This document provides information on medical emergencies that may occur during dental procedures. It discusses the incidence of medical emergencies during dentistry, types of emergencies such as altered consciousness, cardiovascular, allergic reactions and respiratory issues. It also covers prevention, preparation and management of various emergencies like vasodepressor syncope, shock, anaphylaxis, hypertension, asthma, hyperventilation and airway obstruction. Management strategies for emergencies related to diabetes are also discussed.
Epilepsy
Epilepsy is a group is neurological disorder. An epileptic seizure is a paroxysm(sudden) of uncontrolled discharges of neurons causing an event that is discernible(visible) by the person experiencing the seizures or by the observer. The tendency to have recurrent attacks is known as epilepsy.
phenytoin,phenobarbital,sodium valporate ,carbamazepine,clonazepam and diazepam, lamotrigine,pregabalin,felbamate,zonisamide, ETHOSUXIMIDE, LEVETIRACETAM, OXACARBAZEPINE, PRIMIDONE
Headache Syndromes presentation Dr. Tarek .pptxAhmedalmahdi16
The document provides diagnostic criteria and treatment guidelines for various headache conditions including migraine without aura, cluster headaches, chronic daily headaches, and trigeminal neuralgia. It discusses diagnostic features, first-line and alternative treatment options involving medications like triptans, topiramate, propranolol, verapamil, and carbamazepine. It also notes risk factors, complications, and when to consider specialist referral for certain headache conditions.
The document discusses emergency management in dental offices. It outlines various types of dental and medical emergencies that may occur, such as injuries, infections, fainting, seizures and allergic reactions. It emphasizes the importance of prompt diagnosis, pain relief, referral when needed, and having trained staff and emergency equipment. The ABCDE approach of assessing airways, breathing, circulation, disability and exposure is recommended for dealing with medical emergencies until emergency services arrive.
This document provides information on epilepsy including its definition, incidence, epidemiology, pathophysiology, clinical manifestations, assessment and diagnosis, prevention, treatment, and the nurses' role in caring for patients with epilepsy. Epilepsy is defined as a chronic neurological disorder characterized by recurrent seizures caused by abnormal electrical activity in the brain. It affects approximately 50 million people globally and 2-4 million people in the US. The risk factors include genetic predisposition, brain injuries, infections, tumors and other neurological conditions. Treatment involves long-term medication and potentially surgery to remove the epileptic focus in some cases. Nurses play an important role in patient safety, education, and supporting long-term management of the condition.
This document discusses the management of patients with neurological disorders like epilepsy. It defines a seizure as excessive electrical activity in the brain that causes changes in behavior. Epilepsy is characterized by recurrent seizures that may or may not involve loss of consciousness. Some key considerations for dental management of epileptic patients include scheduling appointments when medications have been taken, using proper lighting to avoid triggering seizures, and allowing seizures to run their course without intervention if one occurs. The document also discusses managing pregnant patients by deferring elective procedures if possible, using lead shielding for necessary x-rays, and avoiding teratogenic drugs.
prevention & management of medical emergencies in dental office.pptAdirikak
This document discusses the prevention and management of medical emergencies in the dental office. It begins by emphasizing the importance of prevention through thorough patient assessment and history. It then reviews common types of emergencies seen in dental offices, which are most often altered consciousness, cardiovascular, allergic reactions, and respiratory. The document provides detailed guidance on managing specific emergencies such as adrenal crisis, airway obstruction, anaphylaxis, local anesthesia reactions, angina, and asthma. It stresses the importance of recognition, preparation, basic life support skills, and knowing when to refer patients to advanced medical care.
This document provides information on medical emergencies that may occur during dental procedures. It discusses the incidence of medical emergencies during dentistry, types of emergencies such as altered consciousness, cardiovascular, allergic reactions and respiratory issues. It also covers prevention, preparation and management of various emergencies like vasodepressor syncope, shock, anaphylaxis, hypertension, asthma, hyperventilation and airway obstruction. Management strategies for emergencies related to diabetes are also discussed.
Epilepsy
Epilepsy is a group is neurological disorder. An epileptic seizure is a paroxysm(sudden) of uncontrolled discharges of neurons causing an event that is discernible(visible) by the person experiencing the seizures or by the observer. The tendency to have recurrent attacks is known as epilepsy.
phenytoin,phenobarbital,sodium valporate ,carbamazepine,clonazepam and diazepam, lamotrigine,pregabalin,felbamate,zonisamide, ETHOSUXIMIDE, LEVETIRACETAM, OXACARBAZEPINE, PRIMIDONE
Headache Syndromes presentation Dr. Tarek .pptxAhmedalmahdi16
The document provides diagnostic criteria and treatment guidelines for various headache conditions including migraine without aura, cluster headaches, chronic daily headaches, and trigeminal neuralgia. It discusses diagnostic features, first-line and alternative treatment options involving medications like triptans, topiramate, propranolol, verapamil, and carbamazepine. It also notes risk factors, complications, and when to consider specialist referral for certain headache conditions.
The document discusses emergency management in dental offices. It outlines various types of dental and medical emergencies that may occur, such as injuries, infections, fainting, seizures and allergic reactions. It emphasizes the importance of prompt diagnosis, pain relief, referral when needed, and having trained staff and emergency equipment. The ABCDE approach of assessing airways, breathing, circulation, disability and exposure is recommended for dealing with medical emergencies until emergency services arrive.
This document provides information on epilepsy including its definition, incidence, epidemiology, pathophysiology, clinical manifestations, assessment and diagnosis, prevention, treatment, and the nurses' role in caring for patients with epilepsy. Epilepsy is defined as a chronic neurological disorder characterized by recurrent seizures caused by abnormal electrical activity in the brain. It affects approximately 50 million people globally and 2-4 million people in the US. The risk factors include genetic predisposition, brain injuries, infections, tumors and other neurological conditions. Treatment involves long-term medication and potentially surgery to remove the epileptic focus in some cases. Nurses play an important role in patient safety, education, and supporting long-term management of the condition.
This document discusses the management of patients with neurological disorders like epilepsy. It defines a seizure as excessive electrical activity in the brain that causes changes in behavior. Epilepsy is characterized by recurrent seizures that may or may not involve loss of consciousness. Some key considerations for dental management of epileptic patients include scheduling appointments when medications have been taken, using proper lighting to avoid triggering seizures, and allowing seizures to run their course without intervention if one occurs. The document also discusses managing pregnant patients by deferring elective procedures if possible, using lead shielding for necessary x-rays, and avoiding teratogenic drugs.
prevention & management of medical emergencies in dental office.pptAdirikak
This document discusses the prevention and management of medical emergencies in the dental office. It begins by emphasizing the importance of prevention through thorough patient assessment and history. It then reviews common types of emergencies seen in dental offices, which are most often altered consciousness, cardiovascular, allergic reactions, and respiratory. The document provides detailed guidance on managing specific emergencies such as adrenal crisis, airway obstruction, anaphylaxis, local anesthesia reactions, angina, and asthma. It stresses the importance of recognition, preparation, basic life support skills, and knowing when to refer patients to advanced medical care.
This document discusses the management of violent patients in the emergency department. It notes that violence can result from medical conditions like intoxication, withdrawal, or trauma. To prevent violence, staff should be aware of signs of escalation like aggression or challenges to authority. If a patient becomes violent, staff should try verbal de-escalation and improving the patient's comfort. If that does not work, physical or chemical restraints may be needed. The document provides guidance on appropriate chemical restraint medications and protocols. It also recommends ways for hospitals to reduce violence risks, such as limiting access points, using security screening, and having emergency response plans.
The document is a disclosure statement from Dr. Ahmad Saladdin Sultan stating that he does not have any financial conflicts of interest in relation to the program or presentation being given. It provides background on Dr. Sultan's qualifications and specialty in emergency medicine. The document then covers three parts: headaches including types like migraine, tension, and cluster headaches; Bell's palsy including symptoms, causes, and treatment; and seizures including types, evaluation, and management.
This document discusses various types of medical emergencies that can occur in a dental office setting and how to manage them. It begins by defining what constitutes a medical emergency and then describes common emergencies such as syncope, seizures, respiratory issues like asthma, cardiovascular events like angina and myocardial infarction, allergic reactions, hypoglycemia, and issues related to local anesthetic administration like overdose. For each type of emergency, it discusses signs and symptoms, prevention strategies, and management approaches. Throughout it emphasizes the importance of being prepared for emergencies through training and having emergency equipment and medications available.
This document provides an overview of general toxicology. It discusses factors affecting the toxic response, including factors related to the poison and patient. It describes various types of toxins based on origin, site of action, and organ specificity. It also summarizes approaches to managing the poisoned patient, including stabilization, decontamination, and enhanced elimination techniques like activated charcoal, gastric lavage, forced diuresis, and dialysis. Complications and contraindications of different management strategies are also outlined.
Epilepsy is a chronic neurological disorder characterized by recurrent seizures. It affects approximately 50 million people worldwide. Seizures occur due to abnormal electrical activity in the brain and can vary from brief lapses of awareness to severe and prolonged convulsions. Management involves anti-seizure medications and lifestyle modifications. Nurses play an important role in patient education and safety during seizures.
Epilepsy is a chronic neurological disorder characterized by recurrent seizures. It affects approximately 50 million people worldwide. Seizures occur due to abnormal electrical activity in the brain and can vary from brief lapses of awareness to severe and prolonged convulsions. Management involves anti-seizure medications and lifestyle modifications. Nurses play an important role in patient education and safety during seizures.
Emergencies management in office practice puja fianlllllRaghavendra Babu
This document discusses managing emergencies in a pediatric office setting. It emphasizes the importance of early recognition and stabilization of emergencies before timely transfer to a facility that can provide definitive care. Common office emergencies like anaphylaxis, croup, and seizures are reviewed. For anaphylaxis, early epinephrine administration is critical. Croup is treated with steroids and nebulized adrenaline as needed. Febrile seizures are commonly seen and status epilepticus requires lorazepam or midazolam to control seizures.
1) The document discusses unconsciousness in dentistry, including general causes, predisposing factors, prevention, clinical manifestations, and management.
2) Important causes of unconsciousness discussed include neurogenic syncope, postural hypotension, cardiogenic issues, failed oxygenation, drugs, and acute adrenal insufficiency.
3) The basic steps for management of unconsciousness are: recognition (R), termination of the dental procedure (T), positioning the patient supine with feet elevated (P), then addressing airway (A), breathing (B), and circulation (C). Definitive care then depends on the underlying cause.
This document defines and discusses adverse drug reactions (ADRs). It notes that ADRs affect 6-30% of patients and are a leading cause of death. ADRs are classified as non-immunological or immunological. Risk factors include age, number of drugs used, and immune status. Evaluation of ADRs involves a drug history, ruling out other causes, and assessing the temporal relationship to drug intake. Management involves discontinuing the offending drug if possible. Common ADRs to anti-TB drugs are discussed as well as their management.
This document is a report submitted by Piyush Raj Singh Chauhan to the Dr. A.P.J Abdul Kalam Technical University in Lucknow, India in December 2017. It discusses Piyush's training at a hospital, including first aid techniques like artificial respiration, wound dressing, and reviewing patient charts. It also covers dispensing medication, examining pathology reports, x-rays and MRI scans. The report includes acknowledgments, an introduction, figures to illustrate techniques, and a conclusion on the hospital training experience.
This document discusses nerve agents and their management. It outlines the signs and symptoms of nerve agent exposure including miosis, nausea, muscle weakness, respiratory failure and seizures. It recommends rapid administration of atropine and 2-PAM chloride as antidotes for severe exposures. The roles of various agencies, EMS, hospitals and public health in responding to a nerve agent incident are reviewed, including decontamination, treatment and protecting healthcare workers through appropriate PPE.
This document provides information on medical emergencies that can occur in dental practice settings. It discusses the importance of recognizing at-risk patients and conducting thorough medical histories. It also outlines the primary survey process for assessing airway, breathing, circulation, disability, and exposure during a medical emergency. Finally, it provides details on responding to specific emergency situations like syncope, angina, myocardial infarction, seizures, hypoglycemia, asthma, foreign body obstruction, anaphylaxis, hyperventilation, and adrenal insufficiency.
The document discusses various medical and dental emergencies that may be encountered in dental practice, including syncope, airway obstruction, anaphylaxis, local anesthetic toxicity, asthma attacks, chest pain, hemorrhage, and seizures. It provides details on the signs and symptoms, management, and treatment of each condition. It also covers dental complications such as aspiration, allergic reactions, and sodium hypochlorite accidents, as well as considerations for patients with pacemakers or ICDs.
The document discusses symptom management of side effects from chemotherapy, immunotherapy, and targeted therapy, including mucositis, hair loss, infusion reactions, myelosuppression, peripheral neuropathy, and effects on sex and reproduction. It also covers common toxicities associated with immune checkpoint inhibitors such as pneumonitis, colitis, nephritis, hepatitis, hypothyroidism, and hyperthyroidism. Treatment options are provided for managing many of these side effects.
The document provides an acknowledgment and thanks to various individuals who helped with the completion of a project. It expresses gratitude to faculty members, teaching staff, and parents for their support and guidance. The document includes an introduction to a hospital layout and various departments. It also provides information on first aid treatment for various medical emergencies and procedures like artificial respiration, wound dressing, and routes of injection administration. Tables of contents and figures are included related to the topics discussed.
Anaphylaxis Management: Problems with the Current Paradigm and the need for ...Michael Langan, M.D.
Michael Langan, MD
Geriatrician, MGH Senior Health
September 10, 2012
Epi-Port (cartridge housing, portable, fashionable, easy to use)
Epi-Pod (cartridge, removable, replaceable)
A new drug delivery system for treatment of anaphylactic shock
Twist, Turn, Push (TTP)
From concept to patent to market
1:30P.M.-2:30P.M.
Fox Hill Village Auditorium
Sponsored by the MGH Wellness Center
*************************
This document discusses the management of violent patients in the emergency department. It notes that violence can result from medical conditions like intoxication, withdrawal, or trauma. To prevent violence, staff should be aware of signs of escalation like aggression or challenges to authority. If a patient becomes violent, staff should try verbal de-escalation and improving the patient's comfort. If that does not work, physical or chemical restraints may be needed. The document provides guidance on appropriate chemical restraint medications and protocols. It also recommends ways for hospitals to reduce violence risks, such as limiting access points, using security screening, and having emergency response plans.
The document is a disclosure statement from Dr. Ahmad Saladdin Sultan stating that he does not have any financial conflicts of interest in relation to the program or presentation being given. It provides background on Dr. Sultan's qualifications and specialty in emergency medicine. The document then covers three parts: headaches including types like migraine, tension, and cluster headaches; Bell's palsy including symptoms, causes, and treatment; and seizures including types, evaluation, and management.
This document discusses various types of medical emergencies that can occur in a dental office setting and how to manage them. It begins by defining what constitutes a medical emergency and then describes common emergencies such as syncope, seizures, respiratory issues like asthma, cardiovascular events like angina and myocardial infarction, allergic reactions, hypoglycemia, and issues related to local anesthetic administration like overdose. For each type of emergency, it discusses signs and symptoms, prevention strategies, and management approaches. Throughout it emphasizes the importance of being prepared for emergencies through training and having emergency equipment and medications available.
This document provides an overview of general toxicology. It discusses factors affecting the toxic response, including factors related to the poison and patient. It describes various types of toxins based on origin, site of action, and organ specificity. It also summarizes approaches to managing the poisoned patient, including stabilization, decontamination, and enhanced elimination techniques like activated charcoal, gastric lavage, forced diuresis, and dialysis. Complications and contraindications of different management strategies are also outlined.
Epilepsy is a chronic neurological disorder characterized by recurrent seizures. It affects approximately 50 million people worldwide. Seizures occur due to abnormal electrical activity in the brain and can vary from brief lapses of awareness to severe and prolonged convulsions. Management involves anti-seizure medications and lifestyle modifications. Nurses play an important role in patient education and safety during seizures.
Epilepsy is a chronic neurological disorder characterized by recurrent seizures. It affects approximately 50 million people worldwide. Seizures occur due to abnormal electrical activity in the brain and can vary from brief lapses of awareness to severe and prolonged convulsions. Management involves anti-seizure medications and lifestyle modifications. Nurses play an important role in patient education and safety during seizures.
Emergencies management in office practice puja fianlllllRaghavendra Babu
This document discusses managing emergencies in a pediatric office setting. It emphasizes the importance of early recognition and stabilization of emergencies before timely transfer to a facility that can provide definitive care. Common office emergencies like anaphylaxis, croup, and seizures are reviewed. For anaphylaxis, early epinephrine administration is critical. Croup is treated with steroids and nebulized adrenaline as needed. Febrile seizures are commonly seen and status epilepticus requires lorazepam or midazolam to control seizures.
1) The document discusses unconsciousness in dentistry, including general causes, predisposing factors, prevention, clinical manifestations, and management.
2) Important causes of unconsciousness discussed include neurogenic syncope, postural hypotension, cardiogenic issues, failed oxygenation, drugs, and acute adrenal insufficiency.
3) The basic steps for management of unconsciousness are: recognition (R), termination of the dental procedure (T), positioning the patient supine with feet elevated (P), then addressing airway (A), breathing (B), and circulation (C). Definitive care then depends on the underlying cause.
This document defines and discusses adverse drug reactions (ADRs). It notes that ADRs affect 6-30% of patients and are a leading cause of death. ADRs are classified as non-immunological or immunological. Risk factors include age, number of drugs used, and immune status. Evaluation of ADRs involves a drug history, ruling out other causes, and assessing the temporal relationship to drug intake. Management involves discontinuing the offending drug if possible. Common ADRs to anti-TB drugs are discussed as well as their management.
This document is a report submitted by Piyush Raj Singh Chauhan to the Dr. A.P.J Abdul Kalam Technical University in Lucknow, India in December 2017. It discusses Piyush's training at a hospital, including first aid techniques like artificial respiration, wound dressing, and reviewing patient charts. It also covers dispensing medication, examining pathology reports, x-rays and MRI scans. The report includes acknowledgments, an introduction, figures to illustrate techniques, and a conclusion on the hospital training experience.
This document discusses nerve agents and their management. It outlines the signs and symptoms of nerve agent exposure including miosis, nausea, muscle weakness, respiratory failure and seizures. It recommends rapid administration of atropine and 2-PAM chloride as antidotes for severe exposures. The roles of various agencies, EMS, hospitals and public health in responding to a nerve agent incident are reviewed, including decontamination, treatment and protecting healthcare workers through appropriate PPE.
This document provides information on medical emergencies that can occur in dental practice settings. It discusses the importance of recognizing at-risk patients and conducting thorough medical histories. It also outlines the primary survey process for assessing airway, breathing, circulation, disability, and exposure during a medical emergency. Finally, it provides details on responding to specific emergency situations like syncope, angina, myocardial infarction, seizures, hypoglycemia, asthma, foreign body obstruction, anaphylaxis, hyperventilation, and adrenal insufficiency.
The document discusses various medical and dental emergencies that may be encountered in dental practice, including syncope, airway obstruction, anaphylaxis, local anesthetic toxicity, asthma attacks, chest pain, hemorrhage, and seizures. It provides details on the signs and symptoms, management, and treatment of each condition. It also covers dental complications such as aspiration, allergic reactions, and sodium hypochlorite accidents, as well as considerations for patients with pacemakers or ICDs.
The document discusses symptom management of side effects from chemotherapy, immunotherapy, and targeted therapy, including mucositis, hair loss, infusion reactions, myelosuppression, peripheral neuropathy, and effects on sex and reproduction. It also covers common toxicities associated with immune checkpoint inhibitors such as pneumonitis, colitis, nephritis, hepatitis, hypothyroidism, and hyperthyroidism. Treatment options are provided for managing many of these side effects.
The document provides an acknowledgment and thanks to various individuals who helped with the completion of a project. It expresses gratitude to faculty members, teaching staff, and parents for their support and guidance. The document includes an introduction to a hospital layout and various departments. It also provides information on first aid treatment for various medical emergencies and procedures like artificial respiration, wound dressing, and routes of injection administration. Tables of contents and figures are included related to the topics discussed.
Anaphylaxis Management: Problems with the Current Paradigm and the need for ...Michael Langan, M.D.
Michael Langan, MD
Geriatrician, MGH Senior Health
September 10, 2012
Epi-Port (cartridge housing, portable, fashionable, easy to use)
Epi-Pod (cartridge, removable, replaceable)
A new drug delivery system for treatment of anaphylactic shock
Twist, Turn, Push (TTP)
From concept to patent to market
1:30P.M.-2:30P.M.
Fox Hill Village Auditorium
Sponsored by the MGH Wellness Center
*************************
Similar to Management of acute asthamic attack.pptx (20)
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
4. Prevention
Goals of physical evaluation
Physical evaluation –
▶ Medical history questionnaire,
▶ Physical examination
▶ Dialogue history.
5. ASAPhysicalStatusClassification
▶ Class1: Healthy patient with no systemic disease.
▶ Class 2: Mild Systemic disease with no limits on
activity.
▶ Class 3: Severe systemic disease that limits
activity.
▶ Class 4: Incapacitating systemic disease that is life
threatening.
▶ Class 5: Moribund and E refers to emergency
of any kind.
6. Anxietyrecognition&stressreduction
protocol
▶ Recognize patient’s anxiety level.
▶ Consider using pre-medication or sedation
▶ Schedule morning appointments.
▶ Minimize waiting time and watch appointment
length.
▶ Make sure to use adequate pain control. This will
vary from patient to patient.
▶ Monitor vital signs.
▶ Medical consult if required.
Stanley F Malamed – Med emergencies in the dental office
: 8th Ed
8. Module one – critical or essential emergency drugs
Category Generic
drug
alternative quantity Availability
Allergy –
anaphylaxis
Epinephri
ne
None 1 preloaded
syringe +3x1
ml ampules
1:1000
(1mg/ml)
allergy –
histamine
blocker
Chlorp
henira
mine
Diphenhydra
mine (Benadryl)
3x1 ml
ampules
10 mg/ml
Oxygen Oxygen 1 “E” cylinder
Vasodilator Nitroglycerin Nitrostat
sublingual
tablets
1 metered spray
bottle
0.4 mg
/metered
dose
Bronchodilator Albuterol Metaproterenol 1 metered dose
inhaler
Metered
aerosol
inhaler
Antihypoglyce
mic
Sugar Insta – glucose
gel
1 bottle
Inhibitor of
platelet
aggregation
Asprin None 2 packets 325mg/tabl
et
Stanley F Malamed – Med emergencies in the dental office : 8th
Ed
9. Equipment Recommended Alternative Quantity
Oxygen delivery
system
Positive pressure and
demand valve
Pocket mask
Oxygen delivery
system with bag valve
mask device
Minimum: 1 large
adult, 1 child
1 per employee
Automated electronic
defibrillator(AED)
Many 1 AED
Syringes for drug
administration
Plastic disposable
syringes with needles
3x2 ml syringes with
needles for parenteral
drug administration
Suction and suction
tips
High volume suction
Large diameter, round
ended suction tips
Non electrical suction
system
Office suction system
Minimum 2
Tourniquets Robber and Velcro
tourniquet; rubber
tubing
spygmomanometer 3 torniquets and 1
spygmomanometer
Magill intubation
forceps
Magill intubation
forceps
1 pediatric Magill
intubation forceps
10. Module two – secondary/ noncritical drugs and equipment
Category Generic Drug Alternative Quantity Availability
Anticonvulsant Midazolam diazepam 1x5 ml vial 5 mg/ml
Analgesic Morphine
sulphate
Meperidine 3x1 ml ampules 10 mg/ml
Vasopressor Phenylephrine 3x1 ml ampules 10 mg/ml
Antihypoglycem
ic
50% dextrose Glucagon 1 vial 50 ml ampule
Corticosteroid Hydrocortisone
sodium succinate
Dexamethasone 2x2 ml mix- o –
vial
50 mg/ml
Antihypertensive Esmolol Propranolol 2x100 mg/ml
vial
100 mg/ml
Anticholinergic Atropine Scopolamine 3x1 ml ampules 0.5 mg/ml
Respiratory
stimulant
Aromatic
ammonia
2 boxes 0.3 ml/vaporole
Antihypertensive Nifedipine 1 bottle 10mg/capsule
11. Module three – Advanced Cardiac Life Support (ACLS) : essential
drugs
Category Generic Drug Alternative Quantity Availability
Cardiac Arrest epinephrine 3x10 ml
preloaded
syringes
1:10,000
(1mg/10ml
syringe)
Analgesic Morphine
sulphate
N2O – O2 3x1 ml ampules 10 mg/ml
Antidysrhythmic Lidocaine Procainamide 1 preloaded
syringe and 2x5
ml ampules
100 mg/ syringe
Symptomatic
Bradycardia
Atropine Isoproterenol 2x10 ml
syringes
1.0 mg/10 ml
Paroxysmal
Supraventricular
Tachycardia
verapamil 2x4 ml ampules 2.5 mg/ml
12. Module four – antidotal drugs
Category Generic Drug Alternative Quantity Availability
Opioid
antagonist
Naloxone nalbuphine 2x1 ml ampules 0.4 mg/ml
Benzodiazepine
antagonist
Flumazenil 1x 10 ml vial 0.1 mg/ml
Anticholinergic
toxicity
Antiemergence
delirium
Physostigmine 3x2 ml ampules 1 mg/ml
14. ASTHMA
▶ In 1830 Eberle, a Philadelphia physician, defined it as “paroxysmal
affection of the respiratory organs, characterized by great
difficulty of breathing, tightness across breast, and a sense of
impending suffocation, without fever or local inflammation.”
▶ Today it is defined as “a chronic inflammatory disorder that is
characterized by reversible obstruction of the airways.”
Stanley F Malamed – Med emergencies in the dental office :
8th Ed
15. Predisposing factors:
Extrinsic or allergic asthma,
▶ The allergens may be airborne – house dust, feathers, animal
dander, furniture stuffing, fungal spores, or plant pollens.
▶ Food and drugs – cow’s milk, egg, fish, chocolate, shellfish,
tomatoes, penicillins, vaccines , asprin, and sulfites.
▶ Type I hypersensitivity reaction – Ig E antibodies produced in
response to allergen
▶ Approximately, 50% asthmatic children become asymptomatic
before reaching adulthood
Stanley F Malamed – Med emergencies in the dental
office : 8th Ed
16. Intrinsic or nonallergic, idiosyncratic, nonatopic asthma:
▶ Usually develops in adult age > 35 years
▶ Non – allergic factors – respiratory infection (viral infection is more
common causative factor), physical exertion, environmental and
air pollution, and occupational stimuli
▶ Psychological and physiologic stress can also contribute to
asthmatic episodes in susceptible individuals
▶ Acute episodes are usually more fulminant and severe than those
of extrinsic asthma. Long-term prognosis also less optimistic.
Mixed asthma:
▶ Combination of extrinsic and intrinsic asthma. Major precipitating
factor is respiratory tract infection.
Stanley F Malamed – Med emergencies in the dental office :
8th Ed
17. Status asthmaticus:
▶ More severe clinical form
▶ Experience wheezing, dyspnea, hypoxia
▶ Refractory to 2 – 3 doses of β-adrenergic agents
▶ If not managed adequately, patient may die due to respiratory distress
Prevention:
Medical history regarding
▶ Lung diseases
▶ Allergies to drugs, food, medication, latex.
▶ Usage of drugs, medications, natural remidies.
Stanley F Malamed – Med emergencies in the dental
office : 8th Ed
18. History:
▶ Asthma?
▶ Type extrinsic or intrinsic?
▶ Age of onset
▶ History of acute episodes
▶ Precipitating factor
▶ Management
Stanley F Malamed – Med emergencies in the dental
office : 8th Ed
19. Commonly prescribed drugs for the management:
Bronchodilators:
Sympathomimetic:
▶ Albuterol
▶ Salmeterol
▶ Metaproterenol
▶ Levalbuterol
▶ Epinephrine
▶ Theophylline
▶ Aminophylline
anticholinergic:
▶ Ipratropium
Corticosteroids:
▶ Beclomethasone , Triamcinolone, Flunisolide
▶ Mometasone , Fluticasone, Budesonide
Antimediator: Cromolyn sodium, Nedocromil sodium
Stanley F Malamed – Med emergencies in the dental
office : 8th Ed
20. Dental therapy considerations:
▶ Stress reduction protocol in case of emotional stress
▶ Contraindication of barbiturates and opioids as increase the risk of
bronchospasm
▶ Some inhalational anesthetics like ether irritates respiratory
mucosa
▶ Special care should be taken while prescribing analgesics
▶ Some patients are sensitive to bisulphites, local anesthesia is
contraindicated
Stanley F Malamed – Med emergencies in the dental office : 8th Ed
21. Clinical manifestations:
▶ Feeling of chest congestion
▶ Cough, with or without sputum production
▶ Wheezing
▶ Dyspnea
▶ Patient wants to sit or stand up
▶ Use of accessory muscles of respiration
▶ Increased anxiety and apprehension
▶ Tachypnea (>20 - >40 in severe cases)
▶ Rise in B.P
▶ Increase in heart rate (>120 bpm in severe cases)
Only in respiratory distress
▶ Diaphoresis
▶ Agitation
▶ Somnolence
▶ Confusion
▶ Cyanosis
▶ Supraclavicular and intercostal retraction
▶ Nasal flaring
Stanley F Malamed – Med emergencies in the dental office : 8th Ed
22. Pathophysiology:
▶ Neural control of airways
▶ Airway inflammation
▶ Immunological responses
▶ Bronchospasm
▶ Bronchial wall edema and hypersecretion of mucous glands
▶ Breathing
Oxford textbook of Medicine : 5th Edition
23. Management:
Recognize problem (respiratory distress, wheezing)
Discontinue dental treatment
Activate office emergency team
P – Position, usually upright with arms thrown forward
A → B → C –Assess and perform basic life support as needed
D – Definitive care:
Administer O2
Administer bronchodilator via inhalation
(Episode terminates) (episode continues)
Dental care may continue
Discharge patient
Hospitalize or discharge patient, per
Activate EMS
Administer parenteral drugs
EMS recommendation
Additional considerations: Sedatives which depress respiratory system and central nervous system are absolutely contraindicated. 5mg IV
or IM diazepam may be indicated to decrease anxiety.
Stanley F Malamed – Med emergencies in the dental office : 8th Ed
25. SEIZURES
Types:
Causes:
▶ Congenital abnormalities
▶ Perinatal injuries
▶ Metabolic and toxic disorders
▶ Head trauma
▶ Tumors
▶ Vascular diseases
▶ Degenerative disorders
▶ Infectious diseases
Partial seizures Generalized seizures
Simple partial Absence seizures (true petitmal)
Complex partial Myoclonic seizures
Partial seizures evolving to generalized
tonic – clonic
Tonic – clonic seizures
Unclassified epileptic seizures
Stanley F Malamed – Med emergencies in the dental office : 8th Ed
26. Predisposing factors:
▶ Hypoxia , hypoglycemia, hypocalcemia
▶ Flashing lights, fatigue, decreased physical health, a missed meal,
alcohol ingestion, physical or emotional stress, sleep and
menstrual cycle
Prevention:
▶ Care in selection of LA agent & use of proper technique
▶ Medical history questionnaire about fainting spells, seizures
▶ Dialogue history about previous experience of seizures, onset,
duration, management
Dental therapy considerations:
▶ Conscious sedation – N2O – O2 & benzodiazepines
Stanley F Malamed – Med emergencies in the dental office : 8th Ed
27. Clinical manifestations:
▶ Simple partial seizure – individual remains conscious while a limb
jerks for several seconds
▶ Complex partial seizures – altered consciousness with altered
behavioral patterns (automatisms) like some uncoordinated
purposeless activities (lip smacking, chewing or sucking)
▶ Absence seizure – sudden immobility and a blank stare and minor
facial clonic movements
Stanley F Malamed – Med emergencies in the dental office : 8th Ed
28. ▶ Tonic- clonic seizure –
preictal phase: ↑in anxiety and depression , appearance of aura and soon
loses consciousness, a series of myoclonic jerks occur (epileptic cry)
↑ HR, B.P, bladder pressure, piloerection, glandular hypersecretion,
mydriasis, apnea
Ictal phase: series of generalized skeletal muscle contractions progresses
to a extensor rigidity of extremities and trunk – tonic component
Generalized clonic movements, heavy stertorous breathing, alternate muscle
relaxation and violent flexor contractions – clonic component
Postictal phase: tonic – clonic movements cease, breathing returns to
normal, consciousness gradually returns
Stanley F Malamed – Med emergencies in the dental office : 8th Ed
29. Pathophysiology:
Intrinsic intracellular and extracellular metabolic disturbances in
neurons of epileptic patients
Excessive and prolonged depolarisation
↑ in neuronal permeability to sod. And pot. Ions
Ach. & GABA sustained membrane depolarization followed by local
hyper polarization
This abnormal discharge propagated through neuronal pathways and
partial seizure becomes generalized
Prusinski, L., Fundamentals of Corticosteroid Therapy, Oral Medicine Department, Nation Naval Dental Center, Bethesda, MD, 1997.
30. Management of petitmal seizures:
P – position patient with feet elevated
Seizure ceases: reassure patient seizure continues (> 5 min)
Allow patient to recover before discharge A → B → C
–Assess and perform BLS
Stanley F Malamed – Med emergencies in the dental office : 8th Ed
31. Management of tonic clonic seizure:
Prodromal phase
Discontinue dental treatment
Ictal phase
P – Position patient in supine position with feet elevated
Activation of EMS
A → B → C –Assess and perform basic life support as needed
D – Definitive care
Protect patient from injury
Post ictal phase
P – Position patient in supine position with feet elevated
A → B → C –Assess and perform basic life support as needed
D – Definitive care
Administer O2
Monitor vital signs
Reassure patient and permit recovery
Discharge patient
To hospital To home To physician
Stanley F Malamed – Med emergencies in the dental office : 8th Ed
32. Conclusion
Prompt recognition and efficient management of
medical emergencies by a well-prepared dental
team can increase the likelihood of a satisfactory
outcome.
The basic algorithm for managing medical
emergencies is designed to ensure that the
patient’s brain receives a constant supply of
blood containing oxygen.
33. References
▶ Oxford textbook of Medicine : 5th Edition
▶ Malamed, Stanley, Medical Emergencies in the Dental Office, 8thEd.
Mosby.
▶ Prusinski, L., Fundamentals of Corticosteroid Therapy, Oral Medicine
Department, Nation Naval Dental Center, Bethesda, MD, 1997.