Our group was assigned the topic on vasopressor syncope, a common emergency in the dental settings precipitated due to fear, anxiety and stress associated with dental treatment. Our emergency scenario highlighted a young woman, in her late twenties, who avoids visiting the dentist for extended periods of time due to dental fear. Her appointment for NSPT required her to get local anesthetic.She displayed classic signs & symptoms such as being pale, sweaty, feeling warm and clenching the armrest (white knuckles syndrome) and was in an overall state of panic. After seeing the needle, she loses consciousness and the dental team quickly use ammonia vaporole to help her regain consciousness. In the event, she did not regain consciousness BLS procedures are performed and she is placed in supine position with feet higher than her head.
It is absolutely crucial to always be prepared for an emergency situations and in this scenario the quick thinking helped resolve the situation and prevent it from getting worse.The taping of the ammonia vaporole in the operatory provides easy access and prevents delay of emergency management. However, this situation could have been avoided if the
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An unprepared clinician will likely freeze and be unsure what needs to be done next. In an emergency situation every second counts and can be a matter of life and death. It is important to never assume that an emergency will not occur if a patient appears to be healthy, an emergency like syncope is more common among individuals who are in good overall health. Hence, taking the time and asking questions during the medical/dental health history interview will help the clinician pick up on clues and cues on the patient’s state of mind and help prevent an emergency situation. In an event an emergency thus occurs, all the resources available must be utilized efficiently and
Inadvertent perioperative hypothermia is a common anesthesia-related complication with reported prevalence ranging from 50% to 90%.(ref 3,4 of 4) The clinical consequences of perioperative hypothermia include tripling the risk of morbid myocardial outcomes and surgical wound infections, increased blood loss and transfusion requirements, and prolonged recovery and hospitalization.(ref 5)
A 39 years old male adult attended for a regular 6 monthly dental check up and routine scaling. The patient reports to suffer from anxiety, he is a teacher, a non-smoker, non-drinker and a regular dental attender.
Nitrous oxide is administered via a face mask and is used to take the edge off of your nerves. This form of sedation is great for uncomplicated procedures and for patients experiencing only mild levels of fear or anxiety. If you fall into this category, nitrous oxide sedation may be for you.
American Association of Nurse Anesthetists. Professional Aspects of Nurse Anesthesia Practice. Philadelphia: F. A. Davis Company, 1994. Print.
Volles, D. F. (2011, April 11). University of Virginia Health System Adult and Geriatric Sedation/Analgesia for Diagnostic and Therapeutic Procedures. Retrieved May 12, 2011, from University of Virgina Health System: University of Virginia Health System Adult and Geriatric Sedation/Analgesia for Diagnostic and Therapeutic Procedures
VAP develops in a patient after 48 hours or more of endotracheal intubation. According to a study by Relio et al. (as citied in Fields, L.B., 2008, Journal of Neuroscience Nursing, 40(5), 291-8) VAP adds an additional cost of $29,000-$40,000 per patient and increases the morality rate by 40-80%. Mechanically ventilated patients are at an increased risk in developing VAP due to factors such as circumvention of body’s own natural defense mechanisms in the upper respiratory tract (the filtering and protective properties of nasal mucosa and cilia), dry open mouth, and aspiration of oral secretions, altered consciousness, immobility, and possible immunosuppression. Furthermore, the accumulation of plaque in the oral cavity creates a biofilm that allows the patient’s mouth to become colonized with bacteria.
Reducing risks- blood pressure monitoring, maintenance of personal care records, and regular eye, foot, and dental examinations – general practitioner, endocrinologists, cardiologist, opthomalogist, and dentist (Francis, 2007).
For those with a strong fear of the dentist, general anesthesia or deep sedation offers the highest level of unconsciousness. Patients using these medications will be totally or almost unconscious throughout the work. Patients can't be easily awakened until the sedation wears off or until medication is provided to reverse the
Dentist believe the use of epinephrine is contraindicated in cardiovascular patients because it raises the blood pressure and heart rate. Studies show that the amount of epinephrine in dental cartridges is relatively low, therefore the use of one to three cartridges of lidocaine and epinephrine is safe, though it slightly raises blood pressure and heart rate. The slight rise in heart rate and blood pressure is not clinically or medically important. The wrong volume or concentration of anesthetic solution may produce systemic complications. A study given at Khorasgen Dental School determined that injection of lidocaine without epinephrine caused a reduction of blood pressure and heart rate due to the vasodilative effect of lidocaine. An increase in blood pressure and heart rate after injection of lidocaine with epinephrine was a result as well. Researchers have proved that an increase in cardiovascular parameters after injection of local anesthetics can be due to epinephrine
I seized an opportunity to quietly speak with her and she explained that she had not received an adequate amount of rest the night before and the journey down had been exhausting. She also expressed concerns about being fearful about going into the operating room. I overheard a nurse earlier ask the group as a whole if anyone wanted an ativan to ease anxiety and the group consensus was no. I felt that because it was unanimous, she may have been embarrassed if it was only her that requested it. My concern for this patient was for her to remain comfortable and provide any healing initiatives that would reassure her that she was safe.
Over time as individuals age and are faced with access to care issues they may begin to neglect their oral health. As time passes between dental hygiene cleanings or dentist visits the presence of oral disease may begin to increase.
In this article they interview a dentist Dr. Eric Salmon DDS he talks about the lack of understanding of how to properly care for the teeth and mouth. People including medical doctors do not realize the role the mouth plays in our overall health. He also shares an experience that he went through with a medical doctor who could not figure out why he was sick until one day he found that he had a hole in one of his back molar.
This could be a friend, a relative or even a stranger wearing aligners on their teeth. A patient can describe how the doctor is, whether the doctor is punctual and whether the doctor and their staff treat the patients well. Ask patients whether they have had any problems with the doctor. When you make enquiries, distinguish between treatment procedures that are generally painful and uncomfortable and those that become uncomfortable because of the rough treatment of doctors.
Consequently, I came over and introduced myself. We started talking and after a few minutes, I was able to help alleviate her fears. She mentioned how oblivious she was towards her own dental care. We discussed the advancement and the exponential growth in the field of dentistry and dental hygiene over the past decade. When she inquired why I desire to have a career in dentistry, I told her a story of how I started working as an assistant and was fortunate to have Dr. Bass as my mentor. Dr. Bass would always take the time to explain the surgeries and his techniques by usually starting with a discussion of how x-rays are used to locate the cause of the pain or discomfort. During the surgery, he would go step by step, explaining his surgical methods. Although tooth decay, and the different techniques to extract a tooth may be offensive to some, I find the steps to take care of them intriguing. He made me realize how much I love working with patients and how happy I would be to pursue a career as a
“The history-taking interview should be of high quality and must be accurately recorded” (Craig & Lloyd, p.48). It is important that while obtaining a thorough health history, that the patient is treated with dignity and that their privacy is respected. A complete history involves the collection of physical and psychosocial aspects of one’s health.