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Altered consciousness
DM: hyperglycemia & hypoglycemia
Thyroid gland dysfunction(thyroid
crisis,myxodema coma )
Cerebrovascular accident
Seizures
Anaphylaxis
DIABETES MELLITUS
Is
It
Hypoglycemia
HYPERGLYCEMIA
Slow onset
Drowsiness/disorienta
tion
Dry skin, dry mouth,
deep breathing,
hypotension
Pulse weak
Blood sugar increased
Urine sugar usually
positive
HYPOGLYCEMIA
CLINICAL MANIFESTATION:
Mild
Hunger
Moderate
Nausea
Anxiety
Mood change Sweating
tachycardia
weakness
Poor judgment
Behavior change:
Severe
Hypotension
confusion,
Seizures
uncooperativeness
unconsciousness
4
Management of hypoglycemia
conscious patient
Management of hypoglycemia
unconscious patient
Dental
management of
patient having
thyroid
disorders
DENTAL CONSIDERATION
DENTAL CONSIDERATION
Carbimazole causes
agranulocytosis ,which may cause
DENTAL CONSIDERATION
TERMINATE DENTAL
PROCEDURE
P-POSITION THE
PATIENT WITH LEGS
ELEVATED
A-B-C,ASSESS &
PERFORM BLS ,AS
NEEDED
D-DEFINITVE CARE
SUMMON
EMERGENCY
ASSISTANCE
ADMINISTER
OXYGEN
Dental management of
hypothyroid pt
Stable,
Avoid
Myxedema
CEREBROVASCULAR
ACCIDENTS
o
o
o
o
o
o
CVA
vascular injury
neurologic impairment
Causes areIntracerebral hemorrhage
Thrombosis
Embolism
Vascular insufficency
causes
TIA
neurologic deficit
complete clinical
resolution
within 24 hours
STROKE
Acc. To WHO
It
Etiology
Atherosclerosis
Cerebral
Atherothromboembolis
m
Thrombus
Cerebral embolus
Embolism from the heart (cardiac origin)
Intracranial hemorrhage
Subarachnoid hemorrhage
Intracranial small vessel disease
Arterial aneurysms
Arterio-venous malformation
Haematological disorders
(haemoglobinopathies, leukemia)
Pathophysiology
Ischemia
irreversible cellular damage
in area of infarction
cerebral edema
elevates ICP
neurological deterioration
PT management
Terminate dental procedure
positon the patient comfortably
basic life support as indicated
monitor vital signs
summon medical assitance
manage sign and symptoms
if bp elevated, semi fowlers positon
adminster oxygen do not admister cns deppresants
symptom persist(CVA OR TIA)
hospitalize patient
Symptoms resolve(tia)
follow-up management
Loss of consciousness(cva-hemorrhagic?)
Position patient(supine with legs elevated sligtly)
Basic life support,as indicated
Monitor vital signs
If bp elevated position patient(head/chest slight elevation)
Establish intravenous line ,if avialable
Definitive management(hospitalize patient)
SEIZURES
a paroxysmal disorder of cerebral
function characterized by an attack
involving changes in the state of
consciousness, motor activity or
sensory phenomena; sudden in
onset and usually of brief duration
Excessive discharge of cerebral
neurons
Classification
Partial
seizures
seizures
Generalized
seizures
Causes
Primary
/idiopathic/genetic epilepsy
Secondary
epilepsy
Congenital abnormalities
Metabolic and toxic disorders
Head trauma
Tumours and space occupying lesions
Vascular diseases
Degenerative disorders
Infectious diseases
Clinical features
Partial
Petit
seizures
mal seizures
Grand
mal epilepsy
consciousness
Ictal phase
Tonic component
Clonic component
Postictal phase
Management
PRODROMAL STAGE
procedure
ICTAL STAGE
position the patient (supine
with legs elevated slighty)
summon medical assitance
protect patient from injury
basic life support as indicated
adminster oxygen
monitor vital singns
seizure contiues more than 5 minutes
basic life support
until assitance
arrives
ANAPHYLAXIS
Allergy is a hypersensitive state acquired
through exposure to a particular allergen, reexposure to which produces a hightened
capacity to react
Types
Type I - Anaphylaxis
Type II - Cytotoxic
Type III - Immune complex
Type IV - Cell mediated or Delayed
Predisposing factors
Antibiotics
Esters
Penicillin
Cephalosporins
Tetracyclins
Sulfonamides
Analgesics
Na metabisulfite
Preservative
NSAIDs
Opiods
Morphine
Codeine
Mepiridine
Procaine
Propoxycaine
Benzocaine
Tetracaine
Antioxidant
Aspirin
Local anaesthetics
Methyl paraben
Other agents
Methyl methacrylate
Pathophysiology
Allergen
Sensitizing dose
IgE antibody produced in response to Ag
Mast cell sensitization
Ag destruction
Challenge dose
Ag-Ab reaction
Mast cell degranulation
Release of histamine(chemical mediators of anaphylaxis)
Anaphylaxis
Chemical mediators
Histamine
Vasodilatation, Bronchoconstriction
Increased vascular permeability
Triple response (wheal, flare, flush)
SRS-A
ECF-A
Basophil
kallikrins
Prostaglandins
Platelet
activating factors
Clinical manifestations
Skin
reactions
Respiratory
reactions
Cardiovascular
reactions
Management
(Sign and symptom of allergy present)
terminate dental treatment
Positon the patient(supine with legs
elevated)
Basic life support as indicated
Summon medical assitance
Admister epinephrin(sc, IM, IV)
Admister oxygen
Monitor vital sings
Additional drugs
antihistamine,corticosteroid
Definitive
care
Prevention
History
of known allergy
History
of previous episode
Medical
Allergy
consultation
testing?
REFERENCE
Malamed