Additional Information
Book Details
Abstract
Be prepared to handle life-threatening dental emergencies! Medical Emergencies in the Dental Office, 7th Edition helps you learn the skills needed to manage medical emergencies in the dental office or clinic. It describes how to recognize and manage medical emergencies promptly and proactively, and details the resources that must be on hand to deal effectively with these situations. This edition includes new guidelines for drug-related emergencies, cardiac arrest, and more. Written by respected educator Dr. Stanley Malamed, this expert resource provides dental professionals with the tools for implementing a basic action plan for managing medical emergencies.
"It successfully fulfils its aim of stimulating all members of the dental team to improve and maintain their skills in the effective prevention, recognition and management of medical emergencies." Reviewed by European Journal of Orthodontics, March 2015
"...very easy to read and provides a very comprehensive reference for a variety of medical emergencies." Reviewed by S.McKernon on behalf of British Dental Journal, July 2015
- A logical format reflects the way emergencies are encountered in a dental practice, with chapters organized by commonly seen clinical signs and symptoms, such as unconsciousness or altered consciousness, respiratory distress, seizures, drug-related emergencies, chest pain, and cardiac arrest.
- Step-by-step procedures include detailed, numbered instructions for stabilizing and treating victims (PCABD) in common medical emergencies.
- Full-color illustrations demonstrate emergency techniques in realistic clarity.
- Summary tables and boxes make it easy to find essential concepts and information.
- Quick-reference algorithms in the appendix include step-by-step diagrams showing the decision-making process in common emergency situations.
- A differential diagnosis chapter ends each of the book’s parts on common emergencies.
- UPDATED content includes the most current guidelines for drug-related emergencies, unconsciousness, altered consciousness, and cardiac arrest as well as protocols for obstructed airway management.
- UPDATED PCABD boxes reflect the American Heart Association’s new sequence of steps for stabilizing and treating victims with an easy-to-remember acronym: Positioning, Circulation, Airway, Breathing, and Definitive Management.
- UPDATED! Emergency drug and equipment kit instructions help you assemble emergency kits and ensure that your dental office has safe, current materials on hand.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Inside Front cover | ES2 | ||
| Medical emergencies in the Dental Office | iii | ||
| Copyright | iv | ||
| Dedication | v | ||
| Foreword to the sixth edition | vi | ||
| Preface to the Seventh Edition | vii | ||
| Evolve Instructor Resources | ix | ||
| Acknowledgments | x | ||
| Contents | xi | ||
| Part 1: Prevention | 1 | ||
| Chapter 1: Introduction | 1 | ||
| Morbidity | 1 | ||
| Death | 6 | ||
| Risk Factors | 7 | ||
| Increased number of older patients | 7 | ||
| Medical advances | 11 | ||
| Longer appointments | 11 | ||
| Increased drug use | 11 | ||
| Classification of Life-Threatening Situations | 11 | ||
| Outline of Specific Emergency Situations | 13 | ||
| References | 13 | ||
| Chapter 2: Prevention | 15 | ||
| Evaluation Goals | 15 | ||
| Physical Evaluation | 16 | ||
| Medical history questionnaire | 16 | ||
| University of the Pacific medical history questionnaire | 23 | ||
| Physical examination | 38 | ||
| Vital signs | 39 | ||
| Blood pressure | 39 | ||
| Guidelines for clinical evaluation | 42 | ||
| Heart rate and rhythm | 43 | ||
| Guidelines for clinical evaluation. | 44 | ||
| Respiratory rate | 46 | ||
| Part 2: Unconsciousness | 125 | ||
| Chapter 5: Unconsciousness: General Considerations | 125 | ||
| General Considerations | 125 | ||
| \t Predisposing factors | 126 | ||
| \t Prevention | 127 | ||
| \t Clinical Manifestations | 128 | ||
| \t Pathophysiology | 128 | ||
| Inadequate cerebral circulation | 128 | ||
| Oxygen deprivation | 128 | ||
| General or local metabolic changes | 129 | ||
| Actions on the central nervous system | 129 | ||
| Psychic mechanisms | 129 | ||
| \t Management | 129 | ||
| Recognition of unconsciousness | 130 | ||
| Management of the unconscious patient | 130 | ||
| Chapter 6: Vasodepressor Syncope | 144 | ||
| \tPredisposing Factors | 144 | ||
| \tPrevention | 145 | ||
| Positioning | 145 | ||
| Anxiety Relief | 145 | ||
| Dental therapy considerations | 146 | ||
| \tClinical Manifestations | 146 | ||
| Presyncope | 146 | ||
| Syncope | 147 | ||
| Postsyncope (recovery) | 147 | ||
| \tPathophysiology | 147 | ||
| Presyncope | 147 | ||
| Syncope | 148 | ||
| Recovery | 148 | ||
| \tManagement | 148 | ||
| Presyncope | 148 | ||
| Syncope | 149 | ||
| Delayed recovery | 150 | ||
| Postsyncope | 151 | ||
| ADDENDUM case report—vasodepressor syncope | 151 | ||
| References | 152 | ||
| Chapter 7: Postural Hypotension | 153 | ||
| \tPredisposing Factors | 153 | ||
| Drug administration and ingestion | 154 | ||
| Prolonged recumbency and convalescence | 154 | ||
| Inadequate postural reflex | 154 | ||
| Pregnancy | 154 | ||
| Age | 155 | ||
| Venous defects in the legs | 155 | ||
| Recovery from sympathectomy for high blood pressure | 155 | ||
| Addison’s disease | 155 | ||
| Physical exhaustion and starvation | 155 | ||
| Chronic postural hypotension (Shy-Drager syndrome) | 155 | ||
| \tPrevention | 155 | ||
| Physical examination | 156 | ||
| Dental therapy considerations | 156 | ||
| Dental therapy considerations: postural hypotension | 156 | ||
| \tClinical Manifestations | 156 | ||
| \tPathophysiology | 157 | ||
| Normal regulatory mechanisms | 157 | ||
| Postural hypotension | 158 | ||
| \tManagement | 158 | ||
| Chapter 8: Acute Adrenal Insufficiency | 161 | ||
| \t Predisposing Factors | 162 | ||
| \t Prevention | 164 | ||
| Dialogue history | 165 | ||
| \t Dental Therapy Considerations | 166 | ||
| Glucocorticosteroid coverage | 167 | ||
| Stress reduction protocol | 167 | ||
| Additional considerations | 167 | ||
| \t Clinical Manifestations | 167 | ||
| \t Pathophysiology | 168 | ||
| Normal adrenal function | 168 | ||
| Adrenal insufficiency | 170 | ||
| \t Management | 171 | ||
| Conscious patient | 171 | ||
| Unconscious patient | 173 | ||
| Chapter 9: Unconsciousness: Differential Diagnosis | 177 | ||
| Differential Diagnosis | 177 | ||
| \tAge of Patient | 177 | ||
| \tCircumstances Associated With Loss of Consciousness | 177 | ||
| \tPosition of the Patient | 178 | ||
| \tPresyncopal Signs and Symptoms | 178 | ||
| No clinical symptoms | 178 | ||
| Pallor and cold, clammy skin | 179 | ||
| Tingling and numbness of the extremities | 179 | ||
| Headache | 179 | ||
| Chest “pain” | 179 | ||
| Breath odor | 179 | ||
| Tonic-clonic movements and incontinence | 179 | ||
| Heart rate and blood pressure | 179 | ||
| Duration of unconsciousness and recovery | 180 | ||
| Part 3: Respiratory Distress | 181 | ||
| Chapter 10: Respiratory Distress: General Considerations | 181 | ||
| General Considerations | 181 | ||
| Predisposing Factors | 181 | ||
| Prevention | 182 | ||
| Clinical Manifestations | 183 | ||
| Pathophysiology | 183 | ||
| Management | 183 | ||
| References | 185 | ||
| Chapter 11: Foreign Body Airway Obstruction | 186 | ||
| \tIncidence | 186 | ||
| \tPrevention | 187 | ||
| Rubber dam | 187 | ||
| Oral packing | 187 | ||
| Chair position | 188 | ||
| Dental assistant and suction | 188 | ||
| Magill intubation forceps | 188 | ||
| Tongue grasping forceps | 189 | ||
| Ligature | 189 | ||
| \tManagement | 190 | ||
| Recognition of airway obstruction | 191 | ||
| Complete airway obstruction | 192 | ||
| Phase one. | 192 | ||
| Phase two. | 193 | ||
| Phase three. | 193 | ||
| Partial airway obstruction | 193 | ||
| Basic airway maneuvers | 193 | ||
| Establishing an emergency airway when a patient’s airway is obstructed | 195 | ||
| Noninvasive procedures | 195 | ||
| Back blows | 195 | ||
| Abdominal thrusts and chest thrusts | 196 | ||
| Abdominal thrust (Heimlich Maneuver) | 196 | ||
| Chest thrust | 198 | ||
| Finger sweep | 198 | ||
| Procedures for obstructed airways in infants | 199 | ||
| Invasive procedures: tracheostomy versus cricothyrotomy | 201 | ||
| Anatomy | 201 | ||
| Equipment | 203 | ||
| Use of a 13-gauge needle for cricothyrotomy | 204 | ||
| Contraindications to cricothyrotomy | 204 | ||
| References | 204 | ||
| Chapter 12: Hyperventilation | 208 | ||
| \tPredisposing Factors | 208 | ||
| \tPrevention | 208 | ||
| Medical history questionnaire | 208 | ||
| Physical evaluation | 208 | ||
| Vital signs | 209 | ||
| Dental therapy considerations | 209 | ||
| \tClinical Manifestations | 209 | ||
| Signs and symptoms | 209 | ||
| Effect on vital signs | 210 | ||
| \tPathophysiology | 210 | ||
| \tManagement | 211 | ||
| References | 212 | ||
| Chapter 13: Asthma | 214 | ||
| \tPredisposing Factors | 214 | ||
| Extrinsic asthma | 214 | ||
| Intrinsic asthma | 215 | ||
| Mixed asthma | 215 | ||
| Status asthmaticus | 215 | ||
| \t Prevention | 216 | ||
| Dental therapy considerations | 219 | ||
| \t Clinical Manifestations | 220 | ||
| Usual clinical progression | 220 | ||
| Status asthmaticus | 221 | ||
| \t Pathophysiology | 221 | ||
| Neural control of the airways | 221 | ||
| Airway inflammation | 222 | ||
| Immunologic responses | 222 | ||
| Bronchospasm | 222 | ||
| Bronchial wall edema and hypersecretion of mucous glands | 222 | ||
| Breathing | 223 | ||
| Management | 224 | ||
| Acute asthmatic episode (bronchospasm) | 224 | ||
| Severe bronchospasm | 226 | ||
| References | 228 | ||
| Chapter 14: Heart Failure and Acute Pulmonary Edema | 232 | ||
| \t Predisposing Factors | 233 | ||
| \t Prevention | 234 | ||
| Dialogue history | 235 | ||
| Physical evaluation | 236 | ||
| Vital signs | 236 | ||
| Physical examination | 236 | ||
| Dental therapy considerations | 237 | ||
| \t Clinical Manifestations | 239 | ||
| Left ventricular failure | 239 | ||
| Right ventricular failure | 240 | ||
| Acute pulmonary edema | 241 | ||
| \t Pathophysiology | 241 | ||
| Normal left ventricular function | 242 | ||
| Heart failure | 243 | ||
| \t Management | 245 | ||
| References | 247 | ||
| Chapter 15: Respiratory Distress: Differential Diagnosis | 249 | ||
| \tMedical History | 249 | ||
| \tAge | 249 | ||
| \tSex | 249 | ||
| \tRelated Circumstances | 249 | ||
| \tClinical Symptoms Between Acute Episodes | 249 | ||
| \tPosition | 249 | ||
| \tAccompanying Sounds | 250 | ||
| \tSymptoms Associated With Respiratory Distress | 250 | ||
| \tPeripheral Edema and Cyanosis | 250 | ||
| \tParesthesia of the Extremities | 250 | ||
| \tUse of Accessory Respiratory Muscles | 250 | ||
| \tChest Pain | 250 | ||
| \tHeart Rate and Blood Pressure | 250 | ||
| \tDuration of Respiratory Distress | 250 | ||
| Part 4: Altered Consciousness | 251 | ||
| Chapter 16: Altered Consciousness: General Considerations | 251 | ||
| General Considerations | 251 | ||
| \tPredisposing Factors | 251 | ||
| \tPrevention | 253 | ||
| \tClinical Manifestations | 253 | ||
| \tPathophysiology | 253 | ||
| \tManagement | 253 | ||
| References | 254 | ||
| Chapter: 17 Diabetes Mellitus: Hyperglycemia and Hypoglycemia | 255 | ||
| Acute Complications | 256 | ||
| Chronic Complications | 256 | ||
| Predisposing Factors | 258 | ||
| Classification of Diabetes | 258 | ||
| Type 1 diabetes mellitus | 259 | ||
| Type 2 diabetes mellitus | 260 | ||
| Gestational diabetes mellitus | 260 | ||
| Impaired glucose tolerance/impaired fasting glucose tolerance | 260 | ||
| Hyperglycemia | 260 | ||
| Hypoglycemia | 261 | ||
| Control of Diabetes | 262 | ||
| Management of type 1 diabetes mellitus | 262 | ||
| Management of type 2 diabetes mellitus | 264 | ||
| Prevention | 267 | ||
| Physical examination | 268 | ||
| Dental therapy considerations | 268 | ||
| Clinical Manifestations | 269 | ||
| Hyperglycemia | 269 | ||
| Hypoglycemia | 270 | ||
| \tPathophysiology | 271 | ||
| Insulin and blood glucose | 271 | ||
| Hyperglycemia, ketosis, and acidosis | 272 | ||
| Hypoglycemia | 273 | ||
| \tManagement | 273 | ||
| Hyperglycemia | 273 | ||
| Hyperglycemia—conscious patient | 274 | ||
| Hyperglycemia—unconscious patient | 274 | ||
| Hypoglycemia | 275 | ||
| Hypoglycemia—conscious and responsive patient | 275 | ||
| Hypoglycemia—unresponsive conscious patient | 275 | ||
| Hypoglycemia—unconscious patient | 276 | ||
| References | 278 | ||
| Chapter 18: Thyroid Gland Dysfunction | 281 | ||
| \tPredisposing Factors | 281 | ||
| Hypothyroidism | 281 | ||
| Thyrotoxicosis | 282 | ||
| \tPrevention | 283 | ||
| Physical examination | 284 | ||
| Dental therapy considerations | 285 | ||
| Euthyroid | 285 | ||
| Hypothyroid | 285 | ||
| Hyperthyroid | 285 | ||
| \tClinical Manifestations | 287 | ||
| Hypothyroidism | 287 | ||
| Thyrotoxicosis | 288 | ||
| \tPathophysiology | 288 | ||
| Hypothyroidism | 288 | ||
| Thyrotoxicosis | 289 | ||
| \tManagement | 289 | ||
| Hypothyroidism | 289 | ||
| Unconscious patient with history of hypothyroidism | 289 | ||
| Thyrotoxicosis | 290 | ||
| Unconscious patient with history of thyrotoxicosis | 290 | ||
| References | 291 | ||
| Chapter 19: Cerebrovascular Accident | 293 | ||
| \tClassification | 294 | ||
| Lacunar infarction | 294 | ||
| Cerebral infarction | 294 | ||
| Transient ischemic attack (TIA) | 296 | ||
| Hemorrhagic stroke: intracerebral hemorrhage and subarachnoid hemorrhage | 296 | ||
| \tPredisposing Factors | 297 | ||
| Diabetes mellitus | 298 | ||
| Disorders of heart rhythm | 298 | ||
| Family history and genetics | 298 | ||
| Smoking | 298 | ||
| Physical inactivity | 298 | ||
| \tPrevention | 298 | ||
| Physical examination | 299 | ||
| Vital signs | 299 | ||
| Apprehension | 300 | ||
| Dental therapy considerations | 300 | ||
| Length of time elapsed since the CVA | 300 | ||
| Minimization of stress | 300 | ||
| Assessment of when the post-CVA patient is too great a risk for treatment | 300 | ||
| Assessment of bleeding | 300 | ||
| \tClinical Manifestations | 301 | ||
| Transient ischemic attack | 301 | ||
| Cerebral infarction | 302 | ||
| Cerebral embolism | 302 | ||
| Cerebral hemorrhage | 302 | ||
| \tPathophysiology | 303 | ||
| Cerebrovascular ischemia and infarction | 303 | ||
| Hemorrhagic CVA | 303 | ||
| \tManagement | 304 | ||
| Cerebrovascular accident and transient ischemic attack | 305 | ||
| Conscious patient with resolution of signs and symptoms: transient ischemic attack | 306 | ||
| Conscious patient with persistent signs and symptoms: cerebrovascular accident | 306 | ||
| References | 307 | ||
| Chapter 20: Altered Consciousness: Differential Diagnosis | 311 | ||
| Differential Diagnosis | 311 | ||
| \tMedical History | 311 | ||
| \tAge | 311 | ||
| \tSex | 311 | ||
| \tRelated Circumstances | 311 | ||
| \tOnset of Signs and Symptoms | 311 | ||
| \tPresence of Symptoms Between Acute Episodes | 312 | ||
| \tLoss of Consciousness | 312 | ||
| \tSigns and Symptoms | 312 | ||
| Appearance of the skin (face) | 312 | ||
| Obvious anxiety | 312 | ||
| Paresthesia | 312 | ||
| Headache | 312 | ||
| Drunken” appearance | 312 | ||
| Breath odor | 312 | ||
| \tVital Signs | 312 | ||
| Respiration | 312 | ||
| Blood pressure | 313 | ||
| Heart rate | 313 | ||
| \tSummary | 313 | ||
| Part 5: Seizures | 314 | ||
| Chapter 21: Seizures | 314 | ||
| \tTypes of Seizure Disorders | 314 | ||
| Partial seizures | 316 | ||
| Generalized seizures | 316 | ||
| Grand mal epilepsy | 316 | ||
| Absence seizures | 316 | ||
| Jacksonian epilepsy | 316 | ||
| Psychomotor seizures | 317 | ||
| Status epilepticus | 317 | ||
| \tCauses | 317 | ||
| \tPredisposing Factors | 319 | ||
| \tPrevention | 320 | ||
| Nonepileptic causes | 320 | ||
| Epileptic causes | 320 | ||
| Physical examination | 321 | ||
| Psychological implications of epilepsy | 321 | ||
| Dental therapy considerations | 322 | ||
| Minimal or moderate sedation | 322 | ||
| \tClinical Manifestations | 323 | ||
| Partial seizures | 323 | ||
| Absence seizure (petit mal) | 323 | ||
| Tonic-clonic seizure | 323 | ||
| Prodromal phase | 323 | ||
| Preictal phase | 324 | ||
| Ictal phase | 324 | ||
| Tonic component | 324 | ||
| Clonic component | 324 | ||
| Postictal phase | 324 | ||
| Tonic-clonic seizure status (grand mal status) | 324 | ||
| \tPathophysiology | 325 | ||
| \tManagement | 326 | ||
| Absence seizures and partial seizures | 326 | ||
| Tonic-clonic seizures (grand mal) | 326 | ||
| Prodromal (preictal) phase | 327 | ||
| Ictal phase | 327 | ||
| Postictal phase | 329 | ||
| Grand mal status | 330 | ||
| Preictal phase | 330 | ||
| Ictal phase | 330 | ||
| \tDifferential Diagnosis | 332 | ||
| References | 332 | ||
| Part 6: Drug-Related Emergencies | 336 | ||
| Chapter 22: Drug-Related Emergencies: General Considerations | 336 | ||
| General Considerations | 336 | ||
| \tPrevention | 337 | ||
| Care in drug administration | 338 | ||
| \tClassification | 339 | ||
| Overdose reaction | 340 | ||
| Allergy | 340 | ||
| Idiosyncrasy | 340 | ||
| Management of idiosyncratic reactions | 341 | ||
| \tDrug-Related Emergencies | 341 | ||
| Drug use in dentistry | 341 | ||
| Local anesthetics | 341 | ||
| Antibiotics | 342 | ||
| Analgesics | 342 | ||
| Sedatives | 344 | ||
| Inhalation sedation | 344 | ||
| References | 345 | ||
| Chapter 23: Drug Overdose Reactions | 347 | ||
| \tLocal Anesthetic Overdose Reaction | 347 | ||
| Predisposing factors | 348 | ||
| Patient factors | 348 | ||
| Normal distribution curve | 348 | ||
| Age | 348 | ||
| Body weight | 348 | ||
| Pathologic process | 349 | ||
| Genetics | 349 | ||
| Attitude and environment | 349 | ||
| Sex | 349 | ||
| Drug factors | 350 | ||
| Vasoactivity | 350 | ||
| Dose | 350 | ||
| Route of administration | 350 | ||
| Rate of injection | 351 | ||
| Vascularity of injection (deposition) site | 351 | ||
| Presence of vasoconstrictors | 351 | ||
| Prevention | 351 | ||
| Medical history questionnaire and dialogue history | 352 | ||
| Causes of overdose reactions | 352 | ||
| Biotransformation and elimination | 352 | ||
| Too large a total dose | 353 | ||
| Rapid absorption of drug into circulation | 354 | ||
| Intravascular injection | 355 | ||
| Administration technique | 357 | ||
| Clinical manifestations | 358 | ||
| Onset, intensity, and duration | 358 | ||
| Signs and symptoms | 358 | ||
| Minimal to moderate blood levels | 358 | ||
| Moderate to high blood levels | 360 | ||
| Pathophysiology | 360 | ||
| Local anesthetic blood levels | 361 | ||
| Systemic activity of local anesthetics | 361 | ||
| Cardiovascular actions | 361 | ||
| CNS actions | 362 | ||
| Management | 363 | ||
| Mild overdose reaction with rapid onset | 363 | ||
| Mild overdose reaction with delayed onset (>10 minutes) | 364 | ||
| Severe overdose reaction with rapid onset | 365 | ||
| Severe overdose reaction with slow onset | 367 | ||
| \tEpinephrine (Vasoconstrictor) Overdose Reaction | 368 | ||
| Precipitating factors and prevention | 368 | ||
| Clinical manifestations and pathophysiology | 369 | ||
| Management | 370 | ||
| \tCentral Nervous System Depressant Overdose Reactions | 371 | ||
| Predisposing factors and prevention | 371 | ||
| Clinical manifestations | 372 | ||
| Sedative-hypnotics (including barbiturates) | 372 | ||
| Sedation and oversedation | 373 | ||
| Hypnosis | 373 | ||
| General anesthesia | 373 | ||
| Respiratory arrest | 373 | ||
| Opioid agonists | 373 | ||
| Management | 374 | ||
| Sedative-hypnotic drugs | 374 | ||
| Opioid analgesics | 376 | ||
| \tSummary | 378 | ||
| References | 380 | ||
| Chapter 24: Allergy | 384 | ||
| \tPredisposing Factors | 384 | ||
| Antibiotics | 386 | ||
| Analgesics | 387 | ||
| Antianxiety drugs | 387 | ||
| Local anesthetics | 387 | ||
| Other agents | 389 | ||
| \tPrevention | 389 | ||
| Medical consultation | 391 | ||
| Allergy testing in the dental office | 391 | ||
| Dental therapy modifications | 392 | ||
| Allergy to drugs other than local anesthetics | 392 | ||
| \tManagement | 393 | ||
| Alleged allergy to local anesthetics | 393 | ||
| Elective dental care | 393 | ||
| Emergency dental care | 393 | ||
| Option 1: Consultation | 393 | ||
| Option 2: General anesthesia | 393 | ||
| Option 3: Injectable histamine-blocker | 394 | ||
| Confirmed allergy to local anesthetics | 394 | ||
| \tClinical Manifestations | 395 | ||
| Onset | 395 | ||
| Skin reaction | 395 | ||
| Respiratory reactions | 395 | ||
| Generalized anaphylaxis | 396 | ||
| \tPathophysiology | 398 | ||
| Antigens, haptens, and allergens | 398 | ||
| Antibodies (immunoglobulins) | 398 | ||
| Defense mechanisms of the body | 400 | ||
| Type I allergic reaction—anaphylaxis | 400 | ||
| Sensitizing dose | 400 | ||
| Challenge (allergic) dose | 401 | ||
| Chemical mediators of anaphylaxis | 401 | ||
| Histamine | 401 | ||
| Slow-reacting substance of anaphylaxis | 402 | ||
| Eosinophilic chemotactic factor of anaphylaxis | 402 | ||
| Respiratory signs and symptoms | 402 | ||
| Cardiovascular signs and symptoms | 402 | ||
| Gastrointestinal signs and symptoms | 403 | ||
| Urticaria, rhinitis, and conjunctivitis | 403 | ||
| \tManagement | 403 | ||
| Skin reactions | 403 | ||
| Delayed reactions | 403 | ||
| Rapid-onset skin reaction | 404 | ||
| Respiratory reactions | 405 | ||
| Bronchospasm | 405 | ||
| Laryngeal edema | 407 | ||
| Epinephrine and allergy | 408 | ||
| Generalized anaphylaxis | 409 | ||
| Signs of allergy present | 410 | ||
| No clinical signs of allergy present | 411 | ||
| Laryngeal edema | 412 | ||
| References | 412 | ||
| Chapter 25: Drug-Related Emergencies: Differential Diagnosis | 416 | ||
| Differential Diagnosis | 416 | ||
| \tMedical History | 416 | ||
| \tAge | 416 | ||
| \tSex | 416 | ||
| \tPosition | 416 | ||
| \tOnset of Signs and Symptoms | 417 | ||
| \tPrior Exposure to Drug | 417 | ||
| \tDose of Drug Administered | 417 | ||
| \tOverall Incidence of Occurrence | 417 | ||
| \tSigns and Symptoms | 417 | ||
| Duration of reaction | 417 | ||
| Changes in appearance of skin | 417 | ||
| Appearance of nervousness | 418 | ||
| Loss of consciousness | 418 | ||
| Presence of seizures | 418 | ||
| Respiratory symptoms | 418 | ||
| \tVital Signs | 418 | ||
| Heart rate | 418 | ||
| Blood pressure | 418 | ||
| \tSummary | 419 | ||
| References | 420 | ||
| Part 7: Chest Pain | 421 | ||
| Chapter 26: Chest Pain: General Considerations | 421 | ||
| General Considerations | 421 | ||
| \tPredisposing Factors | 422 | ||
| Risk factors for atherosclerotic disease | 425 | ||
| Smoking and tobacco use | 425 | ||
| Physical inactivity | 426 | ||
| Overweight and obesity | 426 | ||
| Family history and genetics | 427 | ||
| High blood cholesterol and other lipids | 427 | ||
| High blood pressure | 428 | ||
| Diabetes mellitus | 429 | ||
| Metabolic syndrome | 429 | ||
| Chronic kidney disease | 430 | ||
| Mental stress and cardiovascular risk | 430 | ||
| Estrogen status | 430 | ||
| \tPrevention | 430 | ||
| \tClinical Manifestations | 431 | ||
| \tPathophysiology | 432 | ||
| Atherosclerosis | 432 | ||
| Location | 433 | ||
| Chest pain | 434 | ||
| \tManagement | 435 | ||
| References | 435 | ||
| Chapter 27: Angina Pectoris | 440 | ||
| \tPredisposing Factors | 440 | ||
| \tPrevention | 442 | ||
| Physical examination | 445 | ||
| Unstable angina pectoris | 445 | ||
| \tDental Therapy Considerations | 446 | ||
| Length of appointment | 446 | ||
| Supplemental oxygen | 446 | ||
| Pain control during therapy | 446 | ||
| Sedation | 448 | ||
| Additional considerations | 448 | ||
| Vital signs | 448 | ||
| Nitroglycerin premedication | 448 | ||
| \tClinical Manifestations | 448 | ||
| Signs and symptoms | 449 | ||
| Pain | 449 | ||
| Radiation of pain | 449 | ||
| Physical examination | 449 | ||
| Complications | 449 | ||
| Prognosis | 449 | ||
| \tPathophysiology | 450 | ||
| \tManagement | 450 | ||
| Patient with a history of angina pectoris | 450 | ||
| No history of chest pain | 452 | ||
| References | 453 | ||
| Chapter 28: Acute Myocardial Infarction | 456 | ||
| Predisposing Factors | 457 | ||
| Location and extent of infarction | 457 | ||
| Prevention | 457 | ||
| Physical examination | 460 | ||
| Dental Therapy Considerations | 460 | ||
| Stress reduction | 460 | ||
| Supplemental oxygen | 460 | ||
| Sedation | 461 | ||
| Pain control | 461 | ||
| Duration of treatment | 461 | ||
| Six months after MI | 461 | ||
| Medical consultation | 461 | ||
| Anticoagulant or antiplatelet therapy | 462 | ||
| Clinical Manifestations | 462 | ||
| Pain | 462 | ||
| Other clinical signs and symptoms | 462 | ||
| Physical findings | 463 | ||
| Acute complications | 463 | ||
| Pathophysiology | 463 | ||
| Management | 465 | ||
| Immediate in-hospital management | 469 | ||
| Thrombolytic therapy | 470 | ||
| PTCA | 470 | ||
| References | 470 | ||
| Chapter 29: Chest Pain: Differential Diagnosis | 475 | ||
| Differential Diagnosis | 475 | ||
| \tNoncardiac Chest Pain | 475 | ||
| \tCardiac Chest Pain | 476 | ||
| Medical history | 476 | ||
| Age | 476 | ||
| Sex | 476 | ||
| Related circumstances | 476 | ||
| Clinical symptoms and signs | 476 | ||
| Location of chest pain | 476 | ||
| Description of chest pain | 476 | ||
| Radiation of chest pain | 476 | ||
| Duration of chest pain | 477 | ||
| Response to medication | 477 | ||
| Vital signs | 477 | ||
| Heart rate | 477 | ||
| Blood pressure | 477 | ||
| Respiration | 477 | ||
| Other signs and symptoms | 477 | ||
| \tSummary | 477 | ||
| References | 478 | ||
| Part 8: Cardiac Arrest | 479 | ||
| Chapter 30: Cardiac Arrest | 479 | ||
| \tSurvival from Sudden Cardiac Arrest | 481 | ||
| Witnessed versus unwitnessed | 481 | ||
| Initial rhythm | 481 | ||
| Bystander CPR | 482 | ||
| Response time | 482 | ||
| \tThe Chain of Survival | 482 | ||
| The first link: early access | 483 | ||
| The second link: early BLS (CPR) | 483 | ||
| The third link: early defibrillation | 483 | ||
| The fourth link: early ACLS | 484 | ||
| The fifth link: integrated post–cardiac arrest care | 484 | ||
| \tThe Dental Office | 484 | ||
| \tCardiopulmonary Arrest | 485 | ||
| Pulmonary (respiratory) arrest | 485 | ||
| Cardiac arrest | 485 | ||
| \tBasic life support (CPR) | 486 | ||
| Team approach | 487 | ||
| BLS | 489 | ||
| Cardiac arrest in the dental office | 489 | ||
| CPR sequence—adult victim | 489 | ||
| CPR specifics—activating EMS | 492 | ||
| CPR specifics—circulation | 493 | ||
| Assessment of circulation | 493 | ||
| Chest compression | 493 | ||
| Location of compression point | 494 | ||
| Application of pressure | 494 | ||
| Rate of chest compression | 495 | ||
| Compression–ventilation ratio | 496 | ||
| AED technique (adult) | 498 | ||
| CPR specifics—defibrillation | 496 | ||
| Beginning and terminating BLS | 499 | ||
| Transport of victim | 499 | ||
| References | 499 | ||
| Chapter 31: Pediatric Considerations | 505 | ||
| \tPreparation | 505 | ||
| Basic life support | 505 | ||
| Pediatric advanced life support | 507 | ||
| Emergency team | 507 | ||
| Access to emergency medical services | 508 | ||
| Emergency drugs and equipment | 508 | ||
| \tBasic Management | 509 | ||
| Position | 509 | ||
| Circulation | 509 | ||
| Airway and breathing | 509 | ||
| Definitive care | 510 | ||
| \tSpecific Emergencies | 510 | ||
| Bronchospasm (acute asthmatic attack) | 510 | ||
| Generalized tonic-clonic seizure (grand mal seizure) | 510 | ||
| Sedation overdose | 511 | ||
| Local anesthetic overdose | 511 | ||
| Respiratory arrest | 512 | ||
| Recognition of respiratory distress | 513 | ||
| Management of airway obstruction | 513 | ||
| Recognition of respiratory arrest | 513 | ||
| Use of the face mask | 514 | ||
| Cardiac arrest | 515 | ||
| Differences between adult and pediatric cardiac arrest | 515 | ||
| Adults | 515 | ||
| Children | 516 | ||
| CPR sequence—child victim (age 1 year to the onset of puberty) | 516 | ||
| Appendix: Quick-Reference Section to Life-Threatening Situations | 523 | ||
| Index | 535 |