DH 410 Emergencies in Dental Practice

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Questions and Answers

What should be avoided when managing an overdose in a victim of drug toxicity?

Giving an emetic agent (correct)

Cooling the skin with lukewarm water

Providing benzodiazepines

Administration of activated charcoal

Which of the following is a common symptom of opioid toxicity?

Hypotension (correct)

Pupil dilation

High blood pressure

Increased heart rate

What mechanism do opioids use to produce their effects?

Block the release of dopamine

Inhibit the absorption of enzymes in the GI tract

Bind with specific opioid receptors (correct)

Enhance the activity of serotonin

Which of the following is NOT a typical route of administration for opioids?

Transdermal Signup and view all the answers

What is a potential severe consequence of benzodiazepine overdose?

Respiratory arrest Signup and view all the answers

What symptom is associated with benzodiazepine toxicity?

Lethargy Signup and view all the answers

Which property is NOT associated with benzodiazepines?

Analgesic effects Signup and view all the answers

For what purpose is activated charcoal administered in cases of drug overdose?

To prevent systemic absorption of drugs Signup and view all the answers

Which drug is considered a CNS stimulant that can lead to toxicity symptoms such as euphoria and tachycardia?

Amphetamine Signup and view all the answers

What is a common sign of cocaine toxicity?

Euphoria Signup and view all the answers

Which of the following is NOT a typical symptom of amphetamine toxicity?

Hypotension Signup and view all the answers

What should be part of the emergency management for someone experiencing amphetamine or cocaine toxicity?

Monitor vital signs Signup and view all the answers

Which of the following drugs is a dopamine reuptake inhibitor commonly associated with feelings of euphoria?

Cocain Signup and view all the answers

What is considered an extreme symptom of cocaine toxicity?

Cerebral hemorrhage Signup and view all the answers

Which condition is most likely related to methamphetamine use?

Meth mouth Signup and view all the answers

When managing a patient with drug toxicity, what is a priority action?

Contact emergency medical services Signup and view all the answers

Which factor does NOT influence the healing of wounds?

Type of suture used Signup and view all the answers

What is the primary reason for being more aggressive with layered closure in facial wounds?

To preserve normal facial contours Signup and view all the answers

Which of the following is a risk factor for wound infection according to established studies?

Presence of foreign body Signup and view all the answers

When repairing a laceration through the vermilion border of the lip, what is the first step?

Use traction to align the lips Signup and view all the answers

What should be done when encountering intraoral injuries?

Irrigate as per normal procedure Signup and view all the answers

What is a distinguishing feature of wounds located on the face compared to other areas?

Lower incidence of infection Signup and view all the answers

What is essential to inspect for in lip lacerations?

Intraoral foreign bodies Signup and view all the answers

In a three-layer closure for through-and-through lip lacerations, which layer is sutured first?

Mucosal layer Signup and view all the answers

Which component of the skin is responsible for the majority of collagen production?

Dermis Signup and view all the answers

What stage of wound healing involves the development of an epithelial covering over an insutured wound?

Epithelialization Signup and view all the answers

Which stage of wound healing is primarily characterized by the movement of skin edges towards the center of the defect?

Contraction Signup and view all the answers

What can lead to persistent inflammation and result in poor wound healing?

Infection or foreign materials Signup and view all the answers

At what point in the wound healing process do fibroblasts begin synthesizing collagen?

By the fourth day Signup and view all the answers

What does scar maturation refer to in the context of wound healing?

Increase in scar strength and remodeling Signup and view all the answers

What is the main biological process served by the inflammation stage of wound healing?

Removal of debris and bacteria Signup and view all the answers

Which of the following statements about scar tissue is correct?

It continues to remodel for up to two years after a wound Signup and view all the answers

Study Notes

Drug Overdose and Toxicity Overview

Major focus on actions of CNS stimulants and depressants, their toxicities, and treatment.
Recognition of signs and symptoms of common drug abuse and overdose.

CNS Stimulants

Amphetamines
- Act as central nervous system stimulants.
- Examples include Ritalin, Adderall, Phentermine, and Methamphetamine.
- Trigger sympathetic nervous system, leading to increased heart rate, pupil dilation, and reduced digestion.
- Prevent reuptake of excitatory neurotransmitters, causing a constant state of excitation.
Signs and Symptoms of Amphetamine Toxicity
- Euphoria, restlessness, talkativeness, anxiety, and agitation.
- Physical symptoms include tachycardia, hypertension, chest pains, heart palpitations, and possible coma or myocardial infarction (MI).
- Associated clinical signs include "meth mouth" and rampant caries.
Cocaine
- A potent CNS stimulant and vasoconstrictor, also used as a local anesthetic.
- Functions as a dopamine reuptake inhibitor, producing euphoria.
Signs and Symptoms of Cocaine Toxicity
- Symptoms include anxiety, agitation, hyperthermia, seizures, and hallucinations.
- Additional physical symptoms involve tachycardia, chest pain, hypertension, ventricular fibrillation, and potential cerebrovascular accidents (CVA).

Emergency Management of Amphetamine & Cocaine Toxicity

Urgent actions include contacting EMS, positioning patient for comfort, and monitoring vital signs.
Follow C-A-B guidelines (Circulation, Airway, Breathing) as necessary.
Benzodiazepines may be administered by trained professionals.
Cooling the patient's skin with lukewarm water and air fans is recommended.
Avoid the use of emetics, as this may induce seizures.

CNS Depressants

Opioids
- Derived from the opium poppy, with natural sources like morphine and codeine, and synthetic drugs such as heroin and fentanyl.
- Can be taken orally, smoked, or injected.
Mechanism of Action of Opioids
- Bind to specific opioid receptors in the CNS and spinal cord, resulting in sedation, euphoria, and pain reduction.
- Inhibit gastrointestinal motility, leading to constipation.
Signs and Symptoms of Opioid Toxicity
- Present with lethargy, pupil constriction, shallow breathing, hypotension, bradycardia, and flaccid muscles.
- Severe overdose can lead to coma, respiratory depression, and death.
Benzodiazepines
- Primarily used to treat anxiety, seizures, and muscle spasms.
- Administered orally or via IM/IV routes (e.g., Valium, Xanax, Ativan).
- Enhance the action of the inhibitory neurotransmitter GABA in the CNS.
Signs and Symptoms of Benzodiazepine Toxicity
- Lethargy, slurred speech, ataxia, mental confusion, and potential for coma or respiratory arrest.

Skin Anatomy

Epidermis: Composed of keratinized squamous epithelium, avascular in nature.
Dermis: Dense, fibro-elastic tissue that is highly vascularized; primarily made of fibroblasts which produce collagen and elastin.
Subcutaneous Layer: Connects the dermis to underlying tissues, containing varying amounts of adipose tissue.

Wound Healing Stages

Hemostasis: Initial stage to stop bleeding.
Inflammation: Removes debris and bacteria; prolonged inflammation can lead to poor healing.
Epithelialization: Occurs within 24-48 hours in sutured wounds; impeded by eschar and debris.
Fibroplasia: Begins on the fourth day with fibroblasts synthesizing collagen, forming initial scar tissue.
Contraction: Skin edges move towards the center of the wound, influenced by surrounding muscle.
Scar Maturation: Scar strength increases rapidly from days 5-17, and continues to remodel for up to 2 years, never fully reaching original skin strength.

Wound Evaluation - History

Identify factors affecting healing and risk of infection, including:
- Mechanism and time of injury, environment, potential contaminants, animal species in bites, and patient's medical history.
Assess tetanus immunization status and consider handedness or vocation.

Wound Infection Risk Factors

Risk factors include older age, diabetes, width of laceration, and presence of foreign bodies.

Specific Wounds – Face

Facial wounds are less prone to infection due to high vascularity.
Debridement should be minimal to maintain facial contours.
Aggressive layered closure is recommended for facial wounds.

Specific Wounds - Lips

Anatomy: Includes skin, vermilion border, vermilion, oral mucosa, and obicularis oris.
Always inspect lip wounds intraorally for foreign bodies like teeth fragments.
For lacerations through the vermilion border:
- Use traction for alignment before stitching, starting at the vermilion border.
- Repair the orbicularis oris and then the skin.
Through and through lacerations require a three-layer closure:
- Mucosal layer (rapidly absorbable suture).
- Orbicularis oris.
- Skin layer.

Specific Wounds – Intraoral

Normal irrigation practices apply.
Lacerations of the buccal mucosa and gingiva may heal without repair if edges are not widely separated.

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Description

This quiz covers the recognition and treatment of drug overdose and toxicity in dental practice, focusing on CNS stimulants and depressants. It emphasizes the signs and symptoms of toxicity from commonly abused drugs, and appropriate treatment modalities for affected patients.