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- Dorsalsis Pedis
- Tibialsis Posterior
Bright red, spurts
Dark red, steady flow
- 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
Treatment of Internal Bleeding
- Apply cold pack: < swelling & slows bleeding
- For Serious Internal Bleeding:
- Reassure & keep the victim still
- Look for/ care for symptoms of shock
- Loosen tight clothing
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
Signs and Symptoms of Infection
- Pain, tenderness
- Swelling / Swollen glands
- Pus/ exudate
- Red streaks à Septicemia
- 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.
Caused by loss of blood or other body fluids, like serious bleeding or dehydration.
- Shock (Irreversible)
- Patient does not survive
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)
- May be caused by myocardial infarction, cardiac arrhythmias or other cardiac dysfunction
- Blood pressure will be lower than normal
- A life threatening reaction of the body to a substance to which the patient is extremely allergic.
- Epinephrine: 0.01 cc/kg in the tum.
- Susphrine: Half of that, in the fat: 0.005 cc/kg
- Caused by severe infections.
- Toxins are released into the blood stream which cause the blood vessels to dilate.
First Aid: Shock
- 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
- Dilated: Both pupils: Shock, bleeding, exhaustion, drugs (cocaine, amphetamines)
- Constricted: both; Heat stroke, drugs(narcotics)
- Unequal: Head injury, stroke
Partial Airway Obstruction
- Hands to throat
Tx of Partial Obstruction
- Position patient
- Encourage coughing
- If pt stops coughing & cannot speak, treat for total airway obstruction.
Complete Airway Obstruction
- Unable to speak, cough, breathe
- Loss of consciousness
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
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 .
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
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.
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.
- Excessive sputum production
- Possible suffication
- S & S Depend on location in airway.
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
- 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
What are the 2 drug actions?
- Desired drug action: the sought after reaction
- Side Effects
- Not Dose or allergy related
- Adverse drug rxn
Adverse Drug reactions
- Overdose: Elevated blood levels
- Allergic: Hypersensitive, wide range of S&S
- Idiosyncratic: Not Dose or allergy related
Can you a drug reaction with the correct dosage?
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
Low to Moderate LA OD
- Confusion , Disorientation
- Speech Patterns: slurred, stutter
- Muscular Patterns; tremors, twitching
- Increased Vital Signs; BP, Pulse, Respiration
- Headache , Dizziness, Lightheadedness
- Ringing Ears
- Blurred Vision
Moderate to High LA OD
- General tonic – clonic seizures
- Followed by CNS Depression
- Lowered BP,Pulse,respiration
Management to OD
- Stop Tx
- Position Pt
- Administer O2
- Monitor Vitals
- OR call 911
- Manage Seizsure
- O2 or CPR
- Monitor Vitals
L.A. with epi
- Small % Epi
- Localizes med:
- *Bec vessels constricts
- Fearful, anxious
- Increased Cardiac Function
- Similar to anxiety attack
- Small amounts of vasoconstrictor added to LA keeps LA in the area of injection, prolongs anesthetic effect, >BP
Management of ODR to Vasoconstrictor
- Stop Tx
- Position Pt
- Summon 911 , if needed
Drugs Used to Manage Allergy
- Epinephrine: For generalized anaphylaxis + hypotension or respiratory difficulty or cardiovascular difficulty.
- Steroids: prevents recurrence
- allergy: localized erythema, edema
- OD: unlikely
- S.E.: rare but maybe sedation
- allergy: rare
- OD: CNS depression
- S.E.: rare but maybe sedation
- lidocaine, Xylocaine
- mepivicaine, Carbocaine
- etidocaine, Duranest
- prilocaine, Citanest
- bupivacaine, Marcaine
- 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
- 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.
- The heart has stopped beating.
- Most common cause is severe lack of O2 to the myocardial muscle.
- 30 compressions and 2 breaths
- people can get hurt from this