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Pressure Points
- Temporal
- Carotid
- Axillary
- Brachial
- Radial
- Ulnar
- Femoral
- Popiteal
- Dorsalsis Pedis
- Tibialsis Posterior
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Arterial Bleeding
Bright red, spurts
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Venous Bleeding
Dark red, steady flow
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Internal Bleeding
- May be a bruise--> serious internal bleeding
- May cause : Shock, heart failure, lung failure
- S&S: bruised, swollen, tender abdomen; blood in vomit; rectal or vaginal bleeding
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Treatment of Internal Bleeding
- Apply cold pack: < swelling & slows bleeding
- For Serious Internal Bleeding:
- 911
- ABC’s
- Reassure & keep the victim still
- Look for/ care for symptoms of shock
- Loosen tight clothing
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Nose Bleed: Epistaxis (Treatment)
- Pinch soft part of nose below the end of the bone between thumb and forefinger
- Lean head slightly forward; breath through mouth. Alternative: leave head in neutral position
- Assess blood flow; if minor, icepack at bridge of nose
- If fast bleeding continues, call 911
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Signs and Symptoms of Infection
- Pain, tenderness
- Redness
- Heat
- Swelling / Swollen glands
- Pus/ exudate
- Red streaks à Septicemia
- Illness
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Shock
- A form of acute failure of blood circulation
- A life threatening condition with a variety of possible causes: most commonly the reaction of the body to the failure of the cardiovascular system to provide an adequate supply of blood to all vital parts of the body.
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Hypovolemic Shock
Caused by loss of blood or other body fluids, like serious bleeding or dehydration.
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Compensatory Stage
Hemorrhage
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Progressive Stage
Hypovolemic shock
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Refactory Stage
- Shock (Irreversible)
- Patient does not survive
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Neurogenic Shock
Caused by the failure of the nervous system to control the diameter of the blood vessels. ( often seen with brain and spinal cord injuries. No actual blood loss)
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Cardiogenic Shock
- May be caused by myocardial infarction, cardiac arrhythmias or other cardiac dysfunction
- Blood pressure will be lower than normal
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Anaphaltic Shock
- A life threatening reaction of the body to a substance to which the patient is extremely allergic.
- Treatment:
- Epinephrine: 0.01 cc/kg in the tum.
- Susphrine: Half of that, in the fat: 0.005 cc/kg
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Septic Shock
- Caused by severe infections.
- Toxins are released into the blood stream which cause the blood vessels to dilate.
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First Aid: Shock
- Position
- Back, elevate legs if no neck or head injury
- If head or neck injury: lie flat on back while waiting for EMS. Do not move.
- If vomiting- roll to side
- If dyspnea- semi- recline
- Maintain Body temperature
- Call 911
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Pupils
- Dilated: Both pupils: Shock, bleeding, exhaustion, drugs (cocaine, amphetamines)
- Constricted: both; Heat stroke, drugs(narcotics)
- Unequal: Head injury, stroke
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Partial Airway Obstruction
- Coughing
- Cyanosis
- Hands to throat
- Wheezing
- Dyspnea
- Anxiety
- Fear
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Tx of Partial Obstruction
- Position patient
- Encourage coughing
- If pt stops coughing & cannot speak, treat for total airway obstruction.
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Complete Airway Obstruction
- Distress
- Cyanosis
- Unable to speak, cough, breathe
- Loss of consciousness
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Tx of Complete Airway Obstruction
- For the conscious patient
- Heimlich maneuver until object is dispelled or consciousness lost
- Behind, leg between pt’s legs;
- thumb side of fist above
- pt’s navel &
- well below sternum.
- Quick upward thrust
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Loss of Consciousness from Airway Obstruction
- Step One
- Position the choking person on his or her back; if you suspect a spinal injury, be extremely careful not to move or twist the head, neck or spine. If several rescuers are present, use their assistance to minimize this danger .
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Unconsciousness (step 2 & 3)
- Step 2
- Kneel down, straddling the choking person's legs and facing the choking person's abdomen.
- Step 3
- Place the heel of one
- Hand just above
- The navel
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Unconsciousness (step 4-6)
- Step Four
- Place the other hand over the first hand, interlacing the fingers of the two hands.
- Step Five
- Straighten your arms.
- Step Six
- Thrust inward and upward, using a quick motion. Give up to five thrusts in rapid succession.
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Unconsciousness (step 8-9)
- Step Eight
- Tilt the head and give two slow breaths. If the breaths won't go in, re-tilt the head and give two more breaths.
- Step Nine
- Repeat the cycle of thrusts, mouth sweep, head tilt, breaths, head re-tilt and breaths until breaths go in, or until the person begins breathing on his or her own.
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Airway Aspiration
- Dyspnea
- Hoarseness
- Wheezing
- Coughing
- Cyanosis
- Excessive sputum production
- Possible suffication
- S & S Depend on location in airway.
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Major Drugs Commonly Employed In Dentistry
- Local Anesthetics: The most widely used drug in dentistry!
- –Prevention & management of pain
- Analgesics: Pain relieving
- –Mild- nonopiod
- –Strong- opioid e.g.codeine, Demerol, Vicodin, oxycodone
- Antibiotics: to prevent infection; to treat infection
- Antianxiety
- –Barbituates
- –Nonbarbituates
- –Inhalation
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Antianxiety Drugs
- Routes: IV, IM, Oral, Inhalation
- Barbituates: Rarely used, Hang over effect
- Nonbarbituates: Benzodiazepines e.g.diazepam
- –Lower incidence of Side Effects or OD
- Inhalation: N2O-O2 (with 20% or more O2)
- –Psycho-sedation- analgesia, amnesia
- –Contraindications: COPD, Respiratory obstruction
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What are the 2 drug actions?
- Desired drug action: the sought after reaction
- Side Effects
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Idiosyncratic
- Not Dose or allergy related
- Adverse drug rxn
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Adverse Drug reactions
- Overdose: Elevated blood levels
- Allergic: Hypersensitive, wide range of S&S
- Idiosyncratic: Not Dose or allergy related
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Can you a drug reaction with the correct dosage?
Yes
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Predisposing Factors to ODR
- Age( <6 and >65)
- Body Mass: Lack of lean body mass as related to blood volume
- Overall Health: Liver, Kidney Dysfunction (amides); Cardiovascular condition, hyperthyroidism (epi)
- Mental Attitude
- Vasoactivity of Drug : LA are vasodilators/ can flood blood stream
- Dosage: based on body weight
- Rate of Injection: Slower is better
- Vascularity of Injection Site: less vascular is better
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Low to Moderate LA OD
- Confusion , Disorientation
- Excitability
- Speech Patterns: slurred, stutter
- Muscular Patterns; tremors, twitching
- Increased Vital Signs; BP, Pulse, Respiration
- Headache , Dizziness, Lightheadedness
- Ringing Ears
- Blurred Vision
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Moderate to High LA OD
- General tonic – clonic seizures
- Followed by CNS Depression
- Lowered BP,Pulse,respiration
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Management to OD
- Stop Tx
- Position Pt
- Reassure
- Administer O2
- Monitor Vitals
- OR call 911
- Manage Seizsure
- O2 or CPR
- Monitor Vitals
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L.A. with epi
- Small % Epi
- >duration
- Localizes med:
- *Bec vessels constricts
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Epi OD
- Fearful, anxious
- Increased Cardiac Function
- Dizzy
- Similar to anxiety attack
- Small amounts of vasoconstrictor added to LA keeps LA in the area of injection, prolongs anesthetic effect, >BP
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Management of ODR to Vasoconstrictor
- Stop Tx
- Position Pt
- Reassure
- Summon 911 , if needed
- O2
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Drugs Used to Manage Allergy
- Epinephrine: For generalized anaphylaxis + hypotension or respiratory difficulty or cardiovascular difficulty.
- Antihistamine
- Steroids: prevents recurrence
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Esters
- allergy: localized erythema, edema
- OD: unlikely
- S.E.: rare but maybe sedation
- procaine,Novocaine
- propoxycaine,Ravocaine
- benzocaine,Hurricaine
- tetracaine,Pontocaine
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Amides
- allergy: rare
- OD: CNS depression
- S.E.: rare but maybe sedation
- lidocaine, Xylocaine
- mepivicaine, Carbocaine
- etidocaine, Duranest
- prilocaine, Citanest
- bupivacaine, Marcaine
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Cardiovascular Collapse
- The heart is still beating but it cannot circulate the blood.
- Can be caused from:
- 1. Drugs ----- L.A., barbituates , narcotics
- 2. Severe hemorrhage
- 3. Shock
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Ventricular Fibrillation
- Individual heart muscles beat independently - they do not beat as a unit ; therefore, no blood is circulated.
- Dysrhythmia of myocardial muscle fibers.
- Common occurrence in the period immediately following MI ( w/in first 2 - 4 hrs.)
- Leading cause of death from ischemic heart disease.
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Cardiac Standstill
- The heart has stopped beating.
- Most common cause is severe lack of O2 to the myocardial muscle.
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CPR
- 30 compressions and 2 breaths
- people can get hurt from this
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