Medical Emergencies 2024 PDF

MEDICAL EMERGENCY MANAGEMENT American Society of Anesthesiologists Physical Status Classification System American Society of Anesthesiologists Physical Status Classification System (1,2) Classification Conditions Treatment Modifications ASA PS 1...

MEDICAL EMERGENCY MANAGEMENT American Society of Anesthesiologists Physical Status Classification System American Society of Anesthesiologists Physical Status Classification System (1,2) Classification Conditions Treatment Modifications ASA PS 1 Normal, healthy patient, No modifications indicated little or no dental anxiety ASA PS 2 Patient with mild systemic Medical consultation when disease or extreme dental indicated, possible sedative anxiety techniques, pain control ASA PS 3 Patient with severe systemic Exercise caution during disease treatment, allow patient to rest, monitor patient closely, sedative techniques, pain control American Society of Anesthesiologists Physical Status Classification System (cont’d) American Society of Anesthesiologists Physical Status Classification System (1,2) Classification Conditions Treatment Modifications ASA PS 4 Patient with severe systemic Postpone elective dental disease that is a constant care, treat emergency dental threat to life care in a hospital setting ASA PS 5 A moribund patient who is Palliative treatment for pain not expected to survive management only without an operation ASA PS 6 A declared brain-dead Treatment not indicated patient whose organs are being removed for donor purposes Prevention of Emergencies ◦ Attention to prevention ◦ Factors contributing to emergencies BLS Certification Required for licensed dental hygienists Guidelines and training provided by the American Heart Association (AHA) Most current information available in AHA BLS for Healthcare Providers Manual 5 When you least expect it to happen! 7 Division of Duties Emergency Team ◦ Team Member # 1: Evaluates and stays with the patient. Calls for help ◦ Team Member # 2: Collects emergency cart/equipment. Drug Kit, oxygen. Documents vital signs etc. ◦ Team Member # 3: Doctor/ Instructor determines the need for 911 and directs the call to be made Call for help ◦ From a West Liberty phone you must dial 9-911 ◦ In the clinic, you may send someone to the front desk to call or use cell phone Equipment Kit or Cart ◦ Table 9-1 Clinic Emergency Cart Emergency Equipment & Drug Kit Drug Kit ◦ Services available ◦ The Doctor can assemble a drug kit ◦ Basic Kit contains the following: ◦ Epinephrine (epi-pen), Benadryl (tabs & injectable), Aspirin, nitroglycerin, Bronchodilator, glucose, Oxygen ◦ * some may choose to add Naloxone (Narcan) Epinephrine ◦ Injectable bronchodilator: EPI Pen ◦ Used for severe allergic reactions or bronchospasm ◦ Anaphylaxis: Life-threatening allergic reaction ◦ Adult 0.3 mg IM or Subcutaneously ◦ Child: 0.15 mg Diphenhydramine (Benadryl) ◦ Injectable 50 mg or 50 mg tablets ◦ Histamine blocker used for allergic reactions-- Antihistamine ◦ Primarily for non-life-threatening or mild allergic reactions Signs of Allergy ◦ Mild: skin rash, redness, itching Urticaria -hives ◦ Severe: Bronchiolar constriction, asphyxiation, dyspnea, drop in blood pressure, cardiovascular collapse Types of Reactions ◦ Type I ◦Immediate may be mild or severe ◦Angioedema: rapid swelling of skin, subcutaneous tissue & and mucosa. ◦ Type IV Delayed reaction: allergic dermatitis, Example: poison ivy, some latex reactions Anaphylaxis: What type of reaction is this?  Nitroglycerin ◦ Vasodilator used for the treatment of Angina ◦ Patients diagnosed will have their own RX. ◦ Always evaluate BP. It must be at or above the patient’s baseline BP. ◦ Nitrolingual spray has a longer shelf life than tablets ◦ One tablet of.4 mg or metered spray sublingual may provide relief. Two additional doses can be provided at 5-minute intervals. Nitroglycerin Tablets Metered Spray Angina ◦ Call 911 if pain is not relieved with 2 doses of nitroglycerin over 10 minutes. ◦ Administer oxygen ◦ Assess and record vital signs Nitroglycerine ◦ Contraindications: ◦ Patients who have chest pain and exhibit a drop in blood pressure (Systolic < 100) They feel dizzy, faint or lightheaded. ◦ Patients who have taken Viagra or Cialis within the last 24 hours— combination of drugs can lower BP to an unsafe level. Bronchodilator ◦ Treats bronchospasm which is an acute asthmatic attack. ◦ Asthmatic patients may or may not have their RX with them. ◦ Albuterol is most commonly used ◦ Brand names of this drug are Ventolin and Proventil ◦ Relief generally in 30 seconds to 1 minute Albuterol Inhaler Glucose (sugar) ◦ Administered for hypoglycemia ◦ Low blood sugar very common emergency in the dental office ◦ InstaGlucose: Tube ◦ Orange Juice ◦ Cake Icing ◦ Soft drinks Glucose Aspirin ◦ Pre- hospital treatment of suspected heart attack. Always call 911 first. ◦ Many patients take aspirin preventively ◦ Low dose aspirin (81 mg) – regular dose 325 mg. ◦ Recommended for those who have never experienced chest pain before. ◦ Not recommended for suspected stroke. Aspirin 81 mg Aspirin Contraindications ◦ Allergy ◦ Bleeding disorders ◦ Gastric or peptic ulcers Oxygen ◦ Available in an “E” Cylinder 3 ft high ◦ Green in color Contraindications: Hyperventilation High concentration of Oxygen in COPD/Emphysema patients  Oxygen Delivery Systems Device Indications Flow Rate Oxygen Concentration Cannula Patient is breathing and needs low levels of oxygen. 2-6 L/min 25%-40% Face Mask Patient is breathing and needs moderate levels of oxygen:  When cannula is not tolerated  When more oxygen is desired 8-12 L/min 60%  Patient is in shock Non- The patient is breathing and needs high Rebreather levels of oxygen: Mask  Patient is in shock 10-15 L/min 60%-90%  When more oxygen is desired Bag-Valve Patient has stopped breathing; used Mask instead of mouth-to-mouth 10-15 L/min 90%-100% resuscitation. Demand Positive pressure delivery of oxygen on valve demand Used by EMS 100% resuscitatio n Portable Oxygen Delivery System  Masks ◦ Used for oxygen delivery ◦ Disposable masks for CPR delivery ◦ Bag-Valve mask/Ambu Bag: for delivery of breaths for CPR Masks Face Mask Cannula AED: Automated External Defibrillator ◦ Small light weight device that assesses a patient’s heart rhythm and delivers current when necessary. Additional Items ◦ Glucometer to evaluate blood glucose Before meals 80-130mg/dl After meals: < 180 mg/dl Image by Freepik Additional Items ◦ Magill Forceps: remove objects from the trachea when visualized ◦ Pulse Oximeter: to evaluate oxygen saturation of the blood ◦ 95% or higher in health ◦ Less than 92% consult a healthcare provider ◦ Chronic lung disease patients may have levels around 90% Prevention of Medical Emergencies ◦ Careful assessment of the medical history ◦ Note medications being taken ◦ Take Vital Signs ◦ Review Allergies/drug reactions ◦ Reduce stress ◦ Review Post treatment care What are a few conditions that may result in a medical emergency? Syncope ◦ Loss of consciousness caused by decreased blood flow to the brain ◦ 50% of reported emergencies in the dental office. ◦ Supine positioning has greatly decreased this dental office emergency Symptoms ◦ Pale (pallor) ◦ Dilated pupils ◦ Sweaty/clammy skin/cold perspiration ◦ Weakness, dizzy, nausea ◦ Initial increase in pulse/anxiety ◦ Drop in BP ◦ Loss of consciousness Causes ◦ Fear/anxiety (adolescent females) ◦ Orthostatic or postural hypotension ◦ Blood loss ◦ Cardiac Arrhythmias Treatment ◦ Trendelenburg position ◦ Monitor airway & vital signs ◦ Apply cool moist towel to forehead ◦ Record time of unconsciousness in patient chart Hyperventilation ◦ Increased breathing in excess what is required to maintain normal carbon dioxide levels. ◦ Caused by fear/anxiety Symptoms ◦ Feeling of suffocation ◦ Panting or rapid breathing ◦ Shortness of breath ◦ Tingling of hands and feet ◦ Increased heart rate ◦ Syncope Treatment ◦ Stop what you are doing, terminate tx ◦ Have the patient breath into their own hands cupped over their nose and mouth ◦ Have the patient hold their breath and count to ten. Coach them to take slow breaths. ◦ Do not administer oxygen ◦ Only medical emergency where oxygen is contraindicated Asthma ◦ Bronchospasms often triggered by allergies, exercise, respiratory infection Symptoms ◦ Wheezing ◦ Coughing ◦ Breathing difficulty ◦ Cyanosis ◦ Dilated pupils Treatment ◦ Utilize patient’s bronchodilator if possible ◦ Position patient in a manner that is comfortable ◦ Administer oxygen with nasal cannula ◦ Call 911 if patient doesn’t respond to treatment ◦ *** Please do not wear heavy fragrances to clinic COPD ◦ Chronic Obstructive Pulmonary Disease ◦ Emphysema and bronchitis ◦ Loss of elasticity of the lung tissue ◦ Smoking ◦ Pollutants Symptoms & Treatment ◦ Labored breathing ◦ Difficulty exhaling ◦ Have patient use their RX ◦ Bronchodilators One puff, repeat in 5 minutes is necessary. ◦ Sit patient upright ◦ Keep patient comfortable ◦ Call 911 if RX does not produce relief ◦ Oxygen can be delivered if necessary Seizure ◦ Epilepsy ◦ Convulsions or seizures caused by waves of abnormal electrical activity in the brain. ◦ Patient may lose consciousness and become tonic ( major skeletal muscles contract) ◦ Tonic phase followed by the clonic phase (muscles contract and relax in waves) Seizure ◦ Patient may become cyanotic ◦ When seizure subsides a period of drowsiness occurs. ◦ Prevention: medical history, reduce stress ◦ Ask about an AURA  Treatment ◦ Supine position ◦ Move bracket tray & light away from patient ◦ Provide padding for their head ◦ Let the seizure take its course ◦ Contact 911 if seizure does not subside within five minutes. ◦ Monitor airway and vital signs ◦ Document the episode Diabetes ◦ Type I: Insulin Dependent ◦ Type II: Non-insulin Dependent Diabetes ◦ Hypoglycemia is the most common diabetic emergency ◦ Insulin reactions: Too much insulin not enough glucose ◦ Sudden onset ◦ Moist/clammy skin, confusion ◦ Nervousness/shaky feeling, anxious ◦ TX: administer sugar Diabetes ◦ Hyperglycemia ◦ Too much glucose ◦ Not enough insulin ◦ Diabetic Coma: a life-threatening complication if the condition is not treated. ◦ May be seen in: 1. Undiagnosed diabetic 2. Patients neglect to take insulin at the correct dose 3. Uncontrolled diabetic Prevention ◦Thorough Medical History ◦ Type of Diabetes: Age of onset? ◦ Did you eat before your appointment ◦ Did you take your insulin today ◦ Did you take your oral medication ◦ Do not treat an uncontrolled diabetic without consultation with a physician ◦ Patients do not heal well and may need antibiotics ◦ Reduce appointment lengths to allow for eating Treatment Page 147 ◦ Recognize signs of hypoglycemia ◦ Recognize signs of hyperglycemia ◦ Glucometer 70-130 mg/dL before meals