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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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1- Oxygen compressed USP

2- Samaritan PAD

3- Samaritan Defibrillator

Where are the located?

Pads are always hanged with oxygen tank, and these equipment's can be found in Pima dental hygiene clinic/lab.

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Where is the emergency medical equipment and medication kit located in our clinic? 

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Where is the emergency medical equipment and medication kit located in our clinic? 

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It's located by station 8 and can be found in Pima dental clinic/lab.

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What is included in our medication kit? How is this maintained? 

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What is included in our medication kit? How is this maintained? 

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This kit contains

1- (Aspirin) It is used for reducing myocardial infarction and reducing moderate pain.

2- (Chlorpheniramine) Given for mild allergy, used for histamine blocker with dermatology signs like red welts and itching, also for respiration when hard to breath.

3- (Lorazepam) Used for seizures and hyperventilation. Helps to relax muscles.

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Usually used for patients with low blood sugar (Hypoglycemia) in case of emergency, given with juice or soda.

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Used for patients having sudden asthma attack if not responding to first drug which in inhaler (albuterol).

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Used for reversing temporarily effects of opioid medicine.

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Used for patients having asthma attack or bronchospasm.

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Used for mild to moderate allergic reactions.

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Used for acute angina which is chest pain, myocardial infraction which is heart attack, and heart failure.

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Used for patients having life threating allergic reactions like anaphylaxis. It opens up airways to lungs for immediate relief.

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What is the difference between Medical Referrals and Medical Consults. 

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What is the difference between Medical Referrals and Medical Consults. 

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What are Medical Referrals?

A Medical Referral is when a doctor sends a patient to another doctor to take over care for a specific problem or to take over primary care duties.

What is Medical Consult?

A Medical Consult is when doctor sends a patient to a specialist to evaluate the patient and issue a report with a treatment plan.

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It's located in Pima medical clinical manual on page 48 !!!!!

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Where can you find a general list of medical conditions requiring consult? 

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Where can you find a general list of medical conditions requiring consult? 

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PMI Medical Condition Consultation Protocol The following conditions will require that the student obtains a medical consultation for their patient. It is the student’s responsibility for recognizing the patient conditions that require consultation. Students must fill out the proper documentation for the medical consultation and the clinic must receive correspondence from the medical physician before further treatment is rendered. Students are required to follow-up with their patient and/or patient’s physician.

* 1. Myocardial infarction (MI) or cerebrovascular accident (CVA) within 12 months

2. Surgically constructed systemic-pulmonary shunts

3. Stage III or IV cancer

4. Joint Prosthesis

5. Adrenal Insufficiency

6. Anticoagulant therapy

7. Congenital heart defects

8. Congestive heart failure

9. Endocarditis history

10. Renal transplant and hemodialysis

11. Rheumatic heart disease

12. History of tuberculosis

13. Patient receiving interferon treatment

14. Blood diseases, especially acute leukemia, agranulocytosis, granulocytopenia, aplastic anemia, and agama globulin Emia

15. Diabetes if the patient has not had the condition checked by a physician within the last year

16. Active herpes lesions or shingles on head, neck, face, or in oral cavity do not require medical consult, but should be rescheduled until lesions are fully crusted over (no blisters or healed)

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The clinic manual is found in Pima Medical dental clinic and the ASA classifications are found on page 51!!!!! 

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What are the different ASA classifications and where can you find them in the manual for our clinic? 

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What are the different ASA classifications and where can you find them in the manual for our clinic? 

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ASA I- A normal healthy patient Pediatric Examples, including but not Limited to: Adult Examples, Including, but not Limited to: Healthy, non-smoking, no or minimal alcohol use Healthy (no acute or chronic disease), normal BMI percentile for age.

ASA II- A patient with mild systemic disease Mild diseases only without substantive functional limitations. Current smoker, social alcohol drinker, pregnancy, obesity.

ASA III- A patient with severe systemic disease Substantive functional limitations; One or more moderate to severe diseases. Poorly controlled DM or HTN, COPD, morbid obesity (BMI ≥40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, ESRD undergoing regularly scheduled dialysis, history (>3 months) of MI, CVA, TIA, or CAD/stents.

ASA IV- A patient with severe systemic disease that is a constant threat to life Recent (<3 months) MI, CVA, TIA or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, shock, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis.

ASA V- A moribund patient who is not expected to survive without the operation Ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction.

ASA VI- A declared brain-dead patient whose organs are being removed for donor purposes.

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What is the clinical Emergency Assistance plan for our program? 

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What is the clinical Emergency Assistance plan for our program? 

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Clinical Emergency Assistance Plan

In the event of a medical emergency, the following steps should be followed: If a patient is experiencing an emergency:

1. Rescuer #1, Stay calm  The student will stay with the patient, notify the closest student or faculty member (Rescuer #2) by saying, “CODE RED.”  Begin the CABs of Basic Life support 2.

Rescuer #2: notified student or faculty member

If student, must notify RDH instructor or DDS immediately Bring the oxygen tank and emergency mobile cart located at the instructor station, dial 9-1-1 if clinic instructor or supervising Dentist indicates a need.

911 Operator information: 

My name is:

My phone # is: (713) 395-5454

The emergency is:

My location is: Pima Medical Institute Dental Hygiene Clinic 11125 Equity Dr, Ste. 100

Houston, TX 77041

I will be waiting outside the entrance of our facility. Go to the entrance to meet the EMS and bring them to the emergency site.

Rescuer #1: Once the faculty member arrives, remain to assist that faculty member. Assist with BLS and monitoring of vital signs. If instructor is present, verify DDS and EMS has been notified Record in writing a description of the emergency, time it occurred, signs, symptoms, and vital signs. Notify Program Director once situation allows.

Emergency Follow up

All persons (Dentist, Instructor, Student[s]) directly involved in the emergency will meet to provide the following information: 

Description and cause of emergency

Corrective actions to prevent future situation, if applicable.

Accident/incident report will be completed and given to Program Director.

Patient will be called to determine current health status and discussion will be documented in patient chart.

The best way to prevent a medical emergency is to employ the following:

• Complete a comprehensive medical history (interview or questionnaire method) and risk assessment

• Document vital signs at each appointment

• Completion of a physical assessment including:

• Anxiety recognition and stress reduction protocols

• Determination of ASA status • Staff training and proper emergency kit in preparation for a medical emergency

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What do you do if your patient has a medical condition requiring an alert?

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What do you do if your patient has a medical condition requiring an alert?

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We need to follow steps of REPAIR as mentioned below.

R – Recognize signs and symptoms and stop all treatment

E – Evaluate patient’s level of consciousness

P – Place patient in appropriate position

A – Activate the CABs of CPR (circulation, airway, breathing)

I – Implement emergency protocol

R – Refer patient to healthcare professional

For example- Patients during procedure starts to have certain allergic reactions, will need immediate medical alert.

Also let's say, patient with high diabetes >200, if fasting or 1-2 hours postprandial we will have patient walk around and drink water; Re-test after 15 minutes; Refer patient for medical consultation; defer dental treatment for consult outcome. This can avoid for medical emergencies and alerts.

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Describe the risk documentation procedures for medical history, Medical Conditions/ Risk factors, Medications for our clinic (significant risk factors).

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Describe the risk documentation procedures for medical history, Medical Conditions/ Risk factors, Medications for our clinic (significant risk factors).

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Dental treatment with PMI protocols

1- <120/80 Any treatment; no modifications

>120/80, but <130/80 Any treatment; no modifications Encourage patient to see physician

>130/80, but <140/90 • Recheck blood pressure in 5 minutes • Any treatment; no modifications Encourage patient to see physician

>140/90, but <180/110 • Any required, consider intraoperative monitoring of BP for stage 2 hypertension Refer patient to physician promptly (within 1 month)

>180/110 Severe uncontrolled Refer to physician asap; if patient is symptomatic refer immediately.

Diabetes – PMI Protocol

Blood Glucose Level Dental Treatment Modifications

1- < 70 1-Give patient glucose supplements

2- 80-200 No modifications (Ideal)

3- >200, if fasting or 1-2 hours postprandial Have patient walk around and drink water; Re-test after 15 minutes; Refer patient for medical consultation; defer dental treatment for consult outcome.

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Describe the legality of a phone medical consult. 

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Describe the legality of a phone medical consult. 

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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!

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Prosthetic cardiac valve or material

• Presence of cardiac prosthetic valve.

• Transcatheter implantation of prosthetic valve.

• Cardiac valve repair with devices, including annuloplasty, rings, or clips.

• Left ventricular assist devices or implantable.

Previous, relapse, or recurrent infective endocarditis Congenital heart conditions (CHD)

• Unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits.

• A completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure.

• Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device.

• Surgical or transcatheter pulmonary artery valve or conduit placement such as Melody valve and Centegra conduit.

Cardiac transplant that develops a heart valve problem (valvopathy) Updated AHA Guidelines 2021 All total joint replacements 2 years post-procedure; Program compliance with discontinuation of antibiotic premedication will follow clearance via medical consult. The program recognizes the ADA Council on Scientific Affairs clinical practice guidelines which no longer recommend premedication for patients with prosthetic joint replacement as of 2015. The Program will follow the American Academy of Orthopedic Surgeons recommendations until further

Information From Manual page 50

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Symptoms:

Severe headache

Blurred vision

Chest pain

Shortness of breath

Nausea or vomiting

Immediate Management:

1. Stop Treatment Immediately – Keep the patient calm.

2. Position Patient Upright – Helps with breathing and circulation.

3. Check Blood Pressure – If ≥180/120 mmHg, it's a medical emergency.

4. Administer Oxygen – If experiencing chest pain or breathing difficulty.

5. Activate Emergency Services (911) – Transport to the hospital for urgent care.

6. Monitor Vital Signs – Until emergency responders arrive.

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Symptoms:

Sweating, shakiness

Dizziness, weakness

Confusion or irritability

Rapid heartbeat

Loss of consciousness (severe cases).

Immediate Management:

1. Stop Treatment Immediately

2. Check Blood Sugar (If Possible)

3. Give Fast-Acting Sugar (if conscious)

4 oz juice or regular soda

Glucose tablets or gel

1 tbsp honey or sugar

4. Wait 10-15 Minutes & Recheck

5. If Unconscious:

Do NOT give oral sugar

Call 911.

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Additional things can be found in clinic in case of emergency. 

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Additional things can be found in clinic in case of emergency. 

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Emergency Cabinet Contents In the emergency medical cabinet the following items can be found:

an instant cold pack, 2x2 gauze, a stethoscope, a blood pressure cuff, pulse oximeter, blood glucose monitor, a thermometer, as well as the oxygen and nitrous oxide delivery units. In addition, an AED defibrillator and a medication kit are located at the instructor's station in clinic. To use the AED, open the unit, turn the power on, follow the picture and verbal directions. These items will be checked monthly and immediately after use by the Clinic Assistant. A log is kept and initialed after each monthly check.