Blank ER 9-16

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Author:
cumberlanddh
ID:
186420
Filename:
Blank ER 9-16
Updated:
2012-12-02 15:41:59
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Blank ER
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Description:
Office emergencies
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  1. normal blood pressure
    •  SBP <120 mmHg DBP and <80 mmHg
    • lifestyle modification: encourage
    • okay to treat patient
  2. prehypertension
    • SBP 120-139 mmHg; or DBP 80-89 mmHg
    • lifestyle modification: yes
    • okay to treat patient 
  3. stage 1 hypertension
    • SBP 140-159 mmHg; or DBP 90-99 mmHg
    • lifestyle modification: yes
    • must consult with DDS
  4. stage 2 hypertension A
    • SBP >/=160 mmHg; or DBP >/= 100 mmHg
    • lifestyle modification: yes
    • must consult with DDS
  5. stage 2 hypertension B
    • SBP >/= 180 mmHg; or DBP >/= 110 mmHg
    • lifestyle modification: yes
    • must consult with patient's physician
  6. negative effects of hypertension on the human body
    • A: heart diseases
    •          -heart failure
    •          -heart attack
    • B: cerebral vascular accident (stroke)
    • C: renal disease
  7. pharmacologic treatment for hypertension
    antihypertensive drugs
  8. non-pharmacologic therapy- lifestyle modifications
    • 1. lose weight if overweight/obese
    • 2. adopt Dietary Approaches to Stop Hypertension
    •     -eat fruits and veggies, lowfat dairy products and foods rich in K and Ca
    • 3. reduce dietary sodium- no more than 2.4g a day
    • 4. exercise/ adopt a regular aerobic physical activity
    • 5. restrict alcohol consumption to < 1 oz of ethanol daily for men; .5 oz of ethanol for women and lighter weight people
    • 6. cessation of smoking
  9. prolonged bleeding procedures
    • -compression over bleeding area
    • -apply gauze pack with pressure
    • -bandage pack into place firmly when possible
    • -elevate injury above the heart if possible
    • -apply digital pressure on pressure point of supplying vessel if necessary
    • -Activate EMS if shock symtoms occur
  10. bleeding from a tooth socket procedures
    • -pack with folded gauze, don't dab
    • -have pt bite down firmly on gauze
    • -have pt bite on wet tea bag for 10 mins (tea bags have tannic acid)
    • -don't rinse
  11. bleeding from an extremity procedures
    • -activate EMS
    • -elevate the part; support w/ pillows or substitute
    • -apply tourniquet ONLY when limb is amputated,mangled or crushed
    • -once tourniquet is place- do NOT remove it
  12. nosebleed procedures
    • seat patient upright
    • tell pt to breathe through mouth
    • apply cold application to nose
    • press nostril on bleeding side for a few mins
    • advise pt NOT to blow nose for an hour or more
    • if bleeding does not stop, pack nostril with wet cotton roll lubricated w/ water soluble lubricant
  13. hematoma (bruise) from local anesthesia injection procedure
    • Post. Sup. Alveolar Nerve Block hematoma= most common
    • 1. digital pressure applied in mucobuccal fold as far distally as can be tolerated for AT LEAST 2 mins
    • 2. apply ice extraorally
    • 3. for soreness, take analgesic
    • 4. apply heat AFTER 24 hours, warm moist towel for 20 mins every hour
    • 5. hematoma will be present for 7-14 days
  14. pressure points- used in case of severe bleeding
    • 1. Temporal artery - in front of ear
    • 2. Facial artery- through facial notch of mandible
    • 3. Carotid artery- in neck
    • 4. Subclavian artery- passes behind and beneath the collar bone
    • 5. Brachial artery- press 1/2 way between shoulder and elbow
    • 6. Radial artery- thumb side
    • 7. Ulnar artery- little finger/pinky
    • 8. Femoral artery- in groin

    • *****see handout with human drawing
    • **mnemonic device: Tina Fey Can Swim But Runs Ultimately Faster
  15. symptoms of choking
    • ineffective or no cough
    • poor air exchange gasping attempts at breathing
    • unable to speak
    • cyanosis
    • dilated pupil
    • possible cessation of breathing and loss of consciousness
  16. procedures for choking- conscious
    • ask "are you okay?"
    • stand behind person, press thumb of fist btwn belly button and sternum, place other hand over fist and pull in and upward until object dislodges
    • when object is dislodged, administer artificial respiration, if necessary
    • check carotid pulse
  17. procedures for choking- unconscious
    • activate EMS
    • look for object, remove it if visible, no blind sweep
    • if object is NOT dislodged, administer 30 chest compressions
    • look for object, no blind sweep, remove if seen
    • give two breaths
    • repeat
    • when object is dislodged- administer artificial respiration, if necessary
    • check carotid pulse
  18. symptoms of respiratory failure
    • labored or weak respirations or cessation (stop)of breathing
    • cyanosis or ashened-white w/ blood loss
    • pupils dilated
    • loss of consciousness
  19. procedures for respiratory failure
    • -place pt flat on back
    • -clean debris from mouth, if visible
    • -remove removable prosthesis, only if its obstructing airway
    • -establish airway
    • -perform rescue breathing

    adults- initially give 2 breaths of 1 sec each, followed by 1 breath every 5 secs (12x/min)

    child- (1-8 yrs) and infants- initially give 2 breaths of 1 sec each, followed by 1 breath every 3 secs
  20. oxygen administration procedures
    • 1. places patient in supine position and clean debris from mouth
    • 2. open airway by performing modified chin lift or jaw thrust
    • 3. open oxygen flow tank valve (turn key in counter-clockwise direction)
    • 4. adjust O2 flow by turning flow meter knob
    • 5. fit mask over pt's mouth and nose to assure max. oxygen concentration
    • 6. when pt isn't breathing and its necessary to force oxygen into lungs, use the bag mask
    •     a) flow meter should be about 10-15L/ min
    •     b) squeeze bag repeatedly until natural breathing is established. compress resuscitation bag intermittenly at 5-6 sec intervals to provide 10-12 respirations/min - watch chest rise and fall

    **for child 1 ventilation every 3 seconds
  21. symptoms of asthma attack
    • -difficulty breathing, wheezing
    • -cyanosis
    • -dilated pupils
    • -confusion due to lack of oxygen
    • -chest pressure
    • -sweating
  22. procedures for asthma attack
    • activate EMS
    • position pt upright with arms up and supported forward
    • assist w/ pt's own bronchodilator
    • administer supplemental oxygen by nasal cannula
    • epinephrine if pt decompensates
    • supplemental cortisone to pt's who are or have been on corticosterioid therapy
    • basic life support- may need demand valve resuscitator if pt experiences respiratory depression
  23. symptoms of shock
    • pale skin, sometimes cyanotic- due to lack of O2
    • moist skin: cold, clammy
    • weakness and/or restlessness
    • dilated pupils
    • rapid, shallow breathing
    • low blood pressure
    • nausea, vomiting
    • thirst, if shock is from bleeding (polydipsia- excessive thirst due to loss of fluid)
    • eventual unconsciousness if untreated
  24. symptoms of anaphylactic shock
    • swelling of lips, membranes, eyelids, vocal cords resulting in (dysphagia- difficulty in swallowing)
    • urticaria- wheals (rash), itching
    • flushing
    • nausea, abdominal cramps, vomiting, diarrhea
    • respiration distress ( cyanotic, dyspnea- shortness of breath)
    • cardiovascular collapse (drop in BP, rapid weak pulse, palpitations)
    • dilations of pupils
    • sudden loss of consciousness
    • cardiac arrest
  25. procedures of anaphylactic shock
    • activate EMS
    • place in supine position, (except when dyspnea predominates)
    • administer oxygen
    • follow instruction for Epi-Pen- outter thigh
    • perform CPR if necessary
  26. symptoms of stroke- premonitory
    • dizziness, vertigo
    • transient paresthesia or weakness one side
    • transient speech defects- slurred speech
  27. symptoms of stroke- serious
    • headache (with cerebral hemorrhage)
    • breathing labored, deep, slow
    • chills
    • hemiplegia- paralysis one side of body OR
    • hemiparesis- slight or incomplete paralysis on one side of body
    • nausea, vomiting
    • convulsions
    • loss of consciousness (slow or sudden onset)
  28. procedures for stroke
    • activate EMS
    • turn pt on paralyzed side
    • elevate head slightly (dont want to increase blood supply to head)
    • loosen clothing about the throat
    • keep pt quiet, comfortable, warm
    • monitor vital signs
    • administer oxygen, when necessary by nasal cannula
    • if pt goes into convulsion, treat per convulsion
    • dont not give stimulant, sedative or narcotic
    • clear airway, suction vomitus because the throat muscles may be paralyzed
    • administer CPR, if it becomes indicated
  29. symptoms of syncope
    • pale, gray face
    • anxiety
    • dilated pupils
    • weakness, giddiness, dizziness, faintness, nausea
    • profuse cold perspiration
    • rapid pulse at first, followed by slow pulse
    • shallow breathing
    • drop in blood pressure
    • sudden loss of consciousness
  30. procedure for syncope
    • place in Trendelenburg position- feet above heart
    • open airway
    • place cold damp towel on forehead
    • crush ammonia vaporle under pt's nose
    • keep warm
    • monitor vital signs
    • may require oxygen, by nasal cannula
    • keep in supine position 10 mins after recovery to prevent nausea and dizziness
    • 24 hr recovery time- dont continue dental treatment
  31. parts of the oxygen tank
    • green oxygen tank- cylinder- size E is recommended
    • oxygen tank key valve (on/off key on top of tank
    • reducing valve (maintains 50 lbs per square inch pressure
    • pressure gauge (3000lbs per square inch)
    • flow meter (0-10 liters per min)
    • mask
    • tubing
    • positive pressure bag

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