WK3 - Lecture 14 - Heart Failure and Acute Pulmonary Edema PDF

DH 410 EMERGENCIES IN DENTAL PRACTICE Lecture: Heart Failure & Acute Pulmonary Edema Objectives  Understand and discuss risk factors for heart failure and pulmonary edema  Recognize and describe the clinical signs of Right Ventricular (RV) heart failur...

DH 410 EMERGENCIES IN DENTAL PRACTICE Lecture: Heart Failure & Acute Pulmonary Edema Objectives  Understand and discuss risk factors for heart failure and pulmonary edema  Recognize and describe the clinical signs of Right Ventricular (RV) heart failure / Left Ventricular (LV) heart failure  Recognize and describe the clinical signs and symptoms of Acute Pulmonary Edema  Describe management of dental patients with Acute Pulmonary Edema and Heart Failure Heart Failure  Occurs when heart muscle is impaired and no longer pumps sufficient blood to BODY tissues and organs  Blood often backs up and fluid accumulates in the lungs  Pulmonary edema  Lack of oxygen to the brain can lead to loss of consciousness  Lead to absence of pulse  Lead to respiratory arrest Heart Failure  Acute Myocardial Infarction (AMI)  Hypertension most frequent cause  Also associated with:  Thyroid disease  Renal insufficiency  Diabetes  Valvular / Pulmonary disease  Heart Failure  In dental setting, physiological and psychological stress exacerbate symptoms  Stress  Fear Heart Failure – Left vs. Right  LEFT  RIGHT  Left Atrium  Right Atrium  Collectsnewly  Collectsoxygen-poor oxygenated blood blood from the body from lungs  Sends to Right Ventricle  Sends to left Ventricle  Right Ventricle (RV)  Left Ventricle (LV)  Pumps oxygen-poor  Pumps oxygen-rich blood to the lungs to blood out to the body pick up oxygen  FOR REVIEW: Watch Kahn Academy Video on Canvas The functioning of the heart valves and blood flow Grimes, E. B. (2014). Medical emergencies: Essentials for the Dental Professional. Prentice Hall  LEFT Ventricular HF  Inability of the left ventricle to pump blood to the body tissues  Blood coming to left ventricle may back up causing fluid to leak into lungs  Pulmonary edema  Edema = fluid build up / pooling in area of body  Usually occurs BEFORE right ventricular HF Signs and Symptoms: LEFT Heart Failure  Classic sign: dyspnea (shortness of breath)  Tachypnea (rapid breathing)  Symptoms more prominent at night while patient is supine  Head needs to be elevated  Harder to breathe laying flat Signs and Symptoms: LEFT Heart Failure  Non-productive, dry cough due to lung congestion  Pale and cool to touch  Diaphoresis: excessive sweating  Increased BP  Pulse rapid and thready – may alternate between strong and weak Signs and Symptoms: RIGHT Heart Failure  Usually develops AFTER left heart failure  Inability of the heart to pump blood from the systemic circulation to the lungs  Results in congestion in systemic venous system  FOR REVIEW: Watch Kahn Academy Video on Canvas The functioning of the heart valves and blood flow Grimes, E. B. (2014). Medical emergencies: Essentials for the Dental Professional. Prentice Hall Signs and Symptoms: Right Heart Failure  Classic symptom – peripheral edema  Pitting edema (cutaneous) in lower legs and ankles  Fatigue and weakness  Nocturia (waking at night to urinate)  Distended jugular vein  Headaches Pitting Edema Distended Jugular Vein Left-side and right-side heart failure Treatment of Heart Failure  Lifestyle changes can lessen symptoms:  Smoking cessation  Exercise  Weight loss  Limit consumption of caffeine and alcohol  Reduce stress Treatment of Heart Failure  Drug therapy  ACE inhibitors (angiotensin-converting-enzyme inhibitor)  Diurectics  Vasodilators  Beta blockers  Calcium channel blockers Management of Heart Failure Patient in Dental Setting  Questions  Hx of Heart failure  Swelling in feet or ankles  Shortness of breath  Weight gain 3 pounds over 7 days with edema red flag postpone treatment Weight Loss!!! Excessive without trying, and still eating. Management of Heart Failure Patient in Dental Setting  Physical characteristics observed (EO/IO)  Cyanosis  Jugular veins  Swollen Ankles  If present  Vital signs prior to treatment and throughout appointment Management of Heart Failure Incident GENERAL  Stop dental treatment  Position: upright; patient comfortable  Contact EMS  Attempt to calm patient  C-A-B, BLS as needed  Definitive Care:  Administer O2 4-6 L/min  Monitor vitals  Administer Nitroglycerin  *respiratory distress – bloodless phlebotomy Management of Heart Failure Incident GENERAL Bloodless phlebotomy  Process:  Place 3 tourniquets or blood pressure cuffs on 3 limbs  Enough to reduce blood flow, but loose enough to maintain arterial pulse  6 inches below groin and 4 inches below shoulder  Remove one tourniquet at a time every 5-10 minutes and reapply to free extremity  Rationale:  Removes blood from circulation permitting heart to pump remaining blood more effectively  Results in reduction in pulmonary congestion and improved breathing Management of Heart Failure Incident GENERAL ****REVIEW****  BLS TRAINING  Every 2 years minimum  Required to treat patients  Required to have an active RDH license  American Red Cross or American Heart Association Management of Heart Failure Incident GENERAL  Identify emergency  ACTIVATION of emergency response  HIGH QUALITY CPR  Rapid DEFIBRILLATION (AED) Management of Heart Failure Incident  Identify emergency  Check responsiveness  “Are you okay?”  Tap shoulder firmly Management of Heart Failure Incident  Activate emergency response  Unresponsive: call for help (9-1-1 or WLA Sheriff) send for AED  If alone and DO NOT have mobile device: Leave call 9-1-1 AED CPR Management of Heart Failure Incident  HIGH QUALITY CPR  Simultaneously check breathing and pulse No more than 10seconds Check carotid on side of neck (pulse)  NO PULSE 30 compressions : 2 breaths Use AED as soon as it arrives Compressions: 100-120 compressions per minute (“Stayin’ Alive” by Bee Gees) 2 hands, lower breast bone 2 to 2.5 inches deep Management of Heart Failure Incident  Rapid Defibrillation Use AED as soon as it arrives 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