Oral Surgery Competency

Front 1

__% of life threatening situations are preventable and are due to: (4 things)

Back 1

90%
Inadequate preoperative eval
Lack of understanding of pharm. agents
Inadequte monitoring
**Failure to recognize or act on signs of complicaitons

Front 2

Name 2 injectible drugs you should have on hand for emergencies

Back 2

Epinephrine (epi pen)
Diphenhyramine (Benadryl)

Front 3

Name 5 non-injectible drugs you should have on hand for emergencies

Back 3

Oxygen
Albuterol
Glucose
Nitro
Aspirin (325 mg)

Front 4

Name one big issue with nitro tabs

Back 4

Expire (short self life) 90 days after opening

Front 5

Name the form on Nitro used at Creighton, how its used and it's advantage

Back 5

Nitrolingual spray
Sprayed ON tongue not under (3 pumps in 10 minute period)
1 pump=1 nitro tab
Long shelf five

Front 6

BLS begins with 5 steps-name them

Back 6

P-position patient
A-airway
B-Breathing
C-Circulation
D-diagnosis

Front 7

Postioning pt
Conscious- __
Unconscious-___

Back 7

Concious-where pt most comfortable
Unconcious-supine with legs elevated..why? get blood to brain

Front 8

Why do you never leave an unconsoius pt in a sitting position in a dental chair?

Back 8

Can lead to hypotension/hypofusion=death

Front 9

T/F When checking for breathing, chest movment is a good indicator that the pt is breathing

Back 9

False-can be paradoxical movment/rocking-this is why you also need to feel and hear it

Front 10

T/F if a pt is consious and talking than it is safe to assume ABC's ok

Back 10

True

Front 11

Name 2 situations in diagnosis that you would call 911

Back 11

If can't diagnose
If don't like diagnosis

Front 12

It is your legal obligaiton ot keep pt alive until __ or ___

Back 12

Pt recovers or someone arrives who is better trained than you and takes over

Front 13

Name 2 emergencies most likely to occur after local injection

Back 13

Syncope (60%)
Hyperventilation (7%)

Front 14

Name 3 common times for a syncope reaction

Back 14

Sitting upright (starting IV, injection or after injection)
Standing too long
After LONG appt (orthostatic hypotension)

Front 15

Symptoms of Syncope

Back 15

Pallor
Diaphoretic (sweating)
"fidgety"
Doesn't feel well, or dizzy

Front 16

TMT of syncope: List the steps

Back 16

Begin tmt when presyncope noted (terminate dental tmt)
Place in Trendelburg position
Oxygen
Maintain airway
Monitor and record vital signs
Cold compress
Reassurance

Front 17

If Syncope goes unnoticed __ will occur

Back 17

Pt will go unconcious and eventually go into tonic/clonic convulsion (Because of lack of O2 to brain)

Front 18

What special accomodation/change in treament do you make for a woman in her 3rd trimester of Syncope and why?

Back 18

Placed in left lateral position- prevents compression of the vena cava by the uterus/fetus-restores venous return to heart

Front 19

Hyperventilation is most common in __ of __ years of age-rare in children

Back 19

Women ages 15-40

Front 20

Hyperventillation leads to decreased __(hypocapnea) which leads to respiratory __ -causes increased binding of __ so __ result

Back 20

PaCO2
respiratory alkalosis-increased binding of Ca+ and hypocalcemic muscle spasms or tetany results

Front 21

Hyperventilation results in hyper__ and hypo__

Back 21

hyperapnea
hypocapnea

Front 22

Tmt for hyperventillation

Back 22

Rebreathe CO2 or coach pt to control breathing

Front 23

X-rays necessary when an object is either swallowed or aspirated

Back 23

3 are necessary:Chest-both PA and lateral
Abdomen-KUB (kidney, ureter, bladder)

Front 24

2 possible tmt when pt apsirates object

Back 24

1) rigid or flex bronchoscopy
2)open chest

Front 25

Hypoglycemia-list questions to ask your diabetic pt b/4 beginning tmt

Back 25

Did you take your medicine/insulin?
Did you eat?
Did you do a finger stick? What was the reading?
Do you know when your blood sugar is getting low?

Front 26

What is a normal blood sugar (diabetic goal)

Back 26

80-140 mg/dl

Front 27

Symptoms of Hypoglycemia

Back 27

Sweating
Tachycardia
Feeling faint
Nervous/jittery
Mental confusion
Loss of consciousness

Front 28

Blood sugar under __ leads to confusion tremor, diaphoresis, tachycardia

Back 28

<75

Front 29

Blood sugar under __=unconsiousness

Back 29

40

Front 30

Managment of hypoglycemic pt

Back 30

Position conscious pt comfortably
Glucometer
Administer glucose PO
Start IV (prn) if not already established

Front 31

Managment of unconsious diabetic pt-

Back 31

1) Call 911 2) Start IV: Glucagon (.5-1 mg IV/IM/SQ) or Dextrose administer 1 ampule of D50 IV (50% dextrose) or Glucagon IM

Front 32

Angina is usually precipitated by __ __ or __ and is relieved by __ or__

Back 32

exercise emotion heavy meal
rest and/or vasodialation

Front 33

Angina is the result of ___

Back 33

decreased blood flow to the myocardium

Front 34

Signs/symptoms of angina

Back 34

"Balled" fist to chest
Squeezing, choking, burning pain, or numbness usually not increased w/ respiration
Radiation (may be present but more common w/ MI)

Front 35

__-frequency severity location and precipitating events of pain remain relativly constant-predicibly relieved by rest

Back 35

Stable Angina

Front 36

__- any increase in frequency severity of angina symptoms or chagne in location or type of pain, angina at rest

Back 36

Unstable angina

Front 37

Managment of Angina Pectoris

Back 37

1) Position pt (where they are comfortable)
2)Adminster O2
3) sublingual Nitro or 1 pump spray on tongue
4)If no relief after 3 doses then assume MI and treat (Acivate EMS)

Front 38

What is the dosing instrutions and dose for administering Nitro

Back 38

.3 mg every 5 minutes
(start at time 0 administer 1 dose then another at 5 in an the last at 10 minutes)

Front 39

Angina vs MI: Think MI when (6 reasons)

Back 39

Radiate anywhere
First episode pt has experienced
No relief after 3rd nitro dose
Relief w/ nitro but pain returns
Low Systolic BP (angina= inc SBP)
Feeling of "impending doom"

Front 40

Managment of Acute MI

Back 40

1) Position pt
2) Call 911/EMS
3)Vital signs
4) MONA
5)REcord chronology of tmt (time doese etc)

Front 41

What does MONA starnd for

Back 41

M-morphine (or 50% nitrous)
O-oxygen
N-Nitroglycerin
A-Aspirin (NO substitue)

Front 42

What is the dose and dosage instructions for the morphine and aspirin used in MONA

Back 42

Morphine- 1-3mg IV every 5 ming prn (or 35-50% nitrous)
Aspring-325 mg chew and swallow (NOT 81 mg)

Front 43

What are the contraindications of MONA (3)

Back 43

Hypotension for morphine and Nitro (SBP under 90)
Nitro contraindicated if pt has recently taken ED meds w/i last 24 hours (b/c unsafe drop in BP)
ASA: allergy or bleeding disorder

Front 44

What do you do if pt is going into Cardiac Arrest

Back 44

BLS (basic life support)
Get AED/Call 911

Front 45

CVA symptoms

Back 45

All are sudden:
Abrupt severe headache
Altered mental status
Blurring of vision or loss of sight
Speech difficulty
Weakness on one side of face
Paralysis on one side of face
Dizziness

Front 46

What does FAST stand for when treating a CVA pt

Back 46

F-face-ask person to smile
A-arms-ask person to raise arms
S-speech ask pt to repeat a simple sentence
T-time-if showing any of these symptoms time is important
CALL 911or get to the hospital fast

Front 47

Allergic reactions developing w.i __ hours are the most serious

Back 47

1 hour

Front 48

The key to dealing w/ allergic reactions is ___

Back 48

PREVENTION-take careful medical Hx and ask specifically about any medications planned for that day

Front 49

Type 1 allergic reactions aka __ is mediated by __ which is bound to __ and __ cells, when antigen binds causes degranulation and relsease of __ __ and __; reaction takes ___ (amount of time)

Back 49

Immediate hypersensitivity (Anaphalactic)
IgE bound to basophils and mast cells
Minutes to 1 hour-peak at 30 mintues
Release histamine, leukotrienes, cytokines

Front 50

Give examples of localized anaphylaxis

Back 50

Urticaria, angioedema, hay fever, atopic asthma instrinsic)

Front 51

List sites where generalized anaphylaxis affects

Back 51

skin, repiratory, GI, cardiovascular

Front 52

Type II hypersensitivity aka __ mediated by __
examples

Back 52

Cytotoxic/delayed
IgG/IgM
Hemolytic anemaia, leukopenia

Front 53

Type III hypersensitivity aka __
Examples

Back 53

Immune-complex
Lupus, erythema multiforme

Front 54

Give examples of localized anaphylaxis

Back 54

Urticaria, angioedema, hay fever, atopic asthma instrinsic)

Front 55

List sites where generalized anaphylaxis affects

Back 55

skin, repiratory, GI, cardiovascular

Front 56

Type II hypersensitivity aka __ mediated by __
examples

Back 56

Cytotoxic/delayed
IgG/IgM
Hemolytic anemaia, leukopenia

Front 57

Type III hypersensitivity aka __
Examples

Back 57

Immune-complex
Lupus, erythema multiforme

Front 58

Cocaine affects the cardiovascular system 2 ways __ and __
Affects respiratory system by causing __ __ and __

Back 58

Vasoconstrictor (is a LA but all others vasodilate)
Sympathetic tone secondary w/ catcholaime uptake (block re-uptake of NE-will lead to HTN, MI, cVA, Vfib)
Respiratory-cough, irritability, pulm. edema

Front 59

T/F Because cocaine has cardiac side effects it is only safe to used the cardic dose of epi

Back 59

False- local anesthetics w/ a vasoconstrictor is an ABSOLUTE CONTRAINDICATION (if pt used cocaine w/in 2 hours of appt)

Front 60

__ drug sometimes used for sedation will cause withdrawl in coke users

Back 60

Nubain

Front 61

Effects of Meth
CNS- __ __
Cardiovascular: __

Back 61

CNS: addiction, neurotoxic
Cardio: Inc BP, HR, angina, CVA

Front 62

What 2 side effects will occur if epi is used on a pt who took cocaine just before coming into the office

Back 62

Caridac arrhythmias and hypertension

Front 63

Prolonged use of Marijuana will cause chronic __ and smoking w/i 8 hours decreases __; has __ effects w/ sedtive/hypnotic drugs

Back 63

Airway inflammation
Psychomotor function
Synergistic

Front 64

Managment of Epileptic Seizures

Back 64

1. Protect patient (gentle but effective restrain)
2. Suporty airway
3. Administer O2

Front 65

If a seizure persists longer than 5 minutes what should you do

Back 65

Call EMT
Administer IV versed or valium

Front 66

__ is decribed as tonic/clonic muscular activity due to disorganized electrical brain activity ex. are

Back 66

Seizures
Epileptic seizures, toxic seizures, Metabloic seizures

Front 67

Managment of a bronchospasm:

Back 67

1. Position upright (where comfortable)
2. Administer inhaler (bronchodilators)
3. Administer O2
4. Epi .3mg Sq, IM or IV prn
5. Call 911 if no response

Front 68

What questions should you ask and asthmatic

Back 68

How frequently do you use your inhaler?
Do you have it with you?
Ever needed to go to the hospital for breathing tmts?
?Prophlactic dose b/4 start of appt?

Front 69

Management of Generalized Anaphylaxis:

Back 69

1. BLS using PABC's
2/ Call 911
3. Epi .3 mg (child .15 mg) IV, IM or FOM
4. 100% O2
5. IV-rapid infusion of 1L of fluids
6. When stable 50 mg benadryl IV, consider systemic steroids

Front 70

What is the does of epi used in emergency situations for and adult? Child?
What is the dose of benydryl

Back 70

.3 mg
CHild .15 mg
50 mg

Front 71

T/F is NEVER ok to give a person using cocaine epi-even when they are having an anaphylactic reaction

Back 71

False-there is NO contraindicaitons to use of epi in anaphylaxis

Front 72

Symptoms that may indicate a moderate to severe allergic reaction:

Back 72

Swelling of face, eyes, tongue, difficulty swallowing, wheezing, chest discomfort, difficulty breathing, fear, abdomial cramps, N/V, weakness, dizziness, unconsiousness

Front 73

Severe generalized anaphylaxis deveops in __ amt of time
Symptoms Skin:
Lungs:
GI:
Heart:

Back 73

Seconds to 1 hour-peak at 30 min
Skin: pruitis, urticaria, angioedema
Lung: wheezing, cough, dyspnea, tightness, wet rales
GI: N/V, cramps
Heart: hypotension, arrhythmias, shock, LOC, cardiac arrest

Front 74

__ is one reaction that you have to treat-can't just wait for EMT's

Back 74

Severe anaphylactic Rxn

Front 75

___-conditon marked by development of edematous areas of skin, mucous membranes or internal organs; is usually benign unless affects __

Back 75

Angioedema
Mouth, larynx or pharynx

Front 76

TMT for Angioedema

Back 76

Antihistamines are first followed by Epi if swelling of upper airways

Front 77

Managment of mild localized reactions:
Symptoms: __
TMT:__

Back 77

Symptoms: pruitis, localized urticaria, erythema, nasal congestion, watery/red eyes
TMT: None or Benadryl 50 mg every 6 hours for 2 days and remove suspected allergen

Front 78

Management of moderate generalized allergic reactions:
Develops in __ amt of time and Symptoms:
TMT:

Back 78

Minutes to hours
Symptoms: generalized pruitis, urticaria, Inc BP, HR, NO respiratory symptoms
TMT: Benadryl 50 mg IM then 50 mg orally every 6 hours for 2-3 days

Front 79

Urticaria is caused by __ and __ of capillaries of skin as a result of __ release of vasoactive mediators
TMT:

Back 79

Vasodilation and increased permeability
mast cells
TMT: Drugs that block histamine (H1) receptors

Front 80

Urticaria is like angioedema except angio edema __

Back 80

causes edema in deeper regions of the skin and subcutaneous tissue