med emergency, respiratory distress

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Asthma
Chapter 8

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Objectives
• Upon completion of this chapter, you will
be able to:
– Define asthma
– Explain two of the causes of asthma
– Describe the signs and symptoms of asthma
– Describe the treatment provided for an
asthma attack
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Introduction
• Diseases or problems associated with the
respiratory system
– Asthma attacks are one type of emergency
seen in a dental office
– Asthma is a disease of the respiratory tract
that can affect all aspects of the
tracheobronchial tree: trachea, bronchi, and
bronchioles
• Affects a large part of the population
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Types
• Extrinsic asthma (allergic asthma):
– Most common type of asthma in children and
young adults and can be outgrown
• Usually do not exhibit any signs or symptoms of
asthma between episodes
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Types (cont’d.)
– Triggered by exposure to allergen or exercise
induced
– Dental team needs to be aware of any
allergens that trigger a patient’s asthma
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Types (cont’d.)
Emergency Basics Box 8-1: Common Allergens in the Dental Office
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Types (cont’d.)
• Intrinsic asthma (infectious asthma):
– Most often seen in adults older than 35
– Usually occurs as a result of a bronchial
infection
– Patient may exhibit a chronic cough with
sputum production between attacks
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Types (cont’d.)
• Status asthmaticus
– Most severe type that does not respond to
normal drug therapy
– Patient needs to be hospitalized
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Causes
• Asthma attacks can be triggered by many
causes
– Allergens
– Anxiety or emotional upset is the main cause
of attacks in the dental office
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Causes (cont’d.)
– For prevention, it is important for staff to:
• Not keep the patient waiting for an extended period
• Explain and demonstrate procedures/equipment
• Not use threatening terminology (shot)
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Symptoms
• Can occur quickly or over a period of time
• Must distinguish between asthma attack
and airway obstruction
– With an airway obstruction: stridor (constant
pitch musical sound)
– With asthma: wheezing
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Symptoms (cont’d.)
– If a patient has indicated a history of asthma,
the attack should be treated as asthma
• Patient will appear to be struggling for air
– May be sweating, coughing, or nervous
– May complain of severe tightness in chest
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Symptoms (cont’d.)
• Duration varies
– Attack can end quickly if the patient is treated
with a bronchodilator
– Status asthmaticus does not respond to
medication and the patient should be
hospitalized
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Treatment
• Stop all dental treatment
– Remove all materials and instruments from
the patient’s mouth
• Position the patient upright
– Patient can breathe easier if seated upright
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Treatment (cont’d.)
• Use a bronchodilator
– While reviewing the health history, dental
auxiliary should ask if the patient uses a
bronchodilator
• Administer oxygen
– Administer four to six liters of oxygen per
minute by a full-face mask or nasal canula
– Have the patient hold the mask
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Treatment (cont’d.)
• If the bronchodilator does not relieve the
attack, the dentist may have to administer
epinephrine
• If treatment is unsuccessful, call EMS
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Treatment for Asthma
Emergency Basics Box 8-3 Treatment for Asthma
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Summary
• Asthma attacks in the dental office are
most often triggered by anxiety
• Particularly important to keep patients with
asthma calm during dental treatment
• Should an asthma attack occur, administer
treatment promptly
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