CRASH COURSE IN DENTAL MANAGEMENT OF THE MEDICALLY COMPROMISED PATIENT

CRASH COURSE IN DENTAL MANAGEMENT OF THE MEDICALLY COMPROMISED PATIENT. what causes orthostatic hypotension ? long sitting or laying down , blood pools in the lower extremities → poor venous return to the heart [ because of poor muscle contraction] Q: why do pts on beta blockers get orthostatic hypotension ? because B blockers will dilate the blood vessels to reduce the blood pressure → decreased VR to the heart Both vasovagal syncope and orthostatic hypotension will have quick recovery So your management to any pt that loses consciousness is first to adjust their position to supine or Trendelenburg → if they recover quickly [ vasovagal attack or orthostatic hypotension ] but if they don’t recover quickly → check blood glucose [ might be hypoglycemia] EMERGENCY SINGS AND SYMPTOMS MANAGEMENT HYPOGLYCEMIA Sweating Dizziness Increased HR Pulse is pounding and fast Check blood glucose level If the pt is conscious → give any source of oral glucose If the pt is unconscious → Do not give anything by mouth ! Intravenous glucose – dextrose 50% IV OR Glucagon 1mg IM You cannot give epinephrine in the clinic [ only hospital setting] NOTE : PULSE IS POUNDING AND FAST IN HYOGLYCEMIA BUT WEAK AND THREADY IN SYNCOPE EMERGENCY SINGS AND SYMPTOMS MANAGEMENT HYPERGLYCEMIA Confusion and fruit breath Provide only emergency tx and refer to the hospital Crash Course in Dental Management of the Medically Compromised Patient Done By : Sima Habrawi Dentiscope 2020 Edit By : Haif AlQahtani Page 5 of 29 Best area for venipuncture = the dorsum of the hand and wrist – because it is mostly veins and no arteries [ choose straight , soft , elastic veins] do not choose large veins they might be sclerotic Q: pt is unconscious with normal blood glucose and did not recover after position adjustment , what might be the cause? Adrenal crisis EMERGENCY SINGS AND SYMPTOMS MANAGEMENT ADRENAL CRISIS Pale + sweating Nausea and vomiting and abdominal pain ** Thread pulse ** Pt collapses on the dental chair Monitor vital signs + administer O2 IV line to give corticosteroids [ hydrocortisone succinate 100 mg ] Provide advanced resuscitation and transfer to the hospital Q: what causes an adrenal crisis ? if the pt is taking exogeneous source of corticosteroids [ like in medications or some types of herbs] the adrenal cortex will stop producing steroids and will undergo atrophy. In cases of stress [ like in dental procedures] the adrenal cortex cannot produce enough cortisol → pt goes into adrenal crisis Cortisone is produced from → adrenal cortex - Daily production of steroids is 20 mg Adrenal gland insufficiency is either : A. Primary → addisons’s disease [ the adrenal cortex produces enough cortisol for daily need only = 20 mg ] B. Secondary → pt is taking an exogenous source of corticosteroids in the form of medications or herbs EMERGENCY SINGS AND SYMPTOMS MANAGEMENT MYOCARDIAL INFARCTION Pale + sweating Chest pain Irregular pulse BP might be normal or high or low Place pt in upright position Check BP → if the BP is high or normal give Nitroglycerin [ NTG ] or aspirin + O2 Transfer to the hospital Q: what happens if you place a pt having MI in a supine position? More blood will go to the heart and eventually to the lungs through the right side → pulmonary edema and hypoventiliation [ because the alveoli are engorged with blood] Q: why do you need to check the BP before giving NTG? Because NTG is a very potent vasodilator if the BP is already low it will drop it even more. We offer online tutoring, help with assignments and essay writing for all Majors with a guaranteed pass. For assistance Contact Tutor Lucas: