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Similaire à Medical emergencies in dental practice and there basic life support
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Medical emergencies in dental practice and there basic life support
- 1. MEDICAL EMERGENCIES IN DENTAL PRACTICE Ajeet kumar (medicine)
- 2. CONTENTS • INTRODUCTION • PREVENTION • PREPARATION • CONTINUING EDUCATION • OFFICE STAFF TRAINING • ACCESS TO HELP • EMERGENCY SUPPLIES AND EQUIPMENT
- 3. MEDICAL EMERGENCIES • HYPERSENSITIVITY REACTIONS • CHEST DISCOMFORT ANGINA PECTORIS MYOCARDIAL INFARCTION • RESPIRATORY DIFFICULTY ASTHMA HYPERVENTILATION FOREIGN BODY ASPIRATION • ALTERED CONSCIOUSNESS VASOVAGAL SYNCOPE ORTHOSTATIC HYPOTENSION
- 4. • SEIZURE • LOCAL ANAESTHETIC TOXICITY • DIABETES MELLITUS • THYROID DYSFUNCTION • ADRENAL INSUFFICIENCY • CEREBROVASCULAR COMPROMISE
- 6. PREPARATION • Personal continuing education • Auxillary staff education • Establishment & periodic testing of system • Equipping office
- 7. • Important feature of continuing education • Basic life support (BLS): • A- airway • B- breathing • C- circulation
- 8. CPR SEQUENCE-ADULT VICTIM • Step 1: recognition of unconsciousness • Step 2: summon assistance and P-position the patient. • Step 3: A-assessment and maintenance of airway. • Step 4: B-breathing
- 9. • Step 4a: B-assessment of breathing and ventilation, if needed. • Step 4b: rescue breathing. • Step 5: C-circulation. • Step 5a: C-assessment of circulation. • Step 5b: activation of EMS • Step 5c: chest compression • Step 6: defibrillation.
- 10. • Emergency supplies & equipment: • Two principle: • Ensure familiarity with the kit component • Keep it simple.
- 11. ESSENTIAL COMPONENT OF DENTAL EMERGENCY KIT • AIRWAY EQUIPMENT • “E” OXYGEN TANK • OROPHARYNGEAL AIRWAYS(ASSOTRED SIZES) • NASOPHARYNGEAL AIRWAYS(ASSOTRED SIZES) • YANKAUER SUCTION • MAGILL FORCEPS • PORTABLE SUCTION • NASAL CANNULA • FACE MASK WITH RESERVIOR • POCKET MASK WITH OXYGEN INLET • BAG-VALVE-MASK DEVICE
- 12. • PHARMACOLOGICAL AGENTS OXYGEN EPINEPHRINE 1:1000 (PRELOADED SYRINGE) NITROGLYCERIN (SPRAY OR TABLET) ORAL GLUCOSE GLUCAGON ALBUTAROL INHALER WITH SPACER DIPHENHYDRAMINE CORTICOSTERIOD DIAZEPAM PHENYLEPHRINE NASAL SPRAY ASPIRIN
- 13. • ACCESSORIES • BACK UP LIGHT SOURCE • PAPER BAGS • GAUZE • TAPE • TONGUE BLADES • SPHYGMOMANOMETER • STETHOSCOPE • SYRINGES • NEEDLES (25 & 20 GAUZE) • ALCOHOL WIPES • PILLOW • BLANKET • SURGILUBE • GLUCOMETER
- 14. HYPERSENSITIVITY REACTIONS • Several drugs…. • Type-1 (immediate hypersensitivity)….Acute • Mediated by IgE…. • Least severe….Dermal….But sign… • Dentist should ask specifically about medication.. • L.A. check..
- 15. Drugs used in dental practice that may potentially cause an allergic reaction • ANTIBIOTICS • Penicillin • Tetracycline • ANALGESICS • Aspirin • NSAIDs • OPIODS • Morphine • Codeine • ANTIANXIETY DRUGS • Barbiturates LOCAL ANESTHETICS Esters procaine benzocaine Antioxidant sodium met bisulfite Parabens methylparaben OTHER AGENTS methyl methacrylate
- 16. MANIFESTATIONS REACTIONS: SKIN SIGNS: Delayed- onset skin signs: Erythema, uticaria, pruritis, angioedema IMMEDIATE –ONSET SKIN SIGNS: Erythema, urticaria, pruritis RESPIRATORY TRACT Signs with or without cardiovascular or skin signs Wheezing, dyspnea STIRDOROUS BREATHING: (Crowing sound), moderate to severe dyspnea
- 17. • ANAPHYLAXIS (WITH OR WOTHOUT SKIN SIGNS): • Malaise, wheezing, cyanosis, total airway obstruction, cardiac arrest • Management • Stop adm. Of all drugs • Administer epinephrine • Provide iv access • Give oxygen 6l/min
- 18. MANAGEMENT: Stop adm. Of all drugs Admi. Epinephrine 0.3 ml of 1:1000 sc,im,iv Admi. Antihistamine IM or IV, benadryl 50mg/chlor-trimeton 10mg Monitor vital signs Consult physician
- 19. CHEST DISCOMFORT • CLINICAL CHARACTERISTICS: • Squeezing, bursting, burning pain(not sharp) • Substernally located, with variable radiation to left shoulder, arm….. • Heavy meal
- 20. POTENTIAL CAUSES OF CHEST PAIN • Cardiac related • Angina pectoris- most common • Hyperventilation- common • MI- less common • Non cardiac related • Muscle strain • Pulmonary embolism • esophagitis • Intestinal “gas”
- 21. ATHEROSCLEROSIS • Major etiologic factor for all forms of cv dis.. • Represents spl type of thickening of medium and large sized arteries
- 22. RISK FACTORS FOR ATHEROSCLEROTIC DISEASE • Dyslipidemia • Smoking • Hypertension • Insulin resistance and diabetes • Exercise and obesity • Mental stress
- 23. PATHOPHYSIOLOGY Normal blood there is constant movement of lipids When proliferative changes occur, cell losses its ability… This influx initially made up of cholesterol, triglyceride As lesion progress cholesterol becomes predominant lipid Obstruction occur
- 24. MANAGEMENT • Terminate all dental Rx • Position patient in semi-reclined position • Give nitroglycerin tablet or spray
- 25. ANGINA PECTORIS • Def.…. • Spasmodic, suffocating pain
- 26. CLINICAL CHARACTERISTICS • Dull pressure pain • 2-5 min • Gradual onset • Substernal • Asso symptoms present
- 27. Chest pain describes "sharp- knife like pain, associated with breathing Non-ischemic origin Anginal pain is not associated with breathing, not localized, Pt describes as a ‘region’ Stable angina Triggered by four ‘E’…. Pain last for 1-15 min Variant angina Develops at odd times Cause - Coronary artery spasm Unstable angina Important to dental care as Lies intermediate between stable angina and MI Pain differs in character, frequency, duration
- 28. PRECIPITATING FACTORS • Physical activity • Hot, humid environment • Cold weather • Emotional stress • Smoking • High altitudes
- 29. DENTAL THERAPY CONSIDERATIONS • Length of appointment • Supplemental oxygen..3-5 L/min via cannula • Pain control therapy.. L.A.. always small but effective dose • Retraction cord containing epinephrine…contraindicated • Psychosedation • Nitroglycerin spray/tablets 1-2 metered dose(0.3-0.6mg),no more than 3 metered dose Within 15 mins period
- 30. MANAGEMENT
- 31. ACUTE MYOCARDIAL INFARCTION • Deficient coronary arterial blood supply….. • Pain…longer duration than angina • Location…… • Predisposing factors • Coronary artery disease • Obesity • stress
- 32. DENTAL THERAPY CONSIDERATIONS • Stress reduction • Supplemental oxygen • Sedation • Duration of treatment • Six months after MI….. • Anticoagulant therapy
- 33. CLINICAL MANIFESTATIONS • SYMPTOMS • PAIN • Severe to intolerance • Prolonged, 30 min • Crushing, choking • Radiates: left arm, hand, neck • Nausea and vomiting • Weakness • Dizziness • Palpitations • Cold perspiration • SIGNS • Restlessness • Acute distress • Skin-cool, pale, moist • Heart rate- bradycardia to tachycardia; PVCs common
- 34. PATHOPHYSIOLOGY
- 38. ASTHMA • Chronic inflammatory disorder characterized by reversible obstruction of airways…. • Particular challenge…..
- 39. CAUSATIVE FACTORS FOR ACUTE ASTHMA • Extrinsic asthma • Allergy….. • Intrinsic asthma( non allergic asthma) • Pt older than 35 yrs. • Viral infection of the respiratory tract… Most common • Respiratory infection • Physical exertion….. • Mixed asthma • Status asthmatics
- 40. SIGNS AND SYMPTOMS • Feeling of chest congestion • Wheezing • Dyspnea • Increased anxiety • Tachypnea • Rise In B.P. • confusion
- 41. DENTAL THERAPY MODIFICATIONS • Stress reduction protocol • Barbiturates and opioids are contraindicated…. • Use conscious sedation • Pt allergic to bisulfite….. • Administration of bronchodilator….
- 43. PATHOPHYSIOLOGY
- 44. MANAGEMENT
- 46. HYPERVENTILATION Defined as…… Result of extreme anxiety Causes ….pain. Metabolic acidosis…drug intoxication Pt. remain conscious…unconscious..rare
- 47. CLINICAL MANIFESTATIONS OF HYPERVENTILATION • Cardiovascular- palpitations, tachycardia • Neurologic- dizziness, lightheadedness, numbness • Respiratory- shortness of breath • GIT- epigastric pain • Musculoskeletal- muscle pain, tremor • Psychological- tension, anxiety
- 48. PATHOPHYSIOLOGY
- 50. FOREIGN BODY ASPIRATION • Potential problem • Hypopharynx…not harmful.. • Chest & abdominal x-rays… • Larger objects….obstruct airways…. • Pt becomes extremely anxious…cyanosis… unconscious
- 51. Instruments and techniques used to prevent aspiration and swallowing of objects Rubber dam Oral packing Chair position Dental assistant Suction Magill intubation forceps Ligature(dental floss)
- 52. ASSESSMENT OF COMPLETE UPPER AIRWAY OBSTRUCTION Phase signs and symptoms • First phase conscious; universal choking sign (1-3 min) • Second phase loss of consciousness (2-5 min) • Third phase coma; absent vital signs, dilated pupils (5 min)
- 54. Establishing an emergency airway • Non invasive procedures • Back blows • Manual thrust • Abdominal thrust (Heimlich maneuver) • Chest thrust • Finger sweep
- 55. HEIMLICH MANEUVER Described in 1975-Dr. henry Heimlich Primary technique…
- 56. MANAGEMENT OF VISIBLE OBJECTS • If assistant Is present • Place patient in trendelenburg position • Use Magill intubation forceps/suction • If assistant is not present • Instruct patient to bend over arm of chair with their head down • Encourage patient to cough
- 57. MANAGEMENT OF SWALLOWED OBJECTS • Consult radiologist • Obtain appropriate radiograph to determine the location of object • Initiate medical consultation with appropriate specialist
- 58. MANAGEMENT OF ASPIRATED FOREIGN BODIES
- 59. ALTERED CONSCIOUSNESS • Vasovagal syncope……Most common… • 50% of all emergencies…
- 60. DIFFERENTIAL DIAGNOSIS OF UNCONSCIOUSNESS • Neurogenic causes • Breath holding • Carotid sinus disease • Vasovagal syncope • Vasodepressor syncope • Orthostatic hypotension • Seizure disorders • Vascular causes • Cerebrovascular disease • Pulmonary embolism • Endocrinopathies • Hypoglycemia • Addisonian diseases • Hypothyroidism
- 61. • Psychogenic problems • Exposure to toxins and drugs • Cardiogenic causes • Valvular heart dis.. • Dysrhythmia • MI • Disorders of oxygenation • Anemia • High altitude exposure • Decompression sickness
- 62. POSSIBLE CAUSES OF UNCONSCIOUSNESS • Vasodepressor syncope-most common • Drug administration-common • Orthostatic hypotension-less common • Epilepsy-less common • Hypoglycemic reaction-less common
- 63. PATHOPHYSIOLOGY • Inadequate del. Of oxy to brain…. • Oxygen deprivation….. • Sys/local metabolic deficiencies… • Direct/reflux effect on CNS • Psychic mechanisms
- 64. VASODEPRESSOR SYNCOPE • Predisposing factors Psychogenic factors • Fright • Anxiety • Emotional stress • Sight of blood or surgical or other dental instruments Nonpsychogenic factors • Standing posture • Hunger from dieting • Exhaustion • Hot, humid environment
- 65. PATHOPHYSIOLOGY • Decrease in cerebral blood flow • Sudden drop in B.P….slow heart rate
- 66. CLINICAL MANIFESTATIONS • Presyncope • Syncope • Post syncope • Presyncope • Pt feeling warmth, loses color(pale) • Heart rate increases • As it continues. Pupillary dilation, yawning • B.P. and heart rate decreases…..
- 67. SYNCOPE Breathing may become irregular, jerky Pupils dilate Pt takes on death like appearance Heart rate less than 50 beats/min-common Pulse become weak and thread Unconsciousness for more than 5 min….
- 68. POST SYNCOPE(RECOVERY) • With proper position… Recovery is rapid • Pt may demonstrate pallor, nausea, weakness • It can last from few mins-sev hours • Pt experience a short period of confusion • Arterial blood pressure begins to rise..
- 69. MANAGEMENT • Presyncope • Step 1: position • Step 2: A-B-C • Step 3: definite care… • Syncope • Step 1: assessment of consciousness • Step 2: activation of the EMS • Step 3: P • Step 4: A-B-C
- 70. MANAGEMENT
- 71. ORTHOSTATIC HYPOTENSION • Dis. Of ANS…..when pt. assumes upright posture.. • Drop n systolic prs..30mm Hg r diastolic 10mm Hg • Cause-failure of baroreceptor reflex-mediated inc. in peri.
- 72. PREDISPOSING FACTORS • Administration of drugs….. • Inadequate postural reflex…. • Advanced age • Pregnancy…. • Varicose veins • starvation
- 73. • CLINICAL CRITERIA Symptoms develops when individual stands Standing pulse..inc. 30 beats/min Standing Sys.B.P.dec..25mm Hg Standing diastolic..10mm Hg
- 74. PATHOPHYSIOLOGY
- 75. MANAGEMENT
- 76. SEIZURE • Partial seizures motor, sensory, autonomic….. variable degree of amnesia present. • Grand mal seizure(tonic-clonic) frightening display of clonic contraction of extremities last for 2-3 min… • Petit mal seizure(absence) only episodic absence(blank stare)… • Status epilepticus….continuous…medical assistance…
- 77. CAUSES • Congenital abnormalities….. • Perinatal injuries • Metabolic and toxic dis… • Head trauma • Vascular dis.. • Infectious dis…
- 78. MANAGEMENT OF PETIT MAL, PARTIAL SEIZURE
- 79. MANAGEMENT
- 80. LOCAL ANAESTHETIC TOXICITY 1. Dose…Pt.. age, body mass, liver function 2. Manner of drug admin… 3. Choice of L.A. agent
- 81. CAUSES OF HIGH BLOOD LEVELS OF LOCAL ANESTHETICS • Biotransformation of drug is slow • Elimination through kidney is slow • High dose • Absorption is rapid • Inadvertently intravascular
- 82. CLINICAL MANIFESTATIONS OF LOCAL ANESTHETIC OVERDOSE • SIGNS • Low to moderate overdose levels • Confusion • Talkativeness • Apprehension • Slurred speech • Elevated B.P. • Moderate to high blood levels • Generalized tonic- clonic seizure • SYMPTOMS • Headache • Dizziness • Blurred vision • Loss of consciousness
- 85. MANAGEMENT
- 86. DIABETES MELLITUS Most common endocrine Group of dis.. high level of blood glucose resulting From Insulin production…insulin action, both
- 87. CLASSIFICATION By American Diabetes Association Casual blood glucose level…200 mg/dl with symptoms Fasting glucose of 126 mg/dl 2-hour post prandial glucose higher than..200 mg/dl
- 88. ACUTE COMPLICATIONS HYPERGLYCEMIA HYPOGLYCEMIA….blood glucose level below 50 mg/100 ml Loss of consciousness CHRONIC COMPLICATIONS Vascular systems- atherosclerosis, large vessel dis Kidneys- diabetic glomerulonephritis Nervous system- motor, sensory and autonomic nephropathy Eyes- retinopathy, glaucoma
- 89. PREDISPOSING FACTORS TYPE 1-insulin dependent Genetic factors Environmental… Autoimmune.. TYPE 2-non-insulin dependent Genetic factors.. Insulin secretion Insulin resistance obesity Destroy insulin producing β- cells
- 90. CLINICAL MANIFESTATIONS Hypoglycemia Early stage Changes in mood Hunger Nausea More severe stage Sweating Tachycardia Inc...anxiety Later stage Unconsciousness Hypotension hypothermia HYPERGLYCEMIA Dry, warm skin Kussmaul’s respirations Rapid, weak pulse Altered level of consciousness
- 91. MANAGEMENT
- 94. THYRIOD DYSFUNCTION • Thyroid gland… • T3, T4, Calcitonin…normal growth
- 95. PREDISPOSING FACTORS • Hypothyroidism Primary • Autoimmune hypothyroidism • Idiopathic causes • External radiation therapy • Antithyroid drugs…… Secondary • Pituitary tumor • Infiltrative dis of pituitary • Hyperthyroidism • Toxic diffuse goiter • Toxic multinodular goiter • Hashimoto’s thyroiditis • Metastatic follicular carcinoma • Hypothalamic hyperthyroidism
- 96. CLINICAL MANIFESTATIONS- HYPOTHYROIDISM • SYMPTOMS • Paresthesia • Loss of energy • Muscular weakness • Inability to concentrate • SIGNS • “Pseudomyotonic reflexes” • Change in menstrual pattern • Dry skin • Puffy eyelids • Yellow skin • Loss of scalp hair
- 97. CLINICAL MANIFESTATIONS-HYPERTHYROIDISM • SYMPTOMS • Weight loss • Palpitations • Nervousness • Tremor • Chest pain • SIGNS • Fever • Tachycardia • Dysrhythmias • Weakness • Thyrotoxic stare
- 98. MANAGEMENT
- 99. ADRENAL INSUFFICIENCY • Adrenal insufficiency…corticosteroid admin… • manifestation
- 100. PREDISPOSING FACTORS • After sudden withdrawal of steroid hormones • Stress • After bilateral adrenalectomy • Sudden destruction of pituitary gland • Adrenal gland injury
- 101. DENTAL THERAPY CONSIDERATIONS: RULE OF TWO • Adrenocortical suppression should be suspected….if… • Pt. has rcvd dose of 20 mg of cortisone • Via oral or parenteral route for 2 weeks… • Within 2 years of dental therapy
- 102. CLINICAL FEATURES • SYMPTOMS: • Weakness • Anorexia • GIT symptoms • Salt craving • SIGNS: • Weight loss • Hyperpigmentation • hypotension
- 103. PATHOPHYSIOLOGY
- 104. MANAGEMENT
- 106. CEREBROVASCULAR COMPROMISE • Embolization of matter..distant site • Formation of thrombus in a cerebral vessel • Rupture of vessel • Embolize…mostly comes….left side of heart,carotid artery….. • Level of consciousness..depend on the cerebral lesion
- 107. MANIFESTATIONS • Headache..mild to worst • unilateral weakness or paralysis of extremities of facial muscle • Slurring of speech • Difficulty in breathing • Loss of bladder and bowel control • seizures
- 108. MANAGEMENT
- 109. HEMORRHAGIC DISORDERS • Caused by platelet, occassionaly vascular,or by clotting mechanism such as hemophilia. • Causes of bleeding disorders • Platelet disorders: • Thrombocytopenia • idiopathic cytopenic purpura • connective tissue dis • leukaemias • Vascular defects • corticosteroid treatment • ehler’s-danlo’s syndrome • scurvy • Coagulation defects • hemophilia • Vonwillebrands dis • liver dis • Anticoagulant therpay
- 110. Dental extraction, prolonged bleeding, hemorrhagic emergencies Thrombocytopenia Dental management-hemostasis after minor surgery adequate when platelet level >50*10/1 for major surgery more than 75*10/1 Bleeding tendency in such patient is controlled by corticosteroid Coagulation defects Hemophilia A-inheriated,sex linked recessive gene affects male,need for family history,bleeding history and drug history Measurement of activated partial thromboplastin time(APTT) Prothrombin time(PT) bleeding time(BT)… Decrease factor VIII Management(photo) Hemophillia B-pt should receive antofibrinolytic agent may also require factor replacement therapy depending on the procedure.
- 111. MANAGEMENT OF BLEEDING DISORDERS Close communication between dentist and hematologist Comprehensive dental plan-good oral hygiene, prophylaxis Mode of anaethesia …. Some form of hemostatic treatment shoukd be considered…… Common therapy (photo).
- 112. PREGNANACY • Pregnancy has been considered an impediment to dental treatment ….. • STAGES OF PREGNANCY 1st Trimester (1-12 weeks) •Fetal organ formation and differentiation. •Most susceptible to adverse effects of teratogens. •Avoid all elective care but provide care as needed.
- 113. •2nd Trimester (13-24 weeks) •Fetal growth and maturation. •Safest period Trimester (13-24 weeks) •Fetal growth and maturation. •Safest period to provide dental care. •3rd Trimester (25-40 weeks) •Fetal growth continues. •Focus of concern is risk to upcoming birth process and safety and comfort of the pregnant woman
- 114. DENTAL CONSIDERATIONS • timing of treatment for pregnant patients • dental radiation exposure • use of local anesthetics • prescription of common antibiotics and analgesics • nitrous oxide gas administration Treatment Timing First Trimester Spontaneous miscarriages… Avoid elective treatment that can be delayed… • Plaque control • Oral hygiene instruction • Scaling, polishing, curettage Offer anticipatory guidance
- 115. Second Trimester The optimal time for dental treatment Organogenesis complete Easier to prevent than treat established disease Plaque control Oral hygiene instruction Scaling, polishing, curettage Routine dental care Third Trimester Late in term very uncomfortable (short visits) Position slightly on left side Plaque control Oral hygiene instruction Scaling, polishing, curettage Routine dental care (after middle of third trimester, elective care should be avoided)
- 116. Risks of Dental X-Rays • X-ray only if necessary (i.e. root canal therapy, trauma) • When x-rays are indicated, radiation exposure is extremely low • Exposure can be limited by: • Lead apron shielding • Modern fast film • Avoiding retakes • Radiographs during Pregnancy Take as needed with optimal methods for reducing secondary radiation and exposure time. Always use a lead apron. Exposure to fetus (with apron use) is .00001 centiGray.(rad) Daily cosmic radiation - .0004 centiGray (rad)
- 117. SUPINE HYPOTENSION SYNDROME (VENA CAVA COMPRESSION) SYMPTOMS: Sweating Nausea Weakness Sense of lack of air Obstruction of inferior vena cava and aorta from pressure of the large fetus MANAGEMENT: Roll patient onto her left side, left lateral position…..
- 118. PHARMACOTHERAPY IN PREGNANCY COMMON ANALGESICS paracetamol (B) Ibuprofen (B/D*) Oxycodone (B/D*) Hydrocodone and codeine (C/D*) *avoid in third trimester Paracetamol is the analgesic of choice for all stages of gestation COMMON ANTIBIOTICS Penicillin (B) Amoxicillin (B) Cephalexin (B) Clindamycin (B Antibiotics to Avoid during Pregnancy Doxycycline Tetracycline Erythromycin (estolate form) Vancomycin
Notes de l'éditeur
- In dental school, dentist are trained in way to assess patient risk and manage medical emergencies. Imp feature in continuing education is to maintain certification in basic life support(BLS) The dentist must ensure that all office personal are trained to assist in the recognition and management of emergencies.
- Lack of response to sensory stimulation establishes a diagnosis of unconsciousness. Assistance should be sought as soon as unconsciousness is recognized.place the patient in supine position and feet raised. While maintainin head tilt-chin lift,rescuer places his ear 1 inch away from the victim’s mouth and nose so that any exhaled air from the victim may be felt and heard.breathing is assessd for at least 5 sec not more than 10 sec
- 4b-mouth to mask ventilation.give 1 breath every 5-6 sec.each breath shud result in visible chest rise.check pulse in 2min. 5a-having delivered o2 to the blood, health care provider must next determine whether that blood Is being circulated or not.carotid.ease of access,it transport blood to brain.if the rescuer is unsure whether or not the victim has a pulse, chest compression should be started. 5b-inform EMS about location, exactly what happened, condition of the victim, 5c-external chest compression consis rhythmic application of pressure over the lower half of the sternum.sternum is compresses 1-2 inch.Acc to 2005 American heart association guideline compression rate should be 100/min.compression to ventilation ratio:30:2 6-defibrillation stuns the myocardium,producing a period of asystole. If the myocardium is till viable, the heart’s normal pacemaker may resume firing producing an effective ECG rhythm that ultimately may produce adequate blood flow.
- As with all allergies,initiation of type 1 response requires exposure to allergen previously seen by immune system. The reexposure to the antigen triggers a cascade of events that are exhibited locally, systemic If allergy is truly in question…referral to physician is necessary
- determined by the binding of IgE antibodies to a high affinity receptor which binds the Fc portion of IgEs with subnanomolar affinity and is located on the membrane of mast cells and basophils. As a result, a significant fraction of the IgE produced following initial contact with antigen, becomes 'fixed' on the surface of these cells and, in case of a second contact with antigen, the antigen-antibody reactions occurs not only in solution but also or predominantly on the mast cell and basophil membrane The IgE-antigen reaction occurring on the surface of basophils and mast cells leads to receptor cross-linking and degranulation, ie release of vasoactive amines (histamine and serotonin)
- There are many spec. causes of chest pain that is non cardiac In origin…bt sudden onset of chest pain is frightening exp.. Recgn.. Of potentially high risk pt…,incorporation of spc treatment modify go far to diminish life tharetening situation.
- Blood lipid levels and CAD. LDL is responsible. However no cut off point below which there is no risk Bt 300mg/ml –risk 42% risk of ischemic stork for every 7mm hg rise in diastolic blood pressure.
- To maintain normal lipid level
- Characteristic thoracic pain usually substernal precipitated by exercise ,heavy meal Relieved by vasodilator drugs,rest
- Exercise, emotion, exposure to cold, eating
- L.A.-0.04mg=1 cartridge.=1.8mL=1:50,000 conc.epinephrine Psychosedation=n20, o2 not less than 27 to 30%
- to a region of myocardium that results in cellular death and necrosis. Ant.descending branch of the left coronary artery
- Acute dental problems like infection pain…managed by prescribing drugs
- Acute MI is a result of sudden occlusion of major coronary vessel. It results from acute thrombosis, hemorrhage,plaque.. Artery most often involved is ant.descending brach of left coronary artery,supplies ant left ventricle. Blood supply leaving the heart diminished..,leading to sign symptoms
- Patient survival after MI..depends on 1-state of left ventricular function 2-severity of obstructive lesion in the coronary vascular bed…
- Aspirin dose=160-325mg orally..least side effect with 160mg
- 50% of patient..allergans may be household dust, feathers,food,drug Environmental and air pollutionOccupational stimuliPsychological factors Most severe clinical form…pt experience wheezing, dyspnea,hypoxia.. If not managed properly pt may die…respiratoty change..hypotension and respitarory acidosis may follow.
- Provoke bronchospasm Bisulfite is present in la with vasopressor, so plain la is advised. B2 adrenergic agonists..epinephrine,albuterol,isoproterenol… If severe bronchospasm is present IV-hydrocortisone sodium succinate 100-200mg
- Ventilation in excess of that required to maintain normal blood Pao2(arterial oxygen tension) and Paco2. Produced by an increase in frequency or depth of respiration or both.
- Decrease In paco2 level…increase in blood ph-7.55-respiratory alkalosis.
- Foreign body removal
- Acute adrenal insufficiency Acute allergic reaction Cerebrovascular accident Hyperventilation-rare
- 1-Dilatation of peripheral arterioles Failure of normal peripheral vasoconstrictor system Sharp drop in cardiac output Occlusion of the internal carotid of the brain 2-resuscitation of the unconscious pt focuses primarily on relief of obstruction. Brain accounts 2%total body mass,20%total o2, 65%total glucose the body consumes.redding et al noted complete aireway obstruction,victim become anoxic,leads to irrv neurologic change within 4-6 min and to cardiac arrest within 5-10 min. 3-hyperventilation,hypoglycemia
- Pt is In upright position it wil take 30sec to reach the pt into syncope stage.
- If patient does not undergo clinical recovery in 15-20 min,causes other than syncope should be considered.
- Bt it will take few hours
- Following management of presyncope, attempts should be made to determine the cause of the episode while the pt recovers.
- Psychotherapeutics,opiods,drugs used to manage fear and anxiety can cause postural hypotension…midazolam,meperidine Pt in upright for longer period. Two forms..1st in 1st trimester= 2nd in 3rd trimester= woman remains in supine post for more than 5-7 min
- For each 1 inch that the head is situated below the level of the heart, blood pressure increases by 2mm hg.
- Symptoms during which the consciousness is preserved. Grand mal seizure is also called as tonic clonic seizure. 90% of the patient….produced by neurologic dis..meningitis..encephalitis..hardly 5 min. Petit mal seizure incidence is rare aft age of 30 years.pt may experience multiple daily episode..duration rarely exceeds 10 sec… Status epilepticus..seizure that continuous more than 5 min..most common factor is failure of taking anti epileptic drug.
- 1-Hypoxia during delivery, trauma,2-hypocalcemia,hypoglycemia..vascular disease importance in causing seizure is it increase with age..aft 60 yr Any dis that cause impairs th blood flow that can provoke a seizure.
- Tonic clonic seizure
- L.A.when properly used.. As with all medications toxicity reactions occur if L.A. is given in amount that exceed its serum concentration. 2-avoid IV inj.
- Skin- pruritus, mycosis Mouth- gingivitis, perio dis.. Pregnancy- congenital defects, miscarriages
- Management of hyperglycemia-unconscious patient.
- Proper functioning of thyroid gland is vital for normal growth.
- Inherited enzymatic defect,
- Adrenocortical suppression should be suspected if a patient has received glucocorticosteriod therapy through two of the following methods
- 100 mg hydrocortisone sodium succinate …re administered every after 6-8 hrs.
- Drug history-use of medication like blood thinner=coumadin.,aspirin,NSAID and antibiotics….pt asked to stop this drug for 3 days
- Regional anaestheisa wirh inferior alv n. block can cause greater risk of hemorrhage compared woth infiltratiojn Use of fibrin sealants, NSAID should be avoided.
- However, preventive, emergency, and routine dental procedures are all suitable during various phases of a pregnancy, with some treatment modifications and initial planning
- Place a small pillow under right hip - left lateral displacement Head above feet