Lisa Mayo, RDH, BSDH
Concorde Career College
Hypertension (HBP)
 Classifications of BP Levels in Adults
Category
Systolic
Diastolic
Normal
<120
And
<80
Prehypertension
120 – 139
Or
80 - 89
Stage 1
Hypertension
140 – 159
Or
90 - 99
Stage 2
Hypertension
>160
Or
> 100
High Blood
Pressure
Hypertensive Emergency
 Symptoms – similar to MI (heart attack) or CVA
(cerebrovascular accident or stroke)– difficult to
determine exact emergency
– Sudden increase in
BP > 180/110 often
as high as 220/140
– Dyspnea(labored
breathing)
– Chest pain
– Dysarthria(difficulty
speaking)
– Weakness
12-12
– Altered
consciousness
– Visual loss
– Seizures
– Nausea/vomiting
– Eventually coma
Hypertensive Emergency
 Treatment
 Treat quickly to reduce BP to prevent further end
organ damage like acute MI, aortic dissection or
CVA.
 Treating hypertension secondary
 Seat patient upright
 Contact EMS
 Monitor vital signs
 Administer O2 4-6L/minute
In hospital pt will receive a vasodilator or
nitroglycerin.
12-12
Hypotension
 Treatment
 Position supine with feet raised
 Assess airway
 Administer O2 4-6L/minute
 Monitor vital signs
 If no improvement, contact EMS
12-12
Shock
 Condition produced when the cardio-vascular
pulmonary system fails to deliver enough oxygenated
blood to body tissues to support metabolic needs.
 Tissues use anaerobic (without air) metabolic
processes.
 Produces acidosis (increased acidity in blood) and
harmful toxins.
Shock
 Basic positioning
 Upright
 Semi upright
 Supine and horz with the brain on the same level as the
heart
 If face RED = raise head
 Face is Pale = raise the tail
Shock
Stages:
 1. Initial
 2. Compensatory
 3. Progressive
 4. Refractory
Types:
 Hypovolemic
 Cardiogenic
 Obstructive
 Distributive
 Anaphylactic
 Septic
 Neurogenic
Syncope(cerebral ischemia)
 Sudden, transient loss of consciousness and postural
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tone with spontaneous recovery.
Often caused by loss of cerebral oxygenation and
perfusion
Often sign of another underlying condition
Often associated with a stressful condition
Most common med ER in the dental office
Most syncopal episodes occur during the
administration of local anesthetics.
Types of syncope
 Cardiac: usually from underlying heart disease, common
from arrhythmias or obstructions of the heart, potentially
fatal, referral to MD
 Noncardiac: due to seizures, orthostatic hypotension,
situation occurrences(coughing, urinating, Valsalva’s
maneuver-forced expiratory effort against a closed airway,
hyperventilation, metabolic disease(hypoglycemia,
hypoxemia: low oxygen in blood)
 Neurocardiac: most common form encountered by
dental professionals, associated with pain, fear,
exhaustion, illness, activation of the autonomic nervous
system: fight or flight response
Treatment of Syncope
 Remove objects from oral cavity
 Position supine with feet elevated
 Open airway
 Assess circulation
 Loosen tight clothing
 Administer oxygen, 4-6L/minute
 Monitor vital signs
 Call EMS if symptoms do not change
12-12
Treatment of Syncope
 If unconsciousness persists summon EMS
 No longer recommended to use ammonia inhalants
due to adverse side effects in some patients.
 Longer patient in syncope more likely seizure will
occur.
 Recurrence of another syncopal episode is at a
higher risk for the first 24 hours following the
episode.
 Once consciousness returns
 Keep pt in supine position until patient feels well
enough to be returned to upright position and pulse
returns to normal.
12-12
Respiratory Emergencies
 Criteria: conscious pt, difficulty breathing, sit pt
upright
 Categories
1.
2.
3.
Hyperventilation
Asthma
COPD
Hyperventilation: signs & symptoms
 Lightheadedness, dizziness, impaired vision
 Seizures possible
 Can cause hypocalcemia: reduction in calcium levels
in blood
 Tetany: caused by low calcium levels, manifests as
twitching of muscles or spasms, with sharp flexion of
wrist and ankle joints(carpopedal spasms)
 Numbness of extremities: parasthesia
 Chvostek’s sign: from hypocalcemia-an abnormal
spasm of the facial muscles elicited by light taps on the
facial nerve.
Hyperventilation Management
 Operator remain calm
 Place patient in position of their choice: usually
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upright
Loosen tight clothing in neck area
Work with patient to control rate of respirations
Have pt count to 10 in one breath
Breath through pursed lips or nose
NO MORE PAPER BAGS: can cause suffocation and
cardiac arrest.
Hyperventilation treatment
 Monitor vitals
 DO NOT ADMINISTER OXYGEN: can make condition
worse.
 Administer benzodiazepine (Lorazepam 1-2mg IM or
Diazepam 2-5mg IM) We do NOT have in clinic
 No improvement call EMS
Asthma
 Airways are hypersensitive to certain triggers known as
stimuli.
 In response to the stimuli the bronchi contract into
spasm resulting in dyspnea (difficulty in breathing).
 Inflammation is the result of the body’s immune
response to inhaled allergen.
 Inflammation leads to airway narrowing and mucus
production which leads to coughing and wheezing on
expiration and inspiration.
Asthma
 Bronchial inflammation is the result of the body’s
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immune response to an inhaled allergen.
Typical allergens: waste from household insects, grass,
pollen, mold, pet epithelial cells
Cause body to initiate humoral immune response
which produces antibodies
Immunoglobulin E (IgE)is the specific antibody for
environmental allergens
Causes inflammatory response leading to asthma
attack symptoms
5 types of Asthma
 Extrinsic
 Intrinsic
 Drug-induced
 Exercise-induced
 Infectious
Extrinsic
 Most common
 50% of all asthmatics
 Inherited allergic predisposition
 Triggers or stimuli from outside of body
 Pollen, dust, mold, tobacco smoke
 Dental office: eugenol, impression materials, resins,
latex
Intrinsic asthma
 Second major category
 Develops in adults over the age 35, but can be found in
children
 Triggered by psychological and physiological stress –
example: dental appointments
Drug-induced asthma
 NSAIDS: nonsteroidal anti-inflammatory drugs like
ibuprofen and aspirin.
 Metabisulfite: a preservative found in some foods or
local anesthetics containing epinephrine
Exercise induced
 Begins shortly after start of exercise resulting in severe
bronchospasms.
 Inhalation of cold air may provoke mucosal irritation
and airway hypersensitivity.
 Often found in children and young adults due to
increased activity levels.
Infectious
 Viral infections of respiratory tract most common
cause.
 Frequently seen in children and results in increased
airway resistance caused by inflammatory response to
the bronchi to infection.
 Treatment of infection reduces asthma symptoms.
Treatment of asthma attack
 Prevention of acute episodes in dental setting
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important goal.
Including limiting exposure to known allergens and
identified triggers.
Patients should bring bronchodilator to appointment
and should have ready access.
Nitrous oxide not contraindicated, but used with
judgment of patient symptoms.
Local anesthetics with epinephrine may trigger attack
– not recommended.
Treatment asthma attack
 Stop treatment
 Position patient upright with arms forward
 Self-administer own bronchodilator
 Inhale slowly and exhale through pursed lips
 If patient does not have own inhaler use inhaler from
emergency kit
 Albuterol recommended – fast acting and long
duration (4-6 hours)
Treatment of Asthma Attack
 Position patient upright with arms forward
 Self-administer own bronchodilator
 Inhale slowly and exhale through pursed lips
 If patient does not have own inhaler use inhaler from
emergency kit
 Albuterol recommended – fast acting and long
duration (4-6 hours)
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Resp Emerg: COPD
 Management
 Emphysema, bronchitis, chronic asthma
 Manage sitting upright and encourage coughing
 Low flow O2: too much can reduce hypoxic drive
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May not be able to breathe on own again
Cardiac Emergencies
 Categories
1. Congestive Heart Failure
2. Chest Pain
3. Angina
4. Angina and MI
5. Angina vs AMI
Cardiac Emerg: Congestive Heart
Failure
 RT heart failure
 Edema ankles
 Cyanotic
 Prominent jugular veins
 More popular
 LF heart failure
 Dyspnea, coughing, orthopnea
 Congestive heart failure: combo of both, sign will be Pink
frothy sputum (saliva and blood mixed)
 Manage: seated upright and initiate CPR
 LIFE THREATENING!
Cardiac Emerg: Chest Pain
 Criteria: acute, substernal pain, conscious victim
 Angina or AMI
 Management
 Position comfortable
 ABC’s
 Definitive care: hx of angina – admin nitroglycerine
0.3mL if needed up to 3x then call EMS. Admin O2 90100%
 No hx angina: same as w/ angina except use AED if
needed. May admin ASA 325mg or 50/50 N2O
 Monitor pt
Nitroglycerine
 Fairly unstable med
 Allow pt to admin their own
 Various types: sprays, pill, patch
 Never give to pt with low blood pressure
 Do not give to pt who has consumed alcohol
Angina
 Chest pain due to angina is one of the more common
medical emergencies in the dental office.
 Angina due to inadequate supply and/or increased
demand for oxygen to the myocardium (myocardial
ischemia).
 Clinicians should be aware of the patient’s whose
medical hx indicate past incidences of angina.
 CAD, presenting as angina or AMI, is the leading cause
of sudden death in the US.
Cardiac Emerg: Angina and MI
 Symptoms similar
 Pale, cool skin
 Chest pain: possible after exertion/meal/stress
 Substernal pain
 Levine sign (hand on chest from pain)
 What is the Difference?
 MI pain more intense and lasts longer
 Not relieved by nitroglycerine tablets
 Diabetics may experience a silent MI: because of
neuropathy, may not even feel it
Cardiac Emerg: Angina vs AMI
 Acute Myocardial Infarction (AMI)
 May or may not have previous hx of disease
 Not relieved by nitroglycerine
 Longer duration
Acute Myocardial Infarction (AMI)
 Necrosis of a portion of the myocardium due to total
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or partial occlusion of a coronary artery.
Occlusion caused by atherosclerosis, thrombus, or a
coronary spasm.
May form rapidly or over a period of time.
MI can lead to cardiac arrest: when the heart fails to
beat.
Providing basic life support prior to EMS arriving
could save a life.
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Acute Myocardial Infarction (AMI)
 Cardiac dysrhythmia may occur after MI and is a high
risk for death
 Dysrhythmia may present as:
 Bradycardia
 Ventricular tachycardia – rapid contraction with
inadequate ventricular filling
 Ventricular fibrillation – disorganized, irregular
contraction of ventricles
 Asystole – absence of heart contraction
1-13
Signs and Symptoms of AMI
 Classic symptom: chest pain lasting 20 minutes or
longer
 Pressure, tightness, heaviness, burning, squeezing,
crushing sensation in middle of chest and/or lower 1/3
of epigastrium
 Pain may radiate down arms, shoulders, jaw, or back
1-13
Signs and Symptoms of AMI
 Weakness, dyspnea, diaphoresis, irregular pulse,
nausea, vomiting, sense of impending doom, clutching
chest (Levine Sign)
 Women show different symptoms: atypical
discomfort, upper abdominal pain, shortness of
breath, fatigue
 Diabetics suffer silent MIs.
 The elderly show signs of shortness of breath,
dizziness, pulmonary edema, and/or an altered mental
status
1-13
Treatment of AMI
 Recognize signs and symptoms
 Terminate procedure
 If there is a history of angina, follow protocol for
angina
 If no history of angina, contact EMS immediately
 Position patient comfortably, probably upright or
semi-supine
 Assess ABC’s
1-13
Treatment of AMI
 Administer oxygen 4-6L/minute via nasal cannula
 Monitor vital signs: taken before giving nitro or
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immediately after.
Administer nitroglycerine from emergency cart – 3
doses over a 15 minute period
Do not give nitroglycerine to patients with low blood
pressure
Nitroglycerin should alleviate pain within 2 to 4
minutes
If pain diminishes and then returns, most likely AMI
1-13
Treatment of AMI
 Administer aspirin chewed 325 mg. – antithrombotic
effect – clinical effect reached in 20 minutes
 Aspirin should be chewed to enter bloodstream
quicker
 Manage pain to prevent cardiogenic shock with nitrous
oxide, if available
 If cardiac arrest occurs, perform CPR with AED
1-13
Cerebrovascular Accident (CVA)
 Interruption of blood flow to the brain
 Symptoms
 Severe headache
 Paralysis
 Slurred speech, slowed reactions
 Management
 Semi-upright
 ABC’s
 Lay pt paralyzed side down when possible
 BLS, EMS
 No drugs admin.
 GET THEM TO HOSPITAL!
CVA: cerebrovascular accident
 AKA stroke, brain attack
 Abnormal condition of the brain characterized by
occlusion or hemorrhage of a blood vessel resulting in
lack of oxygen (ischemia)
 Leads to cell death
 Using “brain attack” instead of stroke so people will
become more familiar with the signs and symptoms
12-12
CVA
 Second leading cause of death world wide – 4.6
million annually
 United States’ third leading cause of death and
disability – 700,000 cases per year – 100,000 recurrent
strokes per year
12-12
CVA: Treatment
 Primary goal in CVA treatment is to minimize the
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cognitive and physical limitations associated with the
CVA
Contact EMS immediately
Position semi-supine
Basic life support – check airway, breathing, and
circulation
Administer O2 4-6L/min if patient is having dyspnea
(shortness of breath) or shows signs of hypoxia (body
showing signs of lack of oxygen)
Test glucose levels to rule out hypoglycemia
12-12
CVA: Treatment
 Monitor vital signs
 Transport to ED as soon as possible
 Aspirin for ischemic CVA reduces death and
recurrence rates
 Aspirin for intracranial hemorrhage CVA patients
also improved outcomes – however not
recommended to be administered by anyone but
a healthcare provider in the emergency
department
12-12
CVA: Treatment
 In hospital
 CT scan to determine etiology
 Hemorrhagic – probably surgery
 Ischemic – < 3 hours onset of symptoms then
IV thrombolytic therapy with altaplase (r-tPa) –
removes thrombus or embolus to restore blood
flow
 Ineffective after 3 hours
 Contraindicated for hemorrhagic CVA because
it can lead to further brain bleeding.
12-12
New info about strokes
 New evidence that there is a relationship between early
tooth loss and both ischemic and hemorrhagic CVA.
 Theory is that the relationship between the
microorganisms that cause periodontal disease, a chronic
oral infection, producing more inflammatory markers and
clotting factors, leading to an increase in platelet
aggregation, thus contributing to atherosclerosis and
thrombi formation.
 Another theory states that diseases that cause caries and
perio disease are linked with CVA due to the fact that they
share some common lifestyle factors.
Diabetes Millitus
 Metabolic disorder characterized by hyperglycemia
 Etiology: reduction or absence of production of
insulin by beta cells of pancreas or defect of insulin
receptors
 Insulin aids in conversion of sugar and starches to a
form transported to cells and used for energy
Diabetes
 3 types
 Type 1 (formerly IDDM or Juvenile)
 Type 2 (formerly NIDDM or adult onset)
 Gestational
 4th category pre-diabetes or impaired glucose
tolerance
Type 1
 Absolute lack of insulin
 Pancreatic beta cells within Islets of Langerhans
destroyed due to immune dysfunction
 In Islets of Langerhans: alpha cells secrete glucagonraising blood glucose; beta cells secrete insulin
lowering blood glucose.
 Dependent on supplemental insulin for survival
 5-10% of all diabetics
Type 2
 This type of diabetes is increasing comprising 90-95%
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of all diabetics due to:
Increase in life span
Sedentary lifestyle
Poor diet and exercise of adolescents
Pancreas unable to produce sufficient insulin or the
body is not able to use the insulin that is produced
Gestational diabetes
 Glucose intolerance with initial onset during pregnancy
 Usually disappears after pregnancy, but may return years
later
 Etiology: enzyme in placenta and destruction of insulin by
placenta causes the development of gestational diabetes.
 If untreated infant can have fetal macrosomia (big baby
syndrome), hypoglycemia, hypocalcemia, or
hyperbilirubinemia( too much bilirubin in infants blood
and the newborn’s liver can not process the bilirubin
causing jaundice. Bilirubin is produced in the liver, when
the liver breaks down red blood cells
Role of Dental Professional
 Questions to ask all diabetic patients
 Do you monitor glucose levels? If so, how often?
 What were your most recent glucose levels?
 How are you feeling?
 Do you take medication and if so, did you take it today?
1-13
Role of Dental Professional
 Questions to ask all diabetic patients
 Have you eaten today? If so, when?
 Are you having problems with your eyes, feet, legs?
 Do you see your physician regularly?
 Do you see an eye doctor yearly?
 Do you know your average hemoglobin value?
1-13
Role of Dental Professional
 Strategies to implement:
 Schedule appointments in early to mid-morning
 Keep appointments short
 Instruct patients to continue normal dietary intake prior
to appointment
 Check patient’s blood glucose level prior to any invasive
procedure or if patient complains of not feeling well
1-13
Role of Dental Professional
 Strategies to implement:
 Frequent recall examinations and prophylaxis
 Use of topical fluoride: Prevident 5000 paste or gel,
Gelkam
 Recommending saliva substitutes: Biotene or Oral
Balance
1-13
Diabetic Medical Emergencies
 Many – 4 major
 Diabetic retinopathy
 Diabetic neuropathy
 Diabetic nephropathy
 Oral Manifestations
1-13
Retinopathy
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Common sequela (resulting from) diabetes
Leading cause of blindness age 20 – 74
Mild form – increased vascular permeability
Moderate form – vascular closure
Severe form – growth of new blood vessels on retina
and posterior surface of vitreous(layer of collagen)
 Macular edema or a retinal thickening from leaky
blood vessels can develop at all stages of retinopathy
 Prevention: early screening for diabetes and glucose
control.
Neuropathy
 Mild to severe forms of nervous system damage
affecting 60-70% of diabetics.
 Condition not well understood.
 Common symptoms: pain in the feet and hands, slow
digestion, other neurological problems.
Macrovascular and Microvascular
Complications
 Microangiopathic changes where the basement
membrane of the capillaries thickens and can lead to
the formation of a thrombi, impeding blood flow.
 Diminished blood flow can increase the risks of a
stroke and/or myocardial infarctions.
 Lack of blood flow to nervous tissues can damage the
nerves.
 Gangrene: loss of blood to a part of the body
increasing the risk of losing a limb.
Diabetic Nephropathy (kidneys)
 Damages small blood vessels in kidneys
 Impairs ability to filter impurities from blood
 Require transplant or dialysis to cleanse blood
 Once occurs 100% morbidity within 10 years
Oral Manifestations of Diabetes
 Increased incidence of:
 Delayed wound healing leading to secondary oral and
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systemic infections
Periodontal disease
Abscesses
Xerostomia (dry mouth)
Caries
Lichen planus (white lacy streaks on oral mucosa)
Candidiasis (yeast infection in the oral cavity)
Monitoring
 Best method to avoid complications is to maintain
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optimum glucose levels.
Diabetics test blood several times a day
Glucose monitor used
Lancet – drop of blood
Placed on test strip
Inserted into a calibrated glucometer which will
display the patient’s blood glucose readings.
Glucose Readings
 Normal reading 50 – 150 mg/dL
 Less than 50 hypoglycemic
 Greater than 150 hyperglycemic
 Adjustment in medication needed or referral to MD
Diabetic Medical Emergencies
 Diabetic Ketoacidosis (DKA)- severe hyperglycemia
 Hyperosmolar Hyperglycemic Nonketotic Syndrome
(HHNKS)
 Hypoglycemia
Diabetic Ketoacidosis (DKA): severe
hyperglycemia
 Not a common occurrence in dental office
 Types of patients at risk for DKA
 Newly diagnosed Type 1 diabetics
 Patients that are not medicating or eating properly
 Brittle diabetics(when type 1 diabetics have unstable
glucose levels)
 Patients with infections
 Alcohol and cocaine
Diabetic Ketoacidosis (DKA)
 Etiology: insufficient insulin levels in blood to sustain
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normal fat metabolism- severe hyperglycemia
Glucose metabolism insufficient energy source so body
metabolizes fatty acids for energy
By products of fatty acids are ketones which cause the
blood to be more acidic
Ketones are one of a number of substances that
increase in the blood as a result of faulty carbohydrate
metabolism
Ketones excreted in urine along with sodium and
potassium can cause a severe electrolyte disturbance
Diabetic Ketoacidosis (DKA)
 Body exhales carbon dioxide in an attempt to reverse
acidosis
 Leads to tachypnea and increased depth of
respirations – Kussmaul respirations (air hunger)
Signs and Symptoms
of DKA
 Alteration in mental status
 Ranging from drowsiness to coma
 Dehydrated – poor skin turgor
 Skin and mucous membranes warm and dry
 Increased thirst
 Muscle weakness, severe fatigue, and difficulty walking
Signs and Symptoms
of DKA
 Nausea and vomiting
 Blurred vision due to fluid accumulation in lens of eye
 Tachypnea and Kussmaul breathing
 Fruity odor on breath
 Hypotension
 Tachycardia
 In children: cerebral edema is a common
complications with a high mortality and morbidity
rate.
Treatment of DKA
 Determine an accurate blood glucose level
 Need to lower blood glucose level with insulin
 Should only be administered by medical professional
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to prevent hypoglycemia
Contact EMS
IV fluids needed to reverse dehydration
Monitor vital signs
Position patient supine
Hyperosmolar Hyperglycemic State
 Patient will be hyperglycemic and dehydrated, but not
acidotic
 Usually affects infirm, neglected, institutionalized, or
mentally deficient diabetic patients
 Cannot recognize thirst
 Uncommon in dental office
Severe Hypoglycemia
 Used to be known as insulin shock
 Blood glucose level below 40 – 50 mg/dL (milligram
per deciliter)
 Severe hypoglycemia affects 30% of diabetics
 Etiology: missed meal, alcohol, increased exercise
without adjusting insulin dosage
Signs and Symptoms
of Severe Hypoglycemia
 Dizziness
 Fainting
 Weakness
 Headache
 Intense hunger
 Cold, clammy skin
 More likely to occur in dental office than DKA or
Hyperosmolar state
Signs and Symptoms
of Severe Hypoglycemia
 Profuse perspiration
 Irritability or aggressive behavior
 Confusion
 Seizure
 Eventually coma
Treatment of
Severe Hypoglycemia
 Conscious Patient
 Administer 15-20 grams of sugar: table sugar, honey,
candy, OJ, glucose tablets/paste
 Secure airway
 Monitor vital signs
 Positive response should occur within 10 – 15 minutes
Treatment of
Severe Hypoglycemia
 Unconscious Patient
 Tx of choice is Glucagon: 1 mg administered
subcutaneously, intramuscularly or intravenously.
 Contact EMS
 Maintain airway
 Monitor vital signs
Thyroid
 Hypothyroidism: emergency is Myxedema Coma
 Hyperthyroidism: emergency is Thyroid Storm
 Management
 Supine w/ legs slightly elevated
 ABC’s
 Call EMS
 Admin IV 5% dextrose if available and O2
 Hospital Care
 Hypo: mass doses of thyroid hormone for days
 Hyper: mass doses of antithyroid drug propranolol to block
andrenergic-medicated effects of thyroid hormones and lg
doses of glucocorticosteroids to prevent acute adrenal
Thyroid Storm
 Life threatening
 Exacerbation of hyperthyroid state
 Etiologies: undiagnosed hyperthyroid disease,
overzealous treatment of hypothyroidism,
discontinuance of medication, trauma,
infection, DKA, CVA, stress, toxemia of
pregnancy, fright, surgery
 10 – 50% fatal
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Signs and Symptoms
of Thyroid Storm
 Exaggeration of hyperthyroid symptoms
 Fever: as high as 108 degrees F.
 Diaphoresis
 CNS – restlessness, confusion, anxiety,
psychosis
 Pg 212, Table 18.2
1-13
Signs and Symptoms
of Thyroid Storm
 GI symptoms – nausea, vomiting, diarrhea,
jaundice
 Increased systolic BP
 Widened pulse pressure
 Arrhythmias
1-13
Seizures
 Criteria: unconscious victim, tonic-clonic seizure
activitiy
 Most critical stage if the postictal phase (once seizure
has stopped)
 Airway management imperative
 If unconscious: might close off airway
 Management
 Prevent injury, NEVER place fingers in mouth
 ABC’s
 Low O2 after seizure: EMS needed
 Key time=5min. If seizure longer= call EMS
Seizures
See handout for Types
Allergy
 Usual progression
 Skin – eyes – nose – GI – Resp - Cardio
 Allergic rxns
 Mild to mod usually involves skin, eyes, nose,
sometimes resp
 Anaphylaxis
 Severe allergic response
 Involves all systems, esp resp
 Will lead to cario collapse and death
Allergy
 Management
 Position comfortable
 ABC’s
 Admin Benadryl 50mg tablets for 2-3 days, 3-4x/day or
Benadryl IM
 Anaphylaxis: admin a pre-loaded epi syringe
sublingually
 0.1ml for a total of 3 doses every 5min
 Call EMS, pt will need more then epi
Allergy
 Overdose
 Elevated vitals, talkativeness, anxiety, headache, dizzy,
flushed
 Slurred speech, blurred vision, ringing in ears, severeresp difficulty
 Epi
 Elevated vitals, anxiety, tremors, throbbing, headache,
dizziness, pallor, heart palpitations, resp difficulty
Local Anes Overdoes Situations
 Unconscious pt
 Pre-Injenction Stage: hyperventilation or syncope

Supine, syncope management, calm pt
 During Injection: allergy


Admin epi if severe
Admin benadryl if mild
 Post-Injection: overdose

Manage symptoms and monitor vitals
Emergency Drug Kits
 Epi (Pre-Injectable)
 Nitroglycerine
 Oxygen
 Albuterol
 Frosting cake mix
 Benadryl
 Aspirin
 AED
Allergic Rxn
Chest Pain
Resp Distress
Asthma
Diabetes
Allergic Rxn
Heart Issues
Life Saver!
Adrenal Crisis
 Body severely lacking cortisol
 2 reasons:
 Individual not yet diagnosed – needs cortisol to
maintain carbohydrate and protein metabolism
 Often happens as this condition mimics other
illnesses like gastrointestinal illness or psychiatric
disease.
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Adrenal Crisis
 2nd reason:
 Patient with adrenal insufficiency in a stressful
situation and requires additional cortisol

Often occurs in individuals on long time steroid therapy and
the adrenal cortex atrophies.
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Signs and Symptoms of
Adrenal Crisis
 Fatigue
 Lethargy
 Muscle weakness
 Headache
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Signs and Symptoms of
Adrenal Crisis
 Confusion
 Fever
 Nausea
 Vomiting
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Signs and Symptoms of
Adrenal Crisis
 Abdominal pain
 Hypotension – when coupled with stress can lead to
shock and cardiovascular collapse
 Tachycardia
 Diaphoresis- profuse sweating
 Dehydration
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Treatment of Adrenal Crisis
 Contact EMS
 Stabilize until EMS arrives
 Maintain airway
 Monitor vital signs
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Treatment of Adrenal Crisis
 Administer O2 if needed
 IV fluids needed, as well as glucocorticoids which
should only be administered by medical professional
 Therapy will help alleviate cardiac arrhythmias, GI
disturbances, hypotension, and electrolyte inbalance
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