Download Cathie Collier, RDH, MS First Aid CPR Instructor AHA Team

Cathie Collier, RDH, MS
First Aid CPR Instructor AHA
Team Preparation…
It is essential that each team members know the role during a medical emergency
Practice Medical Emergency Drills
Time how long it takes to recognize situation, find equipment and activate 911
Know your strengths and limitations
In office CPR/AED Training
Review CPR skills
Know location and proper use of emergency equipment and first aid supplies
Check expiration dates and working condition of emergency supplies
Call 911 …The sooner the better… REMEMBER… patient can be in denial
When the doctor feels it is warranted
If the diagnosis of the problem remains unknown
The diagnosis IS known but is disturbing
Exact location of building with cross streets, landmarks, name of building, and room number
The telephone number from which the call is being made
The caller’s name and office name
What happened and How many people are involved
The condition of the victim and type of care being given
The caller should stay on the line until further instructed while another person waits for them
outside, if possible.
They will want to know blood pressure and medications
Patient preparation…
Ask patient to bring in list of current medications, OTC, herbal or otherwise
Review what they are taking, why they are taking it, who told them to take it?
Ask for name of current physician and specialist
Medical Histories.. Can we push them to the next level?
Are they really in good health???
Begins when the patient enters the office
Clinical observation, note any changes for “normal”
How often should you review the medical history with your patient?
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How do you review a patient’s medical history?
Long or short form
Documentation of changes
Discuss with patient how their medical condition or medications interacts with their dental
health or dental treatment
Review currents medications and how they can interact with local anesthesia
Always review a child’s medical history with the proper person
Top 5 Therapeutic Drugs
Respiratory – asthma and allergies
Cardiovascular - dyslipidemia, coagulation, and hypertension
Pain - including neuropathic
Gastrointestinal - Ulcers, GERD
Specialty Medications for mental health and sensory issues
Better living through chemistry…
Drug abuse is a major epidemic
½ of Americans use 1 or more prescriptions
1of 5 children uses prescription drugs
9 out of 10 adults 60+ years old
1 person dies every 24 minutes from misuse of drugs
Consequence of medications on overall health…
Over prescribed or unnecessary drugs
Wrong drug for condition
Dosage is too low – not getting therapeutic effects
Dosage is too high – causing detrimental effects
Adverse reactions or drug on drug reactions
Inappropriate compliance
Most Commonly Used Medications…
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Children
Adolescence
Middle Aged
Elderly
All Ages
Asthma medications
Central nervous system
Anti-depressants
Blood pressure and cholesterol medications
Diabetic medications
Blood Pressure
Category
Systolic
Diastolic
Normal
<120
<80
Prehypertension 120-139/80-89
Hypertension
Stage 1 (mild) 140-159
90-99
Stage 2 (moderate) 160-179 100-109
Stage 3 (severe) >180
>110
The Goal Is To Keep the Patient Alive
Stay within your scope of practice
The Good Samaritan Laws
Provide basic minimal quality care
The patient should not suffer as a result of your care
Assure the victim you are doing everything possible
Over All Assessment
S = signs you observe
A = allergies
M = medications current medications
P = Pertinent past medical history
L = Last food or drink intake
E = Events
Note levels of consciousness - AVPU
Alert – oriented to time and place
Verbal - responds to verbal stimuli/ not oriented
Painful – responds to pain
Unresponsive - eyes closed /no movement or respond to stimuli.
The ABC’s
Keep patient in a comfortable position and monitor vitals
Airway
Breathing
Circulation
Definitive diagnosis and treatment
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Dental Office Emergencies
1. Syncope - The most frequent dental emergency
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Do not slap, shake, or throw water on the victim
Position patient and maintain airway, Monitor Vitals
Do not give anything to drink
Move victim only if necessary
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Low Blood Pressure or Shock may occur as a result of blood loss it is the 4th highest dental office
emergency Determine perfusion level by applying pressure to nail beds or oral mucosa. Perfusion is
normal if color returns within 3 seconds.
3. Epilepsy
Idiopathic Epilepsy
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Family history
Appears during childhood (5-8yrs.Old) or adolescence
No brain or CNS abnormalities
Seizures tend to occur during sleep
Symptomatic Epilepsy
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Injury to brain during birth is the most common cause of symptomatic generalized epilepsy.
Head trauma – 1 seizure does not make you an epileptic
Space occupying lesions
Infectious diseases - bacterial meningitis / herpetic encephalitis
Fibril seizures
Degenerative diseases (e.g. Alzheimer's disease):
Get the Facts
 What type of seizure do you have?
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What is you aura? (tonic – clonic)
What anticonvulsant medications do you take?
How controlled are your seizures?
Types of Seizures
Myoclonic -sudden and very short duration jerking of the extremities
Absence - staring spells
Generalized tonic-colonic - grand mal seizures
Atonic – without tone, patient just drops, 15 seconds duration
Tonic – muscle tone stiffens, usually during sleep, 20 seconds duration.
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What to do:
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Stop procedure
Clear all instruments from patient mouth and area
Protect the patient’s head from injury
Place the dental chair in a supported supine position
Lower chair close to the floor
Loosen restrictive clothing
Place the patient on side to reduce chance of aspiration
Do not restrain the patient or put your fingers in their mouth
Time the seizure
Call 911 if the seizure lasts longer than 3 minutes or multiple seizures.
Call 911 if the patient becomes cyanotic from the onset.
Administer oxygen at a rate of 6–8 L/minute.
Be aware of the possibility of compromised airway or uncontrollable seizure.
Talk to patient to evaluate the level of consciousness
Do not allow the patient to leave the office until level of awareness is fully restored
Contact the responsible person to escort patient
Perform oral examination for sustained injuries
Contact family physician or send to an emergency room for further assessment.
4. Asthma is a series of contractions of the smooth muscles surrounding the bronchial tubes constricting
the opening of the airway. People with asthma have chronic airway inflammation and excessive airway
sensitivity to various triggers
Know Trigger Points:
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Tobacco or wood smoke
Breathing polluted air
Respiratory irritants such as perfumes or cleaning products, work related chemicals
Substances such as molds, dust, or animal dander
An upper respiratory infection, such as a cold, flu, sinusitis, or bronchitis
Exposure to cold, dry weather
Emotional excitement or stress
Physical exertion or exercise
Reflux of stomach acid
Sulfites, an additive to some foods and wine
Irritating Chemicals in the Dental Office
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Disinfectants
Bleach
Phenols/ alcohols/ gluts.
Impression materials
Developer/ Fixer
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Adhesives
Asthma Inhalers
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Asthma medications are inhaled to work directly on the inner wall of airways
A bronchodilator opens airways providing quick relief
A corticosteroid inhaler is an anti-inflammatory medicine. Stops underlying inflammation of asthma
Immediate Care for Asthma
 Move the victim from the source
 Keep victim calm and sit in upright position.
 Administered rescue inhaler. Assist victim if this is first time use of inhaler.
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Always use a rescue inhaler that is prescribed to the victim and not of someone else.
Repeat every 10-15 minutes
Steam can be good alternative if inhaler is not available
HYPERVENTILATION
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Signs and symptoms include:
Fast, shallow breathing
Feeling of tingling in the limbs
Dizziness or Cramps
Treatment of Hyperventilation
Move uninjured victim to quiet location
Reassure the victim and remain calm
Encourage the victim to regain control of her breathing
Let victim inhale their own breath to restores the balance of oxygen and carbon dioxide in the blood.
Call a doctor or ambulance if symptoms do not disappear.
5. Allergic Reactions
EpiPen comes in two different doses:
EpiPen 0.3 mg (over approx.66 lbs.)
EpiPen Jr. 0.15 mg (under approx 66 lbs.)
Epinephrine
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Constricts blood vessels
Stimulates Heart Rate
Relaxes smooth muscles in lungs to improve breathing
Reverse hives and swelling
If symptoms persist after first does call 911
Caution When Handling
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Solution should be clear and colorless
Accidental injection into the hands or feet may result in loss of blood flow to affected area. Require
immediate treatment in the ER
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After use place in an impermeable container and give to EMS personnel to take to the ER.
Buys You 15 Minutes…
Document the time of administration
Notify patient’s physician, parent or guardian regarding incident and where patient is being transported.
6. Diabetic Event
Diabetes is a group of related diseases in which blood sugar levels are not regulated.
The body is not producing enough insulin or the body is not utilizing the insulin well.
Regardless of classification Hypoglycemia occurs more often in the dental office
Patient should know their A1C levels
How are they treating condition?
Consider when and how to schedule and treat patient
Care for the Conscious Patient
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Determine last food intake
Did patient take prescribed medications
Liquid sugar is better, enters the stomach quickly glucose cannot diffuse through the mucosa
For severe episodes give a viscous concentrate
Nothing by mouth once unconscious
7. Angina
Nitroglycerin Tablets
One tablet to dissolve sublingual or in buccal pouch and call 911
Nitro-lingual Spray
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Recommended for the dental office rather than sublingual tablets
Use special dose-measuring application papers.
The usual dose is 1/2 to 2 inches applied every 4-6 hours.
The appropriate amount is squeezed as a thin layer onto the paper, spread onto a non-hairy area of the
skin.
Transdermal Patches
 The usual dose is 0.2-0.8 mg/hr.
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Applied for 12 hours then 12 hours off to reduce tolerance
Patches may be applied to any hairless site
Do not be apply to areas with cuts or calluses this can alter absorption
Firm pressure should be used over the patch to ensure contact with the skin.
The patch should not be cut or trimmed.
Patches are waterproof and should not be affected by showering or bathing
How to Store Nitroglycerin
All formulations should be kept at room temperature, 15-30 C (59-86 F).
The sublingual tablets are especially susceptible to moisture
Care should be taken to replace the sublingual tablets every six months
Guidelines for First Aid Kits
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Design your own kit. More familiar with the contents
Emergency kit should be individualized to meet the needs and capabilities of each clinician
The items selected are based on your level and scope of training
Medications do not need to be complicated
Kits must be safe and effective in your hands
No one kit can be recommended or approved by the Council on Dental Therapeutics
Purchase drugs that you are fully capable and trained to administer
Drugs and equipment should be properly stored, dispensed and disposed of as needed.
Consider the dosage recommended for the adult, child and geriatric patients.
Be familiar with the indications, contraindications, adverse effects and expatriation dates.
Most drugs are not necessary. Exceptions are acute bronchospasm (asthma) and angina pain in both
cases the patient will be able to diagnose the problem and self- medicate,