poison ivy).

    Nitroglycerin

    • Used for treating angina (chest pain).
    • Patients should have their own prescription.
    • Blood pressure should be checked before administering. BP must be above the patient's baseline for administration.
    • Available as tablets, or metered-spray sublingual. Two additional doses can be given at 5-minute intervals up to a maximum of 3 doses.

    Bronchodilator

    • Treatment for bronchospasm (acute asthma attack).
    • Commonly Albuterol.
    • Brand names: Ventolin, Proventil.
    • Relief generally takes 30 seconds to 1 minute.

    Glucose

    • Used to treat hypoglycemia (low blood sugar).
    • Common emergency in the dental office.
    • Available in various common forms like InstaGlucose tubes, orange juice, cake icing, and soft drinks.

    Aspirin

    • Used in pre-hospital treatment of suspected heart attacks.
    • Prescriptions may be present on hand.
    • Emergency use only in cases of suspected heart attacks (Call 911).
    • Low-dose aspirin (81 mg) is often taken preventively.
    • Regular dose: 325 mg.
    • Not used for suspected stroke.
      • Not recommended for those who have never experienced a stroke.
    • Common side effects - check for contraindications.

    Oxygen

    • Available in 3-foot-height "E" cylinders, green in color.
    • Contraindications: Hyperventilation, high concentrations in COPD/emphysema patients.

    Oxygen Delivery Systems

    • Different methods for delivering oxygen, such as cannula, face mask, non-rebreather mask, bag-valve mask, and demand valve.

    Portable Oxygen Delivery System

    • Portable oxygen systems provide oxygen when needed.

    Masks

    • Oxygen masks utilized for delivery of oxygen.
    • Disposable masks, Bag-Valve masks (Ambu bags) deliver breaths for CPR.

    AED: Automated External Defibrillator

    • Device for assessing heart rhythm and delivering current when needed.

    Additional Items

    • Glucometer: To measure blood glucose levels.
    • Magill Forceps: Used to remove objects from the trachea or airway.
    • Pulse Oximeter: To measure oxygen level in the blood.
      • 95% or higher in a healthy person
      • Less than 92% consult with healthcare provider.
      • Chronic lung diseases patients may have lower levels around 90%.

    Prevention of Medical Emergencies

    • Diligent review and assessment: carefully assess medical histories and note medications taken.
    • Vital signs: check vital signs.
    • Review allergies and drug reactions: review medical allergies and any adverse drug reactions.
    • Reduce Stress levels: reduce stress.
    • Post-treatment care review: review post-treatment care with your patient.

    Syncope

    • Loss of consciousness due to decreased blood flow to the brain.
      • 50% of reported dental office emergencies.
      • Supine positioning can help.
    • Symptoms: Pale, dilated pupils, clammy skin, weakness, dizziness, nausea.

    Causes of Syncope

    • Fear/anxiety (especially in adolescent females).
    • Orthostatic (postural) hypotension
    • Blood loss
    • Cardiac arrhythmias

    Treatment for Syncope

    • Position: Place patient in the Trendelenburg position.
    • Airway and vital signs: Monitor airway and vital signs continuously.
    • Cooling: Apply a cool, moist towel to the forehead.
    • Record: Document the time of unconsciousness in the patient chart.

    Hyperventilation

    • Increased breathing beyond what is needed to maintain normal CO2 levels.
    • Typically due to fear or anxiety.
    • Symptoms: Feeling of suffocation, rapid breathing, shortness of breath, tingling hands and feet, and increased heart rate.

    Treatment for Hyperventilation

    • Stop what you are doing, terminate immediate treatment.
    • Instruct the patient to breath into their own hand cupped over the mouth.
    • Breathe slowly and count to ten.

    Asthma

    • Bronchospasms often triggered by allergies, exercise, respiratory infection.
    • Symptoms: Wheezing, coughing, difficulty breathing, cyanosis, dilated pupils.

    Treatment for Asthma

    • Utilize patient's bronchodilator: Use the patient's prescription inhaler.
    • Comfortable position: Position the patient comfortably.
    • Oxygen: Administer oxygen with a nasal cannula.
    • Emergency: Call 911 if necessary. Avoid heavy fragrances in the dental office.

    COPD

    • Chronic obstructive pulmonary disease
    • Includes emphysema and bronchitis.
    • Loss of elasticity in the lung tissue.
      • Smoking and other pollutants may trigger these issues.
    • Symptoms and Treatment: Labored breathing, difficulty exhaling.
      Have patient use their bronchodilator; One puff, repeat in 5 minutes if necessary.
      • Sit patient upright for comfort.
      • Call 911 if relief is not shown.
    • Oxygen: Oxygen can be given if needed.

    Seizure

    • Epilepsy: Convulsions, loss of consciousness, tonic and clonic phases.
    • Symptoms: Cyanosis during the seizure. Drowsiness after the seizure.
    • Prevention: Review medical history, reduce stress.
    • Treatment: Place the patient in the supine position. Remove all materials that could hurt the patient. Monitor vital signs. Call 911 if the seizure does not stop within 5 minutes.

    Diabetes

    • Types: Type I (Insulin Dependent) and Type II (Non-Insulin Dependent).
    • Hypoglycemia: Low blood sugar, most common in diabetic emergencies.
      • Symptoms: Moist, clammy skin, confusion, nervousness, shaky feeling, and anxiety.
      • Treatment: Administer sugar (glucose gel, tablets). If unconscious: IV Glucagon and call emergency services.
    • Hyperglycemia: High blood sugar.
      • Diabetic coma: Life-threatening complication, may be seen in individuals who are: untreated, undiagnosed, and those who don't take their medication correctly.
    • Prevention: Thorough medical history (Type of diabetes, age of onset, if the patient ate before the appointment, and if insulin was taken that day.
    • Treatment: Recognize signs of hypoglycemia and hyperglycemia, use a glucometer (70-130mg/dL before meals and <180 mg/dL 2 hours after a meal).
    • If the patient is conscious give glucose tablets, gel or sugar. If the patient is unconscious administer IV Glucagon and call emergency services.

    Stroke

    • Cerebrovascular accident (CVA).
    • Embolism, hemorrhage, or thrombosis.
    • Causes include atherosclerosis, hypertension, and head trauma.
    • Signs and symptoms: Ask about F.A.S.T. Face (smile), Arms (raise both), Speech (repeat phrase), and Time (when did symptoms start).
    • Treatment: Call 911 immediately, terminate treatment, administer oxygen.

    Angina

    • Symptoms: Acute chest pain, tightness, possibly radiating to the left arm/jaw.
    • Treatment: Administer Nitroglycerin. If pain worsens or remains after 2 doses, activate EMS immediately.

    Myocardial Infarction (Heart Attack)

    • Heart attack can be severe.
    • Symptoms: Pain may be severe or not. Coronary artery disease, atherosclerosis commonly cause issues.
    • Treatment: Activate 911 immediately, monitor patient's vitals; administer aspirin and oxygen; and perform CPR if needed. No elective dental treatment for one month following a heart attack.

    Specific Emergencies

    • Local anesthesia reactions (psychogenic, allergic, toxic).
    • Opioid overdose (such as Fentanyl).

    Table 9-3 - Emergency Situations

    • Hemorrhage: Bleeding.
    • Avulsed tooth: Tooth knocked out.
    • Broken instrument: Broken piece of dental machine.
    • Foreign body: Object in the eye.

    Documentation

    • Keep records of every important medical emergency. Include: time of emergency, time you called EMS, time EMS arrived, time emergency was completed, vitals recorded, description of the emergency, and drugs administered.

    Disposal of Drugs

    • Follow FDA guidelines for proper drug disposal.

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    Description

    Test your knowledge on the ASA Physical Status Classification System and its implications for dental treatment. This quiz covers the appropriate treatment modifications for patients with differing levels of physical status and the importance of BLS certification for dental hygienists. Enhance your understanding of emergency protocols in a dental setting.

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