Altered consciousness

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Altered consciousness

  1. 1. ALTERED CONSCIOUSNESS
  2. 2. GENERAL CONSIDERATIONS     Terms Confusion intermingling of ideas Delirium illusions ,delusions Dizziness a disturbed sense of relationship to space unsteady------- Causes  drug overdose…..alcohol……local anesthesia, sedat…  Hyperventilation  Hypoglycemia  Hyperglycemia  Hypothyroidism  Hyperthyroidism  cerebr vasc acc 
  3. 3. ALTERED CONSCIOUSNESS Confusion intermingling of ideas Delirium illusions ,delusions Dizziness a disturbed sense of relationship to space unsteady-------
  4. 4. Predisposing factors Drugs alcohol; local anesth sed,  Hyperventilation  Diabetes mellitus  Thyroid gland dysfunctions 
  5. 5. prevention Early recognition  Avoid drugs  medical history  clinical exam 
  6. 6. Clin manif  Depend on cause in Hyperventilation: rapid respir rate  in Hypoglycemia : cold wet skin  in Hyperglycemia : hot dry skin  in Hypothyroidism: weakness fatigue  in Hyperthyroidism : restlessness  in cerebr vasc acc: sudden loss of consc 
  7. 7. management 1-Recognize  2- terminate dental procedure  3-P-----depend on cause  supine position is accepitable…….  in diabetic & thyroid dis--- upright  in cerebrovasc acc---- can upright to dec bl pr  3- A  B  C  4-definitive care  m- monitor vital signs  m- manage signs & symptom  d-defin tt depend on cause 
  8. 8. DIABETES MELLITUS [dm.] Definition  a disorder of glucose metabolism -- hyperglycemia due to decr insulin secretion or decr its activity or both  Normal glucose level  80----100 mg /100ml blood  decr 50 mg------------hypoglyc in adults  decr 40 mg-----------hypoglyc in children 
  9. 9. Fasting glucose level
  10. 10. complication Acute complications hypoglycemic coma….more acute& danger hyperglycemic coma….less acute & ??  chronic complications Affecting large bl vessels------arteriosclerosis Affecting small bl vessels--- microangiopathy Affecting interstit tissue…..incr infections periodontal infections 
  11. 11. Affecting large bl vessels-----arteriosclerosis Affecting small bl vessels--microangiopathy Affecting interstit tissue….. infections
  12. 12. Predisposing factors Genetic factor  if both parent --------100%offsprings  Disorders destroying islets of langerhans  Other endocrine dysfunctions  corticost ttt ----iatrogenic diabetes 
  13. 13. Classification of diabetes Depending on age  adult onset DM  juvenile onset DM  Depending on insulin injections  insulin dependent DM  non insulin dependent DM  NOW we have these types 
  14. 14. Type I DM  Type II DM  Impaired glucose tolerance I G T  Impaired fasting glucose I F G  Gestational diabetes 
  15. 15. Type I, juvenile, IDDM Genetically determined 8%  Usually start in young  There is no insulin in pat blood ie [ insulinopenic]  glucagon is high  pancreatic B-cells are non responsive 
  16. 16. Genetically determined 8% Usually start in young There is no insulin in pat blood ie [ insulinopenic] glucagon is high pancreatic B-cells are non responsive
  17. 17. GENETICALLY human lymphocytic antigens on the lymphocytes determined by chromosome 6 are impaired  Immunologically may autoimmune response as there are antibodies…  Other causes infect, drugs 
  18. 18. Type II, adult, NIDDM milder  80 %  Usually start in adults  There are enough insulin [ to avoid ketoacidosis]  usually don’t need exogenous insulin  
  19. 19.     May be duo to lack of insulin receptors in peripheral tissues is divided into Non obese type Obese type
  20. 20. Non obese obese
  21. 21. Clinical manifestations D M ----- may be presented as hyperglycemia or hypoglycemia NB hypoglycemia is more dangerous D M ----- may be presented as one or more of its complications 
  22. 22.  In hyperglycemia There is syndrome of poly polyurea, polydipsia ,polyphagia ,blurred vision ,pruritus….  Start by nocturnal enuresis with loss of w --coma  Other S/S….. 
  23. 23. Hyper glycemia
  24. 24.  In hypoglycemia In Early –CNS : hunger, nausea, hyperactive  In Moderate--- adrenaline is released...>  sweating ,bizarre behavioral patterns  In severe: unconsc, seizures ,hypotention &hypothermia  Acute complications are common 
  25. 25. hypoglycemia
  26. 26. Control of DM Self monitoring  Diet control  Physical activity  Oral hypoglycemic drugs  a)sulfonyureas  tolbutamide  Glyburide  b)biguanide metformin  Insulin treatment
  27. 27. Prevention Preliminary patient evaluation  Physical exam  DENTAL observations  -if any doubt--- physician  Type II can tolerate dental care  Type I should be cared  Observe ttt & complications  Adjust dose of local anesth, insulin 
  28. 28. Diabetic patients can tolerate hyperglycemia more than hypoglycemia  So after extensive dental procedures  type I DM ---check blood glucose level in the next few days….  Antibiotic cover is important 
  29. 29. management          I- recognition Sign & sy of hypoglycemia early: hunger ,nausea, Weakness & dizziness moderate :[adren rel],hot moist Pale skin late : anxiety , Headache Altered consc Sign & sy of hyperglycemia…..poly syndrome… blood glucose > 250 [non fasting] Acidosis ph < 7.3 Dry [loss of water],warm skin Abnormal respir [ Kussmaul’s ] Rapid weak pulse Altered consc
  30. 30. D/D hypoglycemia &hyperglycemia         In hypoglycemia onset : rapid [ min] Skin : cold & wet Breath : no odour In hyperglycemia onset : slow [ hours & days ] Skin : hot & dry Breath : acetone   If still in doubt----------apply PABC till medical assist DM patient with imp consc should be managed as having hypoglycemia until proved otherwise
  31. 31. Manag of hypogly a-consc 1-recognition of hypoglycemia  2-terminate dent proc  3-p  4-A, B,C  5-definitive care  oral CHO  orange juice  6- recovery  observe for at least 1h 
  32. 32. Manag of hypogly b-unconsc             1- no time for recognition of hypoglycemia 2-terminate dent proc 3-p 4-A, B,C 5-definitive care summoning of medical assistance IV CHO 50% dextrose 1mg glucagon .5mg epinephrine 6- recovery oral CHO after recovery
  33. 33. Manag of hypergly a-consc 1-recognition of hyperglycemia  2-avoid any dental pro & terminate any one 
  34. 34. Manag of hypergly b-unconsc             1-R 2-terminate dent proc 3-p 4-A, B,C 7-definitive care medical assistance IV CHO 5% , 5% , 5% . 5% . 5% dextrose ?? insulin in emergency give O 8- transport to hospital

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