question

What happens in a anaphalactic reaction

answer

life-threatening causing bronchospam & drop in BP

question

what do you do for an immediate allergic reaction

answer

1.call 911 2.Get preloaded Epi syringe in the emergency kit and inject pen in patient's deltoid,tongue, or lateral thigh re-administer Epi pen in 5 minutes ONLY IF SYMPTOMS PERSIST.

question

Chest pain (Angio Pectoris)

answer

patient has tight , heavy, or constricted chest pain and may clench their fist against their chest

question

What to do when a patient develops Chest Pain

answer

1.CALL 911 and position patient so he/she is comfortable and ask if they have nitroglycerin tablets or spray on them. If not, give two sprays of nitroglycerin(vasodilator)onto the patient's tongue. 2. Dental treatment can continue if patient and doctor are comfortable. Note: important ; do not give spray/tablet if the patient has chest pain and feels dizzy (means BP is dropping, or if patient took Viagra within 24hrs.

question

What to do if patient is experiences heart attack after chest pains, patient says they are getting worse, patient has taken 3 doses of nitroglcerin in 5 min intervals and pain continues,or chest pain went away and came back, or patient has no history of heart disease or chest pain.Crushing, intense, radiating pain from chest to the stomach or to the left side of the neck, jaw, left arm, and/or pinkie finger (tingles). Skin turns ashy gray and patient may sweat profusley.

answer

1. CALL 911 2. Admin. 50 % nitrous oxide & 50 % oxygen (has same effect as morphine) for pain and delivers more oxygen to the muscles/brain 3.give two sprays of nitroglycerin on patient's tongue and have the patient CHEW 1 tablet of adult dose ASPRIN (325mg) EXCEPT if the patient is allergic to asprin, has bleeding disorder,or gastric/peptic ulcer, Asprin prevents clot from getting bigger.

question

What do you do in case of cardiac arrest (uncounscious patient)

answer

1. CALL 911 while dentist lays the patient flat in dental chaior with feet elevated. 2.Dentist checks airway via head/chin lift and checks for breathing and carotid pulse (in groove under the and to the side of the Adam's apple) 3. Dentist gives CPR (15 chest compressions for every 2 breaths) 15:2 ratio

question

What do you do when a patient exhibits diabetic shock (hypoglycemia = low blod sugar)- mental confusion, patient feels cold, sweaty, and shakey.

answer

1. before tx ask patient when did they take their insulin and eat last. if not recent, give patient 1/2 cup orange juice or non-diet soda wait 5 minutes, then give another 1/2 cup. After 5 minutes, give last 1/2 cup within 15 minutes sign should subside Unconscious Diabetic: 1.call 911 lay patient flat feet raised, check airway (head/chin lift), check breathing (look,listen,feel) and check carotid pulse. DO CPR if not breathing/pulse) (15 compression for every 2 breaths) 15:2 2. DO NOT ADMINISTER DRUGS!

question

Syncope (fainting)

answer

can occur with emotional distress (nervous. Occurs when there is temporary decress in bloodflow to the brain dure to the sudden drop in BP,HR,of blood volume change. Can happen with anyone, but patient usually has an underlying medical condition like anemeia or heart disease.

question

What do you do if a patient has signs that they may faint : light headed, nausea, heart palpatation

answer

1. lay pt in dental chair with legs elevated 2. place cold, wet towel over their forehead 3. Adim oxygen and aromatic ammmonia held under patients nose to stimulate bllod flow to the brain via movement.

question

Why are inhaled ammonia used in syncope How do you administer it Do you administer oxygen

answer

Irratates trigeminal nerve sensory endings to cause a reflex stimulation of the medullary respiratory and vasomotor centers. An aromatic ammonia vaporole is crushed between the fingers and held near the patients nose. Administation of oxygen help prevents tissue anoxia

question

symptoms of syncope How to tx syncope

answer

beads of sweat on upper lip, weak thready pulse, cold clamy skin, pallor and a dizzy feeling. Loss of normal vasomotor tonus produces pooling of blood peripherally so that normal blood volumes become insuffient. Placing patient in surpine postition & elevating the feet gives the patient a transfusion of whole blood by utilizing forces of gravity. The head should not be more than 10 degrees lower than the rest of the body.

question

types of syncope and tx

answer

Vasovagal, Neurogenis, & Orthostatic (tx all with high-flowing 100% oxygen) Hyperventilation Syndrome ( oxygen is not indicated) 100% oxygen is a contraindication in patients with Chronic Obstructive Pulmonary Disease (COPD)

question

What signs may a patient experiencing a Siezure (epilepsy)

answer

Patient may have a visual, sound, or smell aura immediately before seizure starts (so ask the patient with seizure hx if they have a common aura or if they have taken their anti-epileptic medication)

question

Siezure (epilepsy)

answer

caused by signals in the brain are disrupted. Grand-mal is most common type (2-3 min) the body becomes rigid and relaxes. Status Epilepticus is a siezure lasting longer than 5 min. and is LIFE threatening. 1. call 911 2. Remove any sharp objects away from patient and have one person gently hold the arms while the other person holds the legs to protect the patient from self injury. Note: if monor has seizure, call aprent into the room to help

question

1.Primary 2.Secondary complications

answer

P= caused manifests itself at the time of anestheia S= manifested later, even though it may be caused at the time of inserting the anesthetic solution

question

MIld complication

answer

exhibits sight change fromnormal expected pattern, and reverses itself without any expected tx (ie: change in voice by injecting anesthesia; is reversible

question

Severve complication

answer

manifests itself by pronounced deviation from normal expected pattern which requires a definitive plan of tx (ie; anaphylatic shock allergy)

question

Transient complication

answer

one that even though severe at the time of occurrence, it leaves no residual effects.

question

Permanent complication

answer

leaves a residual effect even if mild in nature

question

Systemic complications

answer

Psychogenic (syncope/fainting episode), toxic overdose/reduced tolerance, allergy (ie:delayed hypersensitivity), vasoconstrictor effects (increasse HR & BP), and drug intolerence (increase EPI)

question

Local complications

answer

muscle trimus, inability to open mouth, & multiple causes ( muscle trauma, hemorrhage, & injection)

question

Psychogenic reactions

answer

acccounts for the vast majority (99%) of complications emergencies experienced during dental surgery. These states may be physically manifested by palpitations, cold sweat, restlessness, excitation, and fainting.

question

most common detal emergency (complication) associated with local anesthesia

answer

-Syncope (fainting) (can occur just by seeing the needle before it is injected) -Syncope is AKA ;vasdepressor,syncope,vasovagal,neurogenic syncope, and psycholgenic syncope. Can be triggered by a psychogenic response (anxiety) and other factors

question

one cause of syncope is by

answer

cerebral ischemia secondary to inadequate cerebral perfusion and may be induced by cerebral hypoglycermia (want someone who is hyperglycemia in your chair)

question

Most common cause of syncope

answer

emotional stress

question

other causes of syncope

answer

-hyperventalation -excessive couging (can induce a vago-vagal response) -postural hypotension -dysrhymias

question

Diagnosis of syncope; identified by prodromal signs in the anxious patient

answer

-pallor, diaphoresisi (cold persperation), exaggerated yawning, tachycardia, nausea, and light headedness. -Then a sudden drop in BP because not enough CO, loss of consciousness, possible brief cinvulsion, and gererally a rapid recovery of seconds to a few minutes. -Dental tx may be delayed if syncope occurs (they should not drive home)

question

early signs of snycope

answer

Prodromal (early); pallor, sweating-cold, exaggerated yawning, tachycardia,nausea, and light headedness

question

Late signs of syncope

answer

sudden drop in BP, loss of consciousness, breif convulsion, and rapid recovery.

question

Tx of syncope

answer

(want to get the blood to the head by elevating the feet-Trendelenburg) -place pt surpine postion with legs elevated -hyperextend the neck to ensure the pt airway -Admin. oxygen and/or ammonia inhalant -cold towel to forhead, loosen collar -CPR measures are indicated -People in syncope can flat-line due to bradycardia (HR is so low it goes flat-line, but uncommon

question

Tx toxic LA overdose

answer

-risk is relatively low in regional anesthesia of the oral cavity -Most overdoses ao LA in dentistry occurs in young children -Use the least possible volume & concentrations needed to obtain satisfacory anesthsia. speed of injection ois also a factor in rapid absorption of the drug.

question

Intravascular injection

answer

Toxic reactions during regional anesthesia of the oral cavity are much MORE likely to result fron an accidental intravaascular injection than from a tru overdose. -To prevent an invascular injection, always aspirate before injecting.

question

Are allergic reaction to amides rare

answer

YES

question

Allergic reactions

answer

-Allergic reactions to Amides are rare -Most pt claim that allergy is he result of misdiagnosisi and pt misinformation. However when esters were used, allergic reactions where more common -True allergic responses may be localized or general, immediate in onset or delayed -Requires prior sensitization (had the anesthetic before). -If suspect an allergy to LA, ref the pt for prior allergy testing.

question

Drug interaction

answer

-Review any medications your pt may be taking before admin. LA -Potentiation of the BP response to noradrenaline occurs in pt taking tricylic antidepressants, btea blockers, & MAOIs. -You can still admin. a LA , but be aware of possible adverse reactions

question

LA complications

answer

muscle trimus, inablility to open mouth and multiple causes - muscle trauma -hemorrhage -infection

question

Trimus

answer

-most commonly caused by damaging the medial pterygoid muscle by inserting anesthetic directly into the muscle. -hematoma fromation may restrict jaw opening by infleucing the formation of a fibrous band around the medial pteyrgoid muscle -Max opening will begin to narrow 1-6 days after injection, only resolves with tx

question

Tx of trimus

answer

-analgesic -warm saline rinses (works same as water) -and if needed , physical therapy, muscle relaxants - forced opening with sedation (rarely needed)

question

Pain involved post LA

answer

the most common cause of post-injection pain is secondary to periosteal trauma -pain is often the result of carelessness or indifference in one's injection technique -Use of supraperiosteal injections and topical anethetics

question

Chronis pain

answer

last longer than 6 months

question

Neuropathic pain

answer

burning, shooting, or tingling associated with parathesias and dysesthesias

question

Somatic pain

answer

reponds better to opiods anesthetics

question

Hematoma formation

answer

most commonly associated with the posterior alveolar (PSA) nerve block or "high tuberosity" injection -Hematoma is caused by laceration of the posterior alveolar artery, and less often from the injury to the pterygoid venous plexus. -Rapid swelling is manged with ice and pressure.

question

Tissue necrosis

answer

at the site of injection may be seen most commonly in areas if tightly attached mucosa (ie: anterior palate). -is most likely related tothe volume of LA or too rapid of an injection.

question

Blanching of the skin

answer

is associated with sharp pain during injection and related to spasm of the artery that accompanies the nerve at the point of injection. -this spasm is due to NEEDLE TRAUMA or more commonly to INTRARTERAL INJECTION -also do to vasoconstrictors. * some blanching of the mucosa is expected after submucosal admin. of solutions containing vasoconstrictors

question

Neuropathy

answer

regardless of the precise mechanism of injury, most needle-induced nerve injuries result in minor sensory deficits that resolve spontaneously and almost never involve the total distribution of the affected nerve.

question

Neuropathy Etiology

answer

caused by direct nerve injury from a needle insertion, injection of the anesthetic solution directly into the nerve causing pressure , hemorrhage, or ischemic necrosis -Accidental nerve damage from contaiminated solutions is largely a problem of the past -Neuropathy: Anesthesia, Paresthesia, Dysesthesia (worst to tx), & Hyperesthesia

question

Undesired Neurological Symptoms

answer

conditions are usually temporary and caused by gross misdirection of the needle, accidental intravascular injection, and an unusual pattern of anesthetic distribution

question

Undersirable effects: Neurological

answer

-Hemifacial paralysis from anesthesia of the CN7th (facial) from injecting solution within the parotid capsule -Cervical sympathetic block (ptosisi of the upper lid, nasal congestion, papillary constriction) from anesthesic spread through the lateral pharyngeal space.

question

Undesirable Occula effects

answer

most "undesired" occular effects are in response to an accidental intraarterial injection * infusion of anesthetic into a branch of the maxillary artery causes the drug to be distributed to the orbit through retrograde flow. *symptoms; dizziness, diplopia (blurred vision), and temporary blindness.

question

Self inflicted injuries

answer

Trauma to anesthetized soft tissue (tongue,cheeks,lips) -children are the most suseptible. -Give post-opertive instructions to mom and child about eating/drinking after receiving LA (esp. after Md injections involving the tongue and lip anesthesia.

question

Post-injection herpactic lesions

answer

arousal of dormant herpes virus particles by the trauma of injections often seen in pt with HX of recurrent hepers labialis -most common site is the teriminal distribution of the inferior alveolar nerve or superior labial branch of the trigeminal nerve

question

Tricyclic Antidepressants

answer

inhibit neuronal uptake of catecholamines causing increased concentrations of catecholamines at the sympathetic neuroeffector junction. Thus, cardiovascular action of EPI can be increased with these pt

question

PT taking MAO inhibitors

answer

monoamines oxidase helps degrade the vasoconstrictor (EPI), thus once again the cardiovascular action of EPI is increased in MAO inhibitor patients

question

Pt taking Beta Blockers

answer

beta-blocker inhibit vasodialation of arteries by sympathomimetic drugs. This allows the vasoconstricting alph adrenergic effects of EPI to predominate. Thus adim. a vasoconstictor (EPI) to a beta-blocker pt may cause increased BP -Drug interactions in General Anesthesia; some general anesthetic agents (Halothane & Enfluane) sensitize the heart to effects of catocholamines, Thus, lower amounts of EPI vasoconstrictor must be used. -Local Tisue Toxicty; Skeletal muscle is more sensitive to LA than any other tissue- can cause muscle damage but is reversible in 2 weeks. -Neuromuscular Blockade: *many LA can block meuromuscular transmission in humans by inhibiting sodium diffusion through a blockade of Na+ channels in the menbrane *If it is additive to that produced by depolarizing (succinylchorine) and nondepolarising (curare) muscle relaxants, thus may lead to abnormally prolonged periods of muscle paralysis under anesthesia (unlikely to occur in dental outpatient)

question

Malignent Hyperthermia

answer

pharmacogenic disorder in which a genetic variant in the individual alters that person's response to a certain drug -Acute clinical manifestations: tachycardia, tachypnea, unstable BP, acidosis/cyanosis (respiratory and metabolic acidosis), fever, muscle rigidity, and death *realtive contraindication to LA **Ester LA (procaine/propxcaine,tetracaine & choloprociane) can be administered with no risk when MH family hx is known.

question

Cadiovascular concerns

answer

LA have a weak nueromuscular blocking activity and may affect cardio and smooth mucles. At high doses, locals may cause heart beat or arrhymias (at low doses, local treat arrhythmias -Cardiac Na+ channels may block cardiac sodium channels to depress pacemakers activity, causing hypotension with cardiovascular collapse at high doses -Epi or NE used w/LA can cause hypertension and cardiac arrhymias, esp. if used in high doses. Generally , used in very low doses or another vasoconstrictor is used if hx of cardiovascular complication exists.

question

Peripheral & Central Nervous Systoms

answer

LA may be neurotoxic if high doses get into peripheral nevers (ie; Lidocaine is aconcern when used in spinal anesthesia)

question

CNS

answer

common in lower dose effects are confusion,dizziness (hypotentention partial cause), drowsiness,disorientation,slurred speech, (esp. w/epidural or spinal anesthetic) -* excessive blood levels can reusult in excitatory CNS effects.

question

Convulsions:

answer

are serious and related to excessive excitation. If high LA doses are required to achieve effect, a Benzodiazepine (Diazpam (Valium)) is adm. to protect against seizures or convulsions.. -Hyperventilation is beneficial to seizure tx. -Excitatory Effect-especially w/cocaine causing restlessness, paranoid delusions, and visual/auditory disturbances. Cocaine has additive properties.

question

At low doses LA effects

answer

are inhibitory to reduce pain. They initially have exciatory effects.but accidental IV dosse (high toxic dose effects)can cause seizures or convulsions (excitatory effects due to EPI in LA). If using drup w/EPI, too much EPI causes excititory effects.

question

Idiosyncratic reactions

answer

very small % pf pt are susceptable to cardiovascular or CNS effects. -CNS effects(excitation and anxiety)although convulsions may occur at dose safe to the majority of the population. -Problems result from accidental IV injection (IV Lidociane)

question

Hypersensitivity

answer

some pt are allergic to derivitives of ester type anesthetics. -Allergic reactions to amides are rare -Asthmatic attacks can occur, but are much more common with ester la

question

To limit or Avoid Systemic Reactions or Toxcity

answer

-low doses of LA w/vaso (if EPI is not contraindicated) limit systemic absorption in pediatric pt. Use proper injection techniques w/care to avoid IV injection

question

TX if pt experiences convulsions

answer

-place in surpine position & admin. oxygen(ventilate) -Benzodiazepines (diazepam, midazolam) are admin. at low-to-moderate doses

question

lidocaine ((4.4mg/kg )(300mg max)( 36mg=1 carp)) max dose/carps for a 23 lb child

answer

44mg/1.2 carps

question

Lido max dose/carp 34.5 lb child

answer

66mg/1.8 carps

question

Lido max dose/carps 46lb child

answer

88mg/2.4 carps

question

Lido max dose carps 57.5 lb child

answer

100mg/2.6 carps

question

how much Epi is in 1;100,000 lido w/epi

answer

0.018mg

question

How much anesthetic is in 1;100,000 lidocaine 2%

answer

0.36mg

question

How much epi in 1;200,000 lidocaine

answer

0.009mg

question

how much epi in 1;50,000 lidocaine

answer

0.036mg

question

how much anethetic is in 4% articaine

answer

0.72mg

question

How much anesthetic in 3% mepriviccaine

answer

0.54mg

question

Max carps of Lidocaine/dose (Xylocaine)

answer

8..3 carps/300mg

question

Max carps Meprivicaine 3%/dose (Carboocaine)

answer

5.6 carps/300mg

question

Max carpsPrilocaine 4% /dose (Citanest)

answer

5.6 carps/400mg

question

Max carps Buprivicaine 0.05% /dose (Marcaine)

answer

10 carps/90mg

question

Toxic effects (excitatory) of LA

answer

cause light headedness, dizziness, visual & auditory, disturbances, apprehension, disorientation, localized involuntary muscular activity

question

Toxic Effects (Depressant) of LA

answer

slurred speech, drowniness, unconscouisness (seizures) which are the MOST COMMON EFFECT OF LA Overdosage

question

Excessive doses of LA

answer

cause respiratory impairment and death.

question

The most common vasoconstrictors

answer

EPI used in LA that comes in concentrations expressed as ratios (1;50,000 ; 1;100,000; 1;200,000 (the least concentrated) -A concentration of 1;50,000 would cause the greatest vasoconstriction (BEST hemostasis)

question

Epi is endogenously produced in the _________from TYROSINE

answer

adrenal medulla

question

Epi works on what receptors

answer

Both; alpha & beta receptors

question

_____is the most potent sympathomimetic amine

answer

EPI

question

Adrenergic receptors located in the walls of arterioles and produce VASOCONSTRICTION

answer

Alpha receptors

question

Beta receptors

answer

Beta 1 (in the heart to increase HR and cardiac output) Beta 2 (in skeletal muscles and causes vasodialation in skeletal muscles)

question

Purposes of vasoconstrictors (EPI)

answer

-decrease peak plasma concentrations of the LA agent -Increase the anesthetic's durationof actiion -Decrease the min concentration of LA needed for nerve block -Reduce blood loss during surgical procedures -Available vasconstrictors; NE (not used in US) EPI is the most common:Levonordefrin -Epi is the most potent and common vasoconstrictor

question

in a acid environment, such as an infection

answer

decreases LA effectiveness. -Increases the PH of the anesthetic increases its onset but the anesthetic becomes clinically less effective, because the base will precipitate out of alkalinized solution

question

Mechanism of action in LA

answer

is to activate adrengric receptors located on mynocytes of blood vessels. -Vasocontrictors work on alpha receptors of the blood vessels

question

Purpose of using vasoconstrictors

answer

-decrease peak plasma concentration of the LA agent -To increase duration of anesthesia and improve quality -To decrease the min concentration of LA needed for nerve blocks -To reduce blood loss during surgery

question

Treats Asthma

answer

EPI -Epi binds and stimulates both alpha 1&2 adrenergic receptors in walls of arterioles -Beta 2 adregenic activity may cause vasodialation in the skeletal tissue Epi is supplied as; 1,50,000 (0.02mg/ml)= .036 epi 1;100,000 (0.01 mg/ml)= lidocaine (1 carp lidocaine =.01 x 1.8= .018 epi 1;200.000 (0.005mg/ml) = .009 epi

question

Levonordefrin (NEO-COBEFIN)

answer

the least potent vasoconstrictor -a direct acting sympathomimetic amines with less beta 2 activity than epi -Levonordefrin is supplied as 1;20,000 (0.05mh/ml) -it has same clinical activity and cardiovascular side effects as 1;100,000 epi

question

Pt with Coronary Artery Disease

answer

have smaller changes in HR & myocardial contractility, and are more likely to get ventricular dysrhythmias, chest pain, and ishemic electrocardiographic changes (ST depression) after inadvertent IV admin. of EPI

question

using vasoconstictors in hypertensive pt

answer

BP increases are greater in hypertensive pt. than in normal individuals. -they also have higher incidence of dysrhythmias

question

excretion of Esters

answer

appear in small concentration as a parent compound in urine b/c esters are hydrolyzed completely in plasma

question

excretion of Amides

answer

present in urine as the parent compound in a greater % than esters b/c of their more complex process of biotransformation (liver)

question

Vasoconstrictors toxcity and efects

answer

Tachycardia Headaches Hypertension Palpitations Tremors Cardiac dysrythmias

WREB- Local Anesthesia – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards