Essenstial Hypertention, What the Rationale Option Treatment
hypotension and hypertention emergencies in the dental office
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Transcript of hypotension and hypertention emergencies in the dental office
The best way to handle an emergency is to be prepared.
Staff should be trained and frequently updated in first aid and
cardiopulmonary resuscitation procedures. A written
emergency plan should be available
Preparation for Emergencies
Obtain a medical history on
every patient and update it at
each visit.
When confirming
appointments, remind patients
to take their normal
medications on the day of
their appointment
All staff members should be
trained in basic first aid
procedures and basic life
support (CPR).
The office should have a
written emergency plan,
emergency telephone numbers
should be posted at each
phone.
Each office should have an
emergency kit readily
available and each staff
member should know where it
is located.
Health Assessment
One key to reducing risk is to take a health history and vital signs to
identify the “at risk” patient. In some cases, extensive procedures
on “at risk” patients might are best performed in a hospital setting
ABC off any emergency
Supine position
100 % Oxygen
Evaluate Airway,, breathing ,, circulation
Vitals
Temperature . Blood pressure . Pulse .
Respiratory rate
estimationIt has been estimated that one or two life threatening emergencies will occur
in the lifetime practice of a general dentist.
Hypotension
Prevented by proper drug history before procedure
Management – maintenance of airway
- patient is made to lie down flat
- artificial ventilation if required
- medical help
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hypotension
Following syncope it is the most common
cause off loss off consciousness in the Dental
office
Orthostatic Hypotension
postural
Most common cause off hypotension in the
dental office
It is Syncope when the patient is placed
quickly from a supine to upright position
POSTURAL /ORTHOSTATIC
HYPOTENSION
MANAGEMENT OF MEDICAL EMERGENCIES IN DENTAL PRACTICE - 60 16
Pt attains upright position
SBP falls =<60mm of Hg due to ANS response
failure
Cerebral blood flow<critical level
Loss of consciousness
Supination=revival
PATHOLOGY
Drugs
Prolonged
recumbency /
convalescence
Late stage
pregnancy
Varicosities
Addison’s Disease
Severe exhaustion
Shy-Drager
Syndrome
ETIOLOGY
Why Most likely in elderly ?
Aging decreases baroreflex mechanism
which impairs cardioacceleratory response
to preload reduction during upright posture
May be on medications Most susceptible
مالحظات دندانپزشکی
بیماران با سابقه کاهش فشار وضعیتی-1
حین درمان ارامبخش دریافت کرده اند-2
برای مدت طوالنی روی صندلی دندانپزشکی قرار گرفته اند-3
دو تا سه بار در دقیقه به حالت نشسته قرار بگیرند تا عادت کنند
عالئم
تهوع-تعریق-اختالل دبد-گیجی-رنگ پریدگی
از دست رفتن هوشیاری
شبیه به سنکوپ وازودپرسور و برخالف ان اینجا ضربان قلب باال میرود
Vasovagal hypotension
A vasovagal episode or vasovagal response or
vasovagal attack (also called neurocardiogenic
syncope) is a malaise mediated by the vagus
nerve. When it leads to syncope or "fainting", it is
called a vasovagal syncope, which is the most
common type of fainting.Vasovagal syncope more
commonly affects young adults.
Vasovagal Hypotension (syncope)
Initiated by stressful physical ,,
psychological or surgical stimuli ( coughing
pain,, gaging )
The impulses are transmitted directly to
the medula in area closely related to the
nucllei off the vagus nerve
Clinical sign and symptoms
Bradycardia results from Vagal stimulation
and parasympathetic tone
• Vasodilation results from diminished
sympathetic tone
Treatment
Place in Trendelenburg position
• Oxygen
• Vitals
• ABC
• Evaluate BP
( if no BP monitor present , remember palpate
pulse, correlated to a systolic of: Radial 80 mm
Hg , Brachial 70 mm Hg , Carotid 60 m Hg )
• Administer: Phenylephrine spray 0.25-0.5 mg IV
2-3mg IM , Ephedrine 10-25 mg IV
route
Lay the patient flat as soon as possible and
raise the legs to improve venous return
Loosen any tight
clothing.