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What type(s) of medical emergency equipment can be found in our clinic and where are they located?

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What type(s) of medical emergency equipment can be found in our clinic and where are they located?

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Types of medical emergency equipment:

oxygen compressed USP

Samaritant PAD (Blue)

Hearsine Samaritan PAD Defibrillator (Yellow)

Where are they Located:

1- dental hygiene station 8

2-front dental hygiene clinic

3-dental hygiene class lab

PADS are hanging on the oxygen Tank

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Describe the location of the emergency medical equipment and medication kit.

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Describe the location of the emergency medical equipment and medication kit.

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3 locations for medical kits and medical equipment

1- dental hygiene station 8

2-front dental hygiene clinic

3-dental hygiene class lab

Medical Emergency Simulations​

Person 1 – Stays with patient and performs emergency treatment (usually dentist)​

Person 2 – Assists P1, take vitals, admin oxygen, records events and time of medication ​

Person 3 – Retrieves emergency kit, prepares emergency drugs​

Person 4 – Makes necessary phone calls (front office staff)​

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Describe ASA classifications and location in our clinic's manual.

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Describe ASA classifications and location in our clinic's manual.

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Defining ASA Classifications

ASA (American Society of Anesthesiologists) Physical Status Classification System

Assesses a patient's physical condition before anesthesia or surgery

Ranges from ASA I (healthy patient) to ASA VI (brain-dead patient)

ASA I: Normal healthy patient

ASA II: Mild systemic disease

ASA III: Severe systemic disease

ASA IV: Severe systemic disease that is a constant threat to life

ASA V: Moribund patient who is not expected to survive without the operation

ASA VI: Brain-dead patient whose organs are being removed for donor purposes

Locating ASA Classifications in the Clinic Manual

ASA classifications should be clearly defined and documented in the clinic's emergency procedures manual on station 8

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Outline the Clinical Emergency Assistance plan.

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Outline the Clinical Emergency Assistance plan.

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Rescuer #1: Initial Response

1. Stay calm

2. Stay with the patient and notify the closest student or faculty member (Rescuer #2) by saying "CODE RED"

3. Begin the CAB's (Circulation, Airway, Breathing) of Basic Life Support (BLS)

Rescuer #2: Notification and Equipment Retrieval

1. If Rescuer #2 is a student, notify the RDH instructor or DDS immediately

2. Bring the oxygen tank and emergency mobile cart from the instructor station

3. Dial 9-1-1 if the clinic instructor or supervising dentist indicates a need

Provide the 911 operator with:

Your name

Your phone number: (713) 395-5454

Details of the emergency

Location: Pima Medical Institute Dental Hygiene Clinic, 11125 Equity Drive, Suite 100, Houston, TX 77041

4. Go to the entrance to meet the EMS and guide them to the emergency site

Rescuer #1: Assistance and Documentation

1. Once the faculty member arrives, continue to assist them

2. Help with BLS and monitor vital signs

3. Verify that the DDS and EMS have been notified if the instructor is present

4. Record in writing a description of the emergency, the time it occurred, signs, symptoms, and vital signs

5. Notify the Program Director once the situation allows

Emergency Follow-up

1. All persons involved (Dentist, Instructor, Student[s]) will meet to discuss:

Description and cause of the emergency

Corrective actions to prevent future situations, if applicable

Complete an accident/incident report and submit it to the Program Director

2. Call the patient to determine their current health status and document the discussion in the patient chart

Fire Emergency Procedures

Preparation and Training

1. Students and staff are trained on the location and proper use of fire extinguishers and the fire evacuation plan during orientation

2. Students are instructed to stay together during a fire evacuation

Immediate Action on Scene

1. Evacuate the area and activate the Emergency Response System by dialing 9-1-1 from a safe location

2. Use fire extinguishers at your discretion, considering time and safety, and only after evacuating the area

Evacuation Process

1. Exit via the nearest safe evacuation route

2. Evacuation routes are posted near the door of each classroom

3. Instructors ensure all students have evacuated and close the classroom door before exiting the building

Call to Action

Review and update your facility's emergency plan regularly to ensure it meets the latest safety standards and best practices. Provide comprehensive training to all staff and students to ensure they are prepared to respond quickly and appropriately in an emergency situation.

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Distinguish between medical referrals and consults.

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Distinguish between medical referrals and consults.

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What is a Medical Referral?

A medical referral is a request from one healthcare provider to another for the evaluation or treatment of a patient.

Referrals typically involve the transfer of care from one provider to another.

What is a Medical Consult?

A medical consult is a request for a healthcare provider to provide their expertise and recommendations on a specific aspect of a patient's care.

Consults typically involve the primary care provider seeking input from a specialist or subspecialist.

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List contents of the medication kit and explain maintenance procedures.

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List contents of the medication kit and explain maintenance procedures.

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Chlorpheniramine (mild allergy)​: used for histamine blocker for allergic reaction with dermatologic signs like urticaria (red welts) and pruritus (itching) and respiratory symptoms like (wheezing)

Aspirin (MI)​: used or reducing myocardial infarction and reducing moderate pain. 2 baby aspirins given to patient with pain

Lorazepam (seizures or hyperventilation)​: used for seizures or hyperventilation and also will cause skeletal muscle relaxation. Adult dose 4mg

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Explain procedures for patients with medical conditions requiring alerts: Hypertensive Urgency​

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Explain procedures for patients with medical conditions requiring alerts: Hypertensive Urgency​

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Medical conditions:

An extremely high blood pressure reading without target end organ damage​. Newly diagnosed hypertension, poor controlled blood pressure, or noncompliant with therapy​ Headache (moderate to severe)​ Anxiety​ Shortness of breath​ Tinnitus​ Edema​ Epistaxis (nosebleed)​ BP greater than 180/110​

Treatment: REPAIR

R: Recognize S & S: stop procedure: retake BP

E: Evaluate level of consciousness

P: If conscious-seat upright: if unconscious supine

A: Activate CABs/CPR

I: Contact EMS: monitor BP every 5 mins: administer 4-6L O2 (if patient complains of dyspnea)

R: Refer to ER

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Explain procedures for patients with medical conditions requiring alerts: Hypertensive Emergency​

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Explain procedures for patients with medical conditions requiring alerts: Hypertensive Emergency​

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Medical conditions:

Extremely high BP with target end organ damage​, Target end organ damage:​ Aortic dissection​, Cerebral infarction or hemorrhage​, Myocardial infarction​, Renal insufficiency, Symptoms–similar to MI or CVA make it difficult to determine emergency:​ Sudden increase in BP >180/110; often as high as 220/140​, Dyspnea​, Chest pain​, Dysarthria​, Weakness​, Altered consciousness​, Visual loss​, Seizures​, Nausea/vomiting, Eventually coma​

Treatment​:

Treat end organ damage (i.e. MI or CVA).​

Treat hypertension secondarily.​

Seat patient upright.​

Contact EMS.​

Monitor vital signs.​

Administer O2 4–6 liters/minute.​

Drugs should be administered by medical personnel in hospital setting​

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Describe risk documentation procedures for medical history, conditions, and medications: Hypotension

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Describe risk documentation procedures for medical history, conditions, and medications: Hypotension

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Medical History​:

Usually reduction in baseline systolic or diastolic BP of 15–20 mmHg​

Medications:

Often caused by medications (antihypertensive)​

Can lead to shock​

Treatment:​

Position supine with feet raised.​

Assess airway.​

Administer O2 4–6 liters/minute.​

Monitor vital signs.​

If no improvement, contact EMS.​

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Describe risk documentation procedures for medical history, conditions, and medications: Orthostatic Hypotension

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Describe risk documentation procedures for medical history, conditions, and medications: Orthostatic Hypotension

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Medical History:

Normally hypotensive individuals​

Medications:

Medications (antihypertensive)​

Conditions:

Postural hypotension​

Sudden drop in BP due to change in body position​

Usually from supine to sitting or standing​

Dizziness or loss of consciousness may occur​

Etiologies​

Prolonged supine positioning​

Illness​

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Provide sources for general medical conditions requiring consultation.

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Provide sources for general medical conditions requiring consultation.

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Tachycardia – rapid pulse rate > 100 BPM​

Body's attempt to increase O2 to body cells by increasing amount of blood through blood vessels​

Often due to: fever, exercise, nervousness, excitement, meds or stimulant-type drugs, disease states (CHF, hemorrhage, and shock)​

Bradycardia – less than 60 BPM​

May cause lightheadedness, dizziness, chest pain, syncope, circulatory collapse​

Treated with atropine to increase heart rate; May require pacemaker if continues​

Pyrexia/fever – increased temperature​

Infection, neurological disease, malignancy, CHF, trauma, drugs​

Convulsions or delirium may occur with extremely high fevers​

Hypothermia – reduced body temperature; shivering, cool skin, pallor​

Illness, trauma, malnutrition, medications​

Should refer to MD​

Dyspnea ​- Labored breathing, requires excessive effort, Usually require oxygenation​

Stridor ​- Harsh sound on inspiration​, Crowing​, Associated with obstruction​

Wheezing ​- High-pitched sound on expiration or inspiration​, Associated with asthma​

Sighs ​- Deep inspiration and prolonged expiration​, Stress

Tachypnea – abnormally fast rate > 20​

Often seen in hyperventilation​

Bradypnea – slow rate < 12​

Often seen in syncope​

Apnea – absence of breathing ​

If continues results in respiratory arrest​​

Biot's​- Periods of shallow breathing, alternating with apnea​

Cheyne-Stokes ​- Increased rate and depth, alternating with apnea​, Often seen in heart failure and drug overdose​

Kussmaul​ - Increased depth and rate greater than 20​

Often seen in hyperventilation, metabolic acidosis, diabetic ketoacidosis, or renal failure​

Patients may report conditions that increase the risk for a medical emergency.​ Ex. conditions include:​

Heart conditions – MI, CHF, CVA​

Asthma​

Stroke, frequent headaches, or dizziness​

Epilepsy​

Thyroid problems​

Diabetes​

Corticosteroid use​

Allergy​

Bleeding disorders​

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Used with server asthma attack if not responding to first drug of choice albuterol (inhaler)

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used for acute angina ( chest pain, myocardial infraction (heart attack), heart failure(not pumping blood)

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Diphenhydramine (mild-moderate allergic reaction with urticaria and pruritus)​

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Diphenhydramine (mild-moderate allergic reaction with urticaria and pruritus)​

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used for histamine blocker for allergic reaction with dermatologic signs like urticaria (red welts) and pruritus (itching) and respiratory symptoms like (wheezing)

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used Bronchodilator used to treat asthma attack or bronchospasm.

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used for patient with Hypoglycemia (low blood sugar) and given juice or soda (NOT DIET) and oral glucose gel.

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used with server asthma attack if not responding to first drug of choice albuterol (inhaler)

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used for Intramuscular injection for adult is 1mg and 0.5 mg.

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Used for provide a protective barrier during mouth-to-mouth resuscitation

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Used for temporarily reverse the effects of an opioid medicine.

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Discuss legality of phone medical consults.

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Discuss legality of phone medical consults.

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Telephone etiquette

• Smile- they can hear your enthusiasm when you speak if you smile 

• Identify yourself

• Explain the purpose of your call

• Have all of the information ready when you call (dates and times for an appointment or patient’s information for a consultation/inquiry)

• Leave your contact information

• Thank them

• Document the phone call and who you spoke with in clinical notes.

Medical consultation:

- Hello, this is _____________ a dental hygiene student at Pima Medical Institute. I am calling regarding a mutual patient, __________. He/she states on his/her medical history that he/she has medical condition. We would like to clarify what type of dental treatments he/she may receive. Our clinic policy is to have a medical consultation form in his/her chart. I have a HIPAA release form as well that I will send. Is there a fax number or email address that I can send this to? I appreciate your help and if you have any questions, our number is 713-395- 5454. Thank you and have a nice day