Dena 17 - Outcome 7 PDF

Dena 17 - Outcome 7 Rationale: A medical emergency is a condition or circumstance that requires immediate action for a person who has been injured or has suddenly become ill You must be prepared to respond immediately Your knowledge and skills could mean the difference between lif...

Dena 17 - Outcome 7 Rationale: A medical emergency is a condition or circumstance that requires immediate action for a person who has been injured or has suddenly become ill You must be prepared to respond immediately Your knowledge and skills could mean the difference between life and death How can We Prevent a Medical Emergency: Keys to prevent a medical Emergency - ○ 1. Regular assess vital signs ○ Ensure Medical History is updated at every appointment - Most emergencies that occur in the dental office are caused by the combined stress of a person’s daily life and the apprehension of going to the dentist How can we Prepared for a medical emergency: Successful management of medical emergencies in the dental office requires: 1. preparedness 2. prompt recognition 3. effective treatment Ongoing observation of the patient is an important part of emergency preparedness Routine Drills: Training must be current at all times A ”mock emergency” should be created monthly so that the dental team members can practice their roles, take on additional roles, and refine the office’s emergency plan Recoginizing a medical Emergency: A medical emergency can occur at any time Ongoing observation of the patient in the reception area, dental chair, or leaving the office cannot be overemphasized Note the patient’s response to routine questions Slow responses and changes in speech patterns from a previous appointment should be noted for the dentist to evaluate Recognition of a problem is critical Signs and Symptoms: ​Signs ○ Something that you observe in a patient (e.g., a change in skin color, an increase in respiration rate Symptoms ○ Something that the patient tells you he or she is feeling or experiencing Emergency Care Standards:  Dena 17 - Outcome 7 Every member of the dental team must be current in: ○ Cardiopulmonary resuscitation (CPR) ○ “Heimlich maneuver” - J thrust ○ Ability to assess and record vital signs accurately Fundamentals in Case of Emergency: 1. Immediate recognition of an emergency 2. Activation of the emergency response system 3. Early performance of high-quality CPR 4. Rapid defibrillation when appropriate Emergency Kits and O2: Where is the emergency kit? O2? What is in the Kit? Who is responsible to maintain? The Unconsious Patient: Orthostatic Hypotension/Postural Hypotension Can occur when the patient assumes an upright position too quickly A drop in blood pressure caused by lack of sufficient blood flow to the brain Occurs immediately after a sudden change in positioning If orthostatic/postural hypotension occurs, treat as syncope Syncope (Fainting): ○ Occurs when the brain is temporarily deprived of oxygen Possible causes ○ severe emotion ○ Fright ○ drugs ○ profound pain ○ hypoglycemia ○ cardiac arrhythmias ○ sight of blood or instruments ○ one position for a long time ○ missed meals or hunger ○ fatigue or exhaustion Signs & Symptoms of Pre-Syncope: Paleness Pupil dilation Sweating Goosebumps Weakness Visual Changes Chest pain Dizziness or Vertigo Nausea Yawning High blood pressure Syncope:  Dena 17 - Outcome 7 Signs & Symptoms of Syncope: ○ Paleness ○ Unconsciousness ○ Weak, slow pulse Syncope Prevention ○ If a patient tells you that they feel like they may faint: Seat them in a semi-supine position or Lie them down & elevate their legs Management of a Syncope Emergency: 1. Place patient in supine position with feet elevated slightly 2. Call for help from the other dental team members 3. Check airway and breathing 4. Check circulation, loosen tight clothing and assist in the administration of oxygen to speed recovery 5. Monitor vitals 6. If no pulse or if unconsciousness persist call EMS: 911 Cariovascular Emergencies: Angina Pectoris: Chest pain caused by insufficient blood supply of oxygen to the heart. Can be aggravated by exercise, tension, cold weather or a large meal Facts: The patient feels severe chest pain Sensation of severe constriction or pressure on the chest Signs & symptoms are similar to those of mycardial infarction Angina pain usually lasts 3 to 8 minutes (Bird & Robinson, 2018) Pain is relieved or eased promptly by administering nitroglycerin When angina strikes, it is important to remember that the patient could be having a heart attack Angina Pectoris: Signs & Symptoms: 1. Chest pain 2. Pain radiating to the left shoulder 3. Pain radiating to the left side of the face, jaw and teeth 4. Nausea 5. Anxiety 6. Shortness of breath 7. Pale, cool, moist skin 8. Elevated pulse/blood pressure Management of the Emergency: 1. Call a team member for assistance 2. Position patient upright 3. CPR if needed 4. Re-check medical history (is there a history of angina) 5. Assist with the administration of Nitroglycerin  Dena 17 - Outcome 7 6. 2– 3 doses may be administered 7. Assist with the administration of oxygen 8. Monitor and record the patient’s vital signs Myocardial infarction: Commonly referred to as a heart attack: The muscles of the heart are damaged because of an insufficient oxygen supply If this damage is severe enough, the patient will die; however, prompt medical treatment can limit damage to the heart Any unexplained chest pain should be treated as a potential acute myocardial infarction Signs & Symptoms: Chest or upper body discomfort or pain (mild or severe) Pain in the left arm, jaw, and the teeth Shortness of breath Pale, cool, diaphoretic (sweating) skin Nausea and/or vomiting Weakness and/or lightheadedness Pressure, aching, or burning feeling of indigestion Anxiety, denial, depression, feeling of impending doom Chest pain or discomfort lasting 20 mins or longer Management: Call someone from your dental team for help Call 911 Remain with the patient, loosen restrictive clothing If conscious, position patient supine If unconscious, position patient supine or in recovery position Assess vital signs Assess ABC’s Provide CPR as required Assist with administration of oxygen Have nitroglycerin available Allergic Reactions: An allergy is an altered state of reactivity in body tissues in response to a specific antigen (hypersensititivity) A localized allergic response is slow to develop, involving mild symptoms such as itching, erythema & hives Anaphylaxis is a life-threatening allergic reaction that can develop very quickly Mild Allergic Reaction: A mild hypersensitivity due to an exposure to an allergen Signs & Symptoms: Skin: ○ Itching & burning ○ Flushing ○ Hives  Dena 17 - Outcome 7 May be treated with Benadryl (diphenhydramine hydrochloride) *No respiratory problems or signs of shock* Anaphylactic Reaction: A Severe Allergic Reaction Life-threatening Signs & Symptoms: Skin ○ Itching and burning ○ Flushing ○ Hives ○ Swelling of the face and tongue (edema) Cardiovascular system ○ Tachycardia (rapid heart rate) ○ Hypotension (low blood pressure) Respiratory system ○ Painful squeezing sensation of the chest ○ Shortness of breath ○ Coughing ○ Wheezing Gastrointestinal system ○ Nausea and vomiting ○ Abdominal cramps ○ Diarrhea Central Nervous System ○ Feeling of impending doom Treatment/Management Call EMS: 911 Remain calm CPR as needed High flow oxygen Position supine unless contraindicated (in respiratory distress position in the upright position.) Prepare to assist with administration of: ○ Epinephrine ○ Diphenhydramine (Benadryl) Respiratory Emergencies: 1. Airway Obstrustion 2. Asthma 3. Hyperventilation Airway Obstruction (Causes & Risk): High risk in Dentistry… why?  Dena 17 - Outcome 7 ○ Recline position ○ Slippery environment (saliva+blood) ○ Foreign objects used orally Definition: ○ Object(s) blocking the airway Types: ○ Partial obstruction with good air exchange ○ Partial obstruction with poor air exchange ○ Complete obstruction Signs ans Symptoms: Airway Obstruction Prevention: How can we prevent airway obstructions in a dental office? ○ High volume evacuation ○ Rubber dam ○ Tying ligatures on rubber dam clamps ○ Using a throat pack (gauze placed at base of throat) during sedation surgical procedures ○ Upright position during impressions Airway obstruction Managment: Partial with Good Air Exchange 1. Position the patient - sitting up 2. Encourage patient to continue coughing Partial with Poor Air Exchange 1. Treat as a complete airway obstruction Complete Airway Obstruction 1. Call EMS: 911 2. Attempt to dislodge the obstructed object by performing the Heimlich maneuver until EMS arrives  Dena 17 - Outcome 7 If patient loses consciousness, begin CPR Asthma: Definition: Chronic inflammatory disease of the airway Can be mild, moderate or severe Can vary from person to person Can flare up from time to time and then not appear for long periods Can vary from one episode to the next Possible Types: 1. Extrinsic (allergic) Dust, pollen, or other irritants in atmosphere Often seasonal More common in children (tends to clear in adulthood) 2. Intrinsic (non-allergic) Not due to allergic reaction Non-seasonal May be related to: emotional stress, inhaled fumes, viral infections, cold air, strenuous exercise More common in adults Signs and Symptoms: 1. Shortness of breath 2. Anxiety and apprehension 3. Positioned upright, leaning forward 4. Spasmodic, unproductive cough 5. Wheezing (common on exhalation if air movement is adequate) 6. Hyper-inflated chest (easy to breathe in, difficult to breathe out) 7. Rapid, shallow respirations 8. Rapid pulse 9. Fatigue Management: 1. Call for help from the other dental team members 2. Position patient comfortably - upright 3. Try to calm patient if necessary 4. Assist in inhaler administration - (Ventolin) 5. Call 911 - if condition cannot be controlled 6. Assist with administration of oxygen 7. CPR as required Hyperventilation: What is it?  Dena 17 - Outcome 7 Occurs when there is an increase in breathing rate causing an excessive amount of carbon dioxide leaving the body Respiratory rate above 20 breaths/min Possible causes Psychological High altitudes Medical: ASA (Aspirin) overdose, head injury, hyperglycemia (diabetic coma), pregnancy Signs and Symptoms: 1. Anxiety leading to panic 2. Dyspnea (shortness of breath) 3. Dizziness or lightheadedness 4. Numbness and tingling of the hands and feet 5. Chest pain/tightness 6. Tiredness 7. Carpopedal spasms 8. Deep, rapid respirations 9. Rapid pulse Management of Hyperventilation 1. Place the patient in a comfortable position - upright 2. Attempt to calm the patient. With reassurance and repetition, instruct the patient to slow down their breathing – count to 10 in one breath and breathe through nose 3. Have the patient breathe slowly into cupped hands to increase the level of carbon dioxide Seizures: ​An involuntary, sudden change in sensation, behavior, muscle activity or level of consciousness resulting from overactive brain cells Possible Causes: 1. Epilepsy a. A chronic brain disorder characterized by recurrent seizures with or without a loss of consciousness 2. High fever 3. Head injury 4. Cerebrovascular accident (CVA) (stroke) 5. Alcohol or drug withdrawal 6. Hypoxia 7. Hypoglycemia 8. Cenrtal nervous system infections 9. Brain Tumors  Dena 17 - Outcome 7 Signs & Symptoms: The patient may experience an aura – peculiar sensations such as hallucinations of sight and sounds, odd tastes, abdominal pain or a sensation of movement in a body part that is not physically moving Loss of consciousness The patient may cry out uncontrollably The patient’s body may become rigid then hyperextend in convulsions Heavy labored breathing Clenched jaw Management of a Seizure 1. Supine position (lying down, face up) 2. Ensure patient safety (remove all sharps, instruments, trays, tables) 3. Maintain airway (do not attempt to place anything in mouth) 4. Monitor vital signs (pulse, blood pressure) 5. 100% oxygen (face mask or nasal prongs) *post seizure* 6. Reassure and relax patient *First time seizure should prompt call to general practitioner* *Seizures lasting longer than 5 minutes should initiate EMS (911)* Stroke/Cerebrovascular Accident (CVA): A stroke is an injury or death of brain tissue due to the interruption of cerebral blood flow Possible Causes ○ Ischemia – blockage of a blood vessel in the brain. Most often a blood clot. ○ Hemorrhage due to ruptured or traumatized cerebral blood vessels. Signs and Symptoms ○ Facial drooping, confusion and agitation ○ Headache, dizziness ○ Dysphasia (communication difficulties), hemiparesis (muscular weakness or partial paralysis) ○ Gait disturbances or uncoordinated fine motor movements Altered level of consciousness Management of a Stroke 1. Call EMS: 911 2. CPR as required 3. If conscious, position in supine position 4. If unconscious, position in supine or recovery position 5. Administer oxygen with a non-rebreather mask 6. Protect paralyzed extremities 7. Provide reassurance 8. Prepare for vomiting and airway obstruction Diabetes Mellitus: Diabetes Mellitus is a metabolic disorder that results from disturbances in the body's normal insulin mechanism. The disease is classified in two categories:  Dena 17 - Outcome 7 ○ Type I diabetes mellitus- patient becomes insulin dependent for survival (absolute lack of circulating insulin) 5-10% of diabetics are Type I ○ Type II diabetes mellitus- patient is not insulin dependent but manages the disease by balancing food intake and taking medication *Gestational diabetes – occurs in 2-5% of pregnant women* Hyperglycemia: What is it? ○ Abnormally high blood glucose level ○ Develops when the body cannot make enough insulin. (Type 1 Diabetes) Develops when the body cannot respond to insulin properly. (Type 2 Diabetes) If untreated a Type 1 diabetic can experience a serious condition known as Ketoacidosis (DKA) and a life threatening diabetic coma Possible Causes: Undiagnosed Diabetes Diabetics not using medication or not eating properly Uncontrolled diabetes Food/nutrition/diet choices Activity level Signs & Symptoms: Polyuria (excessive urination) Polydipsia (increase thirst), dry mouth and dry skin Acetone breath (fruity smell) Blurred vision and headache Deep, rapid breathing Tachycardia (increased heart rate) Lower blood pressure Loss of consciousness Managment of Hyperglycemia: 1. Call EMS: 911 2. If the patient is conscious: Position the patient in a sitting or lying position  Dena 17 - Outcome 7 Assess vital signs Administer oxygen by face mask. If vomiting, use a nasal cannula 3. If the patient is unconscious: Position the patient in a supine or recovery position Assess vital signs Administer oxygen 4. Obtain a blood glucose level if trained to do so If patient’s blood sugar level is high do not administer glucose 5. Continuously reassess and keep patient comfortable and monitor vitals until EMS arrive Hypoglycemia (Insulin Shock): An abnormally low blood sugar level. ○ The brain relies on a continuous supply of glucose. When levels drop below normal the function of a brain will be affected Possible Causes: Most often caused by the treatment of diabetes, not the disease process itself. However, non-diabetics can also experience hypoglycemia if there is not enough sugar in the blood at a given time. Causes: ○ Skipping meals ○ Vomiting after meals ○ Taking an insulin overdose, whether accidental or intentional ○ Excessive or strenuous exercise ○ Stress ○ Alcohol or drug overdose (Aspirin) Signs and Symptoms: Develop suddenly and progress rapidly, usually within minutes: 1. Headache 2. Weakness with lack of coordination 3. Hunger 4. Shakiness / tremors 5. Normal blood pressure 6. Increased pulse rate 7. Apathy / combativeness / irritability 8. Diaphoresis (clammy/moist skin) 9. Slurred speech 10. Confusion leading to unconsciousness 11. Convulsions in later stages Managment of Hyperglycemia (Insulin shock):  Dena 17 - Outcome 7 1. If the patient is conscious with an intact gag reflex, assist them to ingest one of the following: a. Orange juice with sugar, soft drinks containing sugar, sugar cubes, sugar candy b. Monitor vitals c. Allow 10-15 minutes for the patient to respond to the glucose intake 2. If the patient has become unconscious call EMS:911 and a. Smear a thin layer of a sugary substance on the inside of their cheeks (avoid solid glucose administration to an unconscious patient as this may compromise their airway) b. Provide basic life support (CPR) as needed c. Administer high flow oxygen d. Monitor vital signs e. Position the patient on their side to protect their airway PART 2 Dental Office emergency kit: In most offices, a standardized emergency kit is equipped and organized with emergency supplies USask Emergency Procedures stored with emergency kits: Medical emergency procedures & anaphylaxis bookles with emergency kits USask Emergency Kits: USask Procedure Manual ○ explains what is in each kit & how to deal with each type of emergency ○ notes expiry dates  Dena 17 - Outcome 7 Blood glucose Monitor at USask: Anaphylaxis Booklet ar USask: Page 1 has directions on how to use EpiPen® st nd Adult EpiPens on 1 , 2 & 3rd floor clinic and Oral surgery/FPC Note: At USASK junior or pediatric ○ EpiPens® are only stored on main floor clinic (2) Emergency Kit Maintenance: 1. Routine check of supplies to determine whether they are in working order 2. Weekly or monthly examination for expiration of drugs within the emergency kit 3. Daily check of oxygen tank or tanks Oxygen: The most frequently used “drug” in a medical emergency The ideal agent for resuscitation of a patient who is unconscious but is still breathing oxygen If the patient is not breathing, air must be administered through rescue breathing or similar emergency measures A portable unit with tanks of oxygen may be stored where it can be moved quickly into a treatment room if needed Important Note: Only DDS can administer oxygen! RDA can only assist the operator with preparing the equipment Components of Oxygen Equipment: Oxygen tank/cylinder – GREEN in colour Gauge regulator Tubing Delivery Systems Nasal Cannula Face Mask  Dena 17 - Outcome 7 Oxygen Tank: Also known as oxygen cylinders Always GREEN in colour Made of steel or aluminum Available in different sizes Oxygen Regulator: - Controls the flow of oxygen out of a tank Tubing: Used for connecting the oxygen tank at the gauge regulator to the face mask Allows delivery of oxygen to the patient Delivery System: Cannula Mask