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64 Cards in this Set
- Front
- Back
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why do we ask about previous anesthetics (local, sedation and general) when taking a health history
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To check for adverse reactions:
- Psychogenic reactions (syncope) - Paresthesia - Difficulty with obtaining profound anesthesia |
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what is the only emergency where you would not give oxygen
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hyperventilateion
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this drug is given for the acute relief of an attack or prophylaxis of angina pectoris due to coronary artery disease
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Nitroglycerin (.4 mg tablets or .4-.8mg translingual spray) : relaxes vascular smooth muscle
predominately venous dilation also coronary artery dilation |
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what would you administer to a diabetic who is conscious and is having a hypoglycemic attack
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hyperglycemic agent:
- oral glucose 10-20 g - 1 cup of OJ - can of soda (40+ g) |
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t/f you administer the same protocol for an unconscious or conscious diabetic
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false!
unconscious is given 50% dextrose via IV 50 ml or glucagon 1mg don't give anything by mouth = choking hazard |
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why is aspirin given
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prophylaxis of Myocardial infarction or treatment of acute myocardial infarction: prevents formation of the platelet aggregating substance thromboxane A2
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platelet aggregate inhibitor
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Aspirin: chewable 81 mg
adult 2-4 tablets |
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what would be administered for the treatment of reversible airway obstruction (bronchospasm) secondary to asthma/COPD or allergic reaction
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Bronchodilator albuterol:
stimulates beta-2 receptors which results in relaxation of bronchial smooth muscle |
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how much albuterol is administered during a reversible airway obstruction
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</= 12yrs:
- mild = 2 puffs over 4-6 hrs - severe = 4-8 puffs over 20 mins >12 years - mild: 2 puffs over 4-6 hrs - severe: 4-8 puffs every 20 mins for up to 4 hrs |
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what is given in an anaphylaxis/anaphylactoid reaction
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epinephrine: stimulates alpha and beta adrenergic receptors
-relaxes smooth muscle of bronchial tree and supports CV |
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what adverse reaction may someone have from the administration of epinephrine
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epinephrine can prod. ventricular tachycardia fibrillation
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what is the ratio of epinephrine that you will see in a epipen
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1:1000
adults: 0.3 mg; peds 0.15mg |
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this drug competes with histamine for cell receptor sites on effector cells
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antihistamine: given in uncomplicated allergic reactions and as an anaphylaxis as an adjunct to epinephrine and other standard measures after the acute symtoms have been controlled
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midazolam
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Anticonvulsant: use in the management of seizures 2-5 mg IV or 5-10 mg IM (intramuscular)
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this drug is used to treat syncope
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smelling salts = aromatic ammonia 1 vial respiratory stimulant
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what is the purpose of an AED
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stops an arrhythmia and allows the heart to reestablish an effective rhythm
*** only effective for pulseless arrhythmia's VT/VF(ventricular tachycardia, ventricular fibrillation) |
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what patients are at inc. risk for sudden cardiac arrhythmias SCA
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Peds:
-children who have inherited or have a congenital cardiac cond - acute medical problems that cause inflammation of the heart Adults: - prev. heart attack - coronary artery dz |
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Where do you check the pulse of an unconscious compared to a conscious patient
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conscious: radial pulse
unconscious: carotid pulse - no pulse = begin CPR call for AED * if pulse, monitor blood press. |
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what are the CPR steps
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1. compress 100 times/min to a depth of 2 in
2. no stopping for rescue breaths b/s it interrupts blood flow 3. rescue breaths are still recommended for O2 deprivation related cardiac arrest ( near drowning) |
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how can you prevent an airway obstruction (foreign obj. or unconscious patient with a displaced tongue/pharyngeal soft tiss)
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rubber dam, throat screen or pack, avoid deep levels of sedation
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how do the symptoms differ from a partial airway obstruction (stridor) and a complete obstruction
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stridor:
-gasping for breath - retraction of suprasternal and intercostal spaces complete obstruction: -no breath sounds - patient unable to speak |
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when would you preform a cricothyrotomy
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Pierce the cricothyroid membrane:
in an unconscious airway obstruction patient only when suction, CPR, and ventilation are unsuccessful |
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what are some factors that may trigger an asthma or bronchospasm (spasm and constriction of lower airway)
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Asthma:
- emotional stress - upper respiratory infections - environmental allergens -allergic rxn General anesthesia: - vagal stimulation by mucous, blood -mechanical stimulation -irritating vapors (general anesthesia) |
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how would you prevent an asthma attack
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- No recent URI for asthmatics (>2-3 wks)
- good medical hx: well controlled asthma - don't treat patient's with symptoms ie. wheezing - avoid precipitating triggers |
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A patient is having a asthma attack. WHAT DO YOU DO!!!???
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Position: comfortable
airway/breathing: provide 100% O2 circulation: monitor Drugs: bronchodilator Refractory to bronchodilator therapy: epinephrine: may be due to an allergic reaction |
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what would cause emesis
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aspiration of stomach content into lung tissue
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how would you prevent emesis
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-maintain protective reflexes: pt conscious during NO2
- high vol. suction - empty stomach before sedation: NPO (nothing per oral) for 6-8 hrs, solids or milk clear liquids up to 2 hrs before appointment |
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If you have a patient who has:
- dyspnea/tachypnea (difficulty/rapid breathing) - cyanosis/mottled skin -auscultation of chest (wet lung fields) - elevated temp w/in 12 hrs. what might you suspect |
Emesis of aspiration of vomitus
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You have a patient who as aspirated their stomach contents what do you do!
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Position: trendelenberg = head down, and roll onto right side (confines to right lung
Airway: suction aggressively breathing: administer 100% O2 |
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what causes angina pectoris
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Ischemia of heart muscle: due to insufficient blood supply may have resulted from atherosclerotic plaque, coronary artery vasospasm
Or increased demand Inc. HR or BP |
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what do you do to avoid angina pectoris
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- medical hx
- stress reduction protocol: short appointment, gentile tech, profound anesthesia, sedation - supplemental O2 - preoperative nitroglycerin |
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You have a patient who is complaining of:
- chest pain that is radiating it his left shoulder and arm up to his lower jaw. - he also has a squeezing, burning, pressure, palpitation, that feels like "indigestion" |
angina pectoris
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You have a patient suffering from angina pectoris you put them in a comfortable position, give them 100% O2, and monitor their BP. Have you covered all of your ABC's
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NO
remember MONA M = morphine O = oxygen N = nitroglycerin A = aspirin |
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You have a patient call in to set up an appointement they tell you that they had a MI 4 mos ago can you see this patient
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NO no treatment for 6 mos. post MI
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do you limit vasoconstrictor does in a person who has had MI
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yes avoid 1/50,000 epinephrine
limit 2 cartridges with vasoconstrictor |
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you have a patient who has severe chest pain that is sudden radiating and crushing press. you think that it is ______ so you give nitroglycerine but the pain is not relieved this patient actually is having _______. what else will you give
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1. angina pectoris
2. myocardial infarction - administer: M: morphine O: 100% O2 N: already administered A: 325 mg of aspirin |
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how much epinephrine is given to an adult who is having an allergic/anaphylactic rxn
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0.3mg
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what is given to a cutaneous allergic rxn
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benadryl 50 mg
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why are steroids given in an allergic/anaphylactic rxn
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to prevent recurrence
- hydrocortisone 100mg IV/IM - decadron 8 mg IV?IM |
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when would you transport a seizure victim to the ER
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1. If seizure is > 5min
2. if followed immediately by another seizure 3 If patient is injured |
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what may cause syncope: cessation of blood flow to the brain
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1. cardiac:
-orthostatic: dehydration and hypovolemia, elderly, meds - arrhythmia 2. noncardiac: vasovagal: pain and anxiety 3. hypoglycemia: |
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Your patient appears pale ashe-grey, they are sweaty, nauseated, eyes are dilated, convulsive movements/twitching. what does your patient have
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syncope
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Your patient feels like they are suffocation, tightness in the chest, rapid respiration, giddy light-headedness, paresthesia of hands, feet, perioral, trembling
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hyperventilation
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what are the 4 main areas that we want to determine with the patient assessment
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1. medical hx and ASA classification
2. preoperative vitals 3. medical consultation: if necessary 4. anxiety level assessment ** the major endpoint of medical work up is to determine whether the patient has the physiologic/psychological reserve to undergo the planned treatment with low risk of complication |
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this ASA classification has No dyspnea, undue fatigue or precordial (chest) pain with NORMAL activity
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ASA I
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this ASA classification has MILD DYSPNEA AFTER NORMAL ACTIVITY AND MAY REST AT A TOP OF A FLIGHT OF STAIRS
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ASA II
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this ASA classification has dyspnea during norm. activity and is comfortable at rest in any position. but needs to rest BEFORE reaching top of a flight of stairs
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ASA III
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this ASA classification has dyspnea and orthopnea at rest. The patient will rest several times when climbing stairs
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ASA IV
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at what ASA Classification will the patient not tolerate psychological/procedural stress well
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ASA III
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In which ASA classification will the psychological stress/procedural decompensate the patient.
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ASA IV = emergency care only
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what ASA classification requires a medical consult and which has an advised medical consult
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required: ASA IV
advised: ASA III |
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latex allergy is becoming more freq. what % of health care workers compared to gen pop. has the allergy
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5% of pop. and 15% of healthcare workers
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what will recent consumption of alcohol have on the effect of nitrous oxide
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makes the use of sedation unpredictable. The patietn will be more sensitive to the effects of nitrous oxide and will inc. the likelihood of rendering the patient unconscious
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What should you do with a patient that has used recreational drugs in the last 48 hrs
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deny care
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What head/ear/eyes/nose/throat disorders are contraindicated for nitrous
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1. glaucoma: will inc. the press in the eye
2. middle ear disturbances: like ear infections or recent surgery. these contraindicate nitrous b/c nitrous gas diffuses into the closed spaces resulting in inc. press in middle ear = headaches, rupture of tympanic memb., hearing loss as well as surgical graft displacement 3. upper respiratory infections: due to congested nasal passage will impair the uptake of nitrous and possible cross contamination |
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which respiratory disorders are contraindicated for nitrous
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COPD: avoid nitrous oxide/oxygen sedation for severe COPD patients, however it is ok for early stage of dz.
Why? in COPD there are chronically elevated levels of CO2 thus the primary stimulus is dec. levels of O2. high levels of O2 may depress the drive for respiration. So the O2 flow level should be kept at 4L/min or less to maintain hypoxic drive |
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why is nitrous oxide indicated for in asthma
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asthma is exacerbated by stress; therefore alleviation of the stress response by nitrous oxide sedation is advantageous. also admin. of supplemental O2 is beneficial for these patients
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what BP must you have to be treated at the school of dentistry
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<180/110 provided that this patient does not have a co-diagnosis of cardiac and cerebrovascular dz and is asymptomatic
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T/F all cardiovascular dz call for minimization of vasoconstrictors (2 cartrides of 1:100,000 epinephrine
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true
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why are nitrous oxide administration indicated for patients with various cardiovascular dz's
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1. oxygen is concurrently being administered with nitrous oxide which inc. the supply of O2.
2. nitrous oxide reduces the workload on the heart (dec. anxiety) which results in less oxygen demand as a result of a lowered stress response |
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how long must you wait to treat a patient that has had a stroke (cerebrovascular accident)
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no elective dental care for 6 months
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why is N2O a good option for someone with kidney disease
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The problem of delayed drug elimination is a concern in these patients. nitrous oxide is eliminated almost entirely through the lungs, therefore making nitrous an attractive sedation option for the patient presenting with kidney dz.
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diabetes affects multiple organ systems. How can nitrous be a good alternative to ea. organ system
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diabetes affects teh heart, vasculature and the kidney (coronary artery peripheral vascular dz, and kidney failure) N2O is indicated :
1. oxygen! raises the inspired conc. of O2 2. nitrous reduces stress and anxiety which lowers the O2 demand 3. patients with end stage renal dz nitrous will not affect the kidneys |
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what GI disorder is Nitrous contraindicated
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bowel obstruction: N2O will diffuse into closed spaces and expand air pockets in the intestines which result in inc. press (pain)
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