Lecture 9: Asthma - Dental Emergencies PDF

DH 410 EMERGENCIES IN DENTAL PRACTICE PRACTICE Lecture 9: Asthma Objectives  Understand and discuss pathophysiology of Asthma  Identify signs and symptoms of Asthma  Explain treatment modalities for Asthma  Determine appropriate emergency steps for patients experiencing...

DH 410 EMERGENCIES IN DENTAL PRACTICE PRACTICE Lecture 9: Asthma Objectives  Understand and discuss pathophysiology of Asthma  Identify signs and symptoms of Asthma  Explain treatment modalities for Asthma  Determine appropriate emergency steps for patients experiencing an Asthma Attack Asthma  Affects 1 of 12 children in the U.S.  25 million people (Asthmatics) in United States (1 in 13 people)  Approx. 11 people die each day in the U.S.  4,415 deaths due to Asthma in the U.S. (2020)  https://www.aafa.org/asthma-facts/ Asthma  Chronic respiratory disorder  Inflammation of the trachea, bronchi, and bronchioles  Via triggers  Recurring attacks of dyspnea (running out of air), wheezing, coughing, and chest tightness Asthma  Airways are hypersensitive to certain triggers  Bronchi contract into spasm resulting in dyspnea  Inflammation is the result of the body’s immune response to inhaled allergen  airway narrowing and mucus production which leads to coughing and wheezing Figure 13.1 Bronchioles of normal and asthmatic patient Asthma  Triggers:  Influencedby multiple genetic, developmental, and environmental factors  Common Allergens: dust, grass, pollen, mold, pet dander  Dental office triggers:  stress-induced  allergic response to dental material Other Asthma Triggers  Air pollution  Industrial compounds  Chemicals  Childhood infections  Exercise  Stress Types of Asthma  Extrinsic  Intrinsic  Drug-induced  Exercise-induced  Infectious Extrinsic Asthma  MOST COMMON  50% of all asthmatics  Inherited allergic predisposition (most often)  Triggers from outside of body  Pollen, dust, mold, tobacco smoke  Dental office: eugenol, impression materials, resins, & latex Intrinsic Asthma  Second major category  Usually in adults > 35 years  But may be found in children  Triggered by psychological and physiological stress  Can resemble panic attack  dental appointments (stressful!)  Drug-induced Asthma  NSAIDS (Aspirin)  Metabisulfite (common preservative in foods and drugs)  Approx. 10% of Asthmatics have Sulfite allergy (discussed more in Anesthesia courses) Exercise-induced Asthma  Begins shortly after start of exercise  Inhalation of cold air may provoke mucosal irritation  Often found in children and young adults due to increased activity Infectious Asthma  Viral infections of respiratory tract most common cause  Frequently seen in children  Treatment of infection reduces asthma symptoms Signs and Symptoms of Asthma  Attacks vary in frequency, duration, degree of symptoms  Range from mild periods of wheezing, mild coughing, and slight dyspnea  To severe attacks that can lead to total airway obstruction and respiratory failure (asthmaticus)  Attacks triggered by infection – gradual onset, long duration  Attacks triggered by allergen – acute onset, short duration if trigger removed Signs and Symptoms of Mild Asthma Attack  Respiration is difficult  Respiration rate is slightly faster than normal range  Complete sentences can be spoken  Mild complaints of wheezing, cough, shortness of breath, or tightness in the chest  Skin color is good Signs and Symptoms of Moderate Asthma Attack  Respiration is moderately difficult  Respiration rate is faster than normal range  Only phrases or partial sentences can be spoken  Moderate complaints of wheezing, cough, shortness of breath, or tightness in the chest Signs and Symptoms of Moderate Asthma Attack  Skin color is normal or may be pale  Slight to moderate “drawing in” of muscles between the ribs is necessary to breath  Signs and Symptoms of Severe Asthma Attack  Respiration rate is  Severe complaints of very fast, or very slow wheezing, cough, with a lot of distress shortness of breath, or tightness in the chest  Only single words or short sentences are  Skin color is poor spoken  Level of awareness is decreased Prevention of Asthma  Medical History Review  Prevention of Asthma - FYI Medical History Review Questions….Ask. Ask. Ask. Open Ended!  Do you have Asthma?  What type of asthma?  What causes asthmatic episodes?  What happens during an episode?  How often do you develop symptoms?  When was the last time you experienced an attack?  What medication or how do you manage an attack?  Have you required emergency care or hospitalization for an episode? Prevention of Asthma  Medical History Review  Patients should bring bronchodilator to appointment and should have ready access  Prevention of Asthma  Nitrous oxide NOT contraindicated  Local anesthetics WITH epinephrine may trigger attack – not recommended (it may increase possibility of a panic attack)  Treatment of Asthma Attack  Position patient upright  Remove all materials from mouth  Self-administer own bronchodilator  Inhale slowly and exhale through pursed lips  If patient does not have own inhaler use inhaler from emergency kit  Albuterol recommended – fast acting and long duration (4-6 hours) Patient positioned upright Figure 13.4 Patient using inhaler during asthma attack Figure 13.3 Albuterol inhaler Treatment of Asthma Attack  Administer oxygen 4-6 L/minute (if needed)  Monitor vital signs  If symptoms do not subside contact EMS  Epinephrine (.3 mg of 1:1000) can be used if bronchodilator ineffective  Epi-Pen References Malamed, S. F. (2022). Medical emergencies in the dental office. Elsevier. Grimes, E. B. (2014). Medical emergencies: Essentials for the Dental Professional. Prentice Hall Asthma & Allergy Foundation of America https://www.aafa.org/asthma-facts/