DENA - 1240
Medical Emergencies in the Dental Office
Revised 2016 by: Theresa Lennon
Course Description
The course is designed to cover the causes of various medical emergencies and how to manage an episode in the dental office. Through lectures and reading materials the student will learn about various conditions that can lead to a medical emergency in the dental office, how to recognize it and what management steps are necessary in that particular case. The student is also taught how to prevent a medical emergency from occurring via proper history taking techniques. The course also includes a laboratory project, which involves independent research on a given systemic condition.
Credits/Modes of Instruction
This is a one (1) credit undergraduate course in lecture format that relies on regular activities, assignments, and completion of weekly topics.
Prerequisites: Dynamics of Healthcare in Society (For Participating Health Science Careers Program Students)
Instructor:
The instructor will be a Rutgers, SHP faculty (or adjunct) member.
Course Objectives:
1. Identify the data used to prevent a medical emergency in the dental setting including the patient’s physical state (vital signs) and mental state.
2. Recognize symptoms of medical emergencies which may occur in the dental practice setting or other site, including those related to Metabolic diseases, Cardiopulmonary diseases, Neurological disturbances, Allergic reactions, Visual obstructions, Respiratory disturbances, Shock, Syncope, Emotional disturbances, Thyroid diseases, and Adrenal insufficiency.
3. Identify the procedures necessary to maintain the physiology of respiration and circulation during an emergency.
4. Identify and carry out general procedures to be followed in case of an emergency:
● Summon aid immediately without alarming the patient or other patients
● Reassure the patient and make patient comfortable
● Position patient to support circulation and respiration
● Initiate required emergency procedures until the dentist or physician arrives.
● Describe onset of condition and subsequent signs/symptoms to attending dentist and/or physician
● Assist attending dentist and/or physician in administering required emergency treatment
5. Identify the responsibilities and limitations of dental personnel in first aid procedures.
6. Identify the procedures to be provided for a patient with the specific medical emergencies listed in item to be covered in the course.
7. List the essential items needed in the office in case of an emergency.
8. Identify and demonstrate didactic knowledge of use of emergency equipment and drugs.
Course Requirements for Completion:
Attendance is required to keep up with the information presented in class. Students will be expected to participate in classroom discussions and group activities. Each course unit will include readings, assignments, and a short quiz as developed by high school faculty. In addition, successful completion the course projects will be required. There will be a cumulative final exam based on class content and assigned readings
Evaluation/Assessment Methods:
20% Attendance/Participation/Group Discussion – Students are expected to attend all classes and participate in classroom discussions and group activities.
20% Unit Quizzes – Students will be required to take a short quiz at the completion of each unit. Content will be based on lectures, readings, and classroom discussions/activities - as developed by high school faculty.
30% Unit Assignments – Each unit will have specific assignments geared to meet unit objectives. These assignments can be completed as homework or in class, as time permits determined by high school faculty.
30% Course Exams/Projects/Practical Drills – as assigned by high school faculty
Final high school grade is calculated as described above and determined by high school faculty.
Final Examination (developed and administered and by Rutgers-SHP) – Successful completion of a cumulative final exam at the end of the course is required and will determine college credit grade.
Upon successful completion of the course students will be eligible to take the Health Science Careers standardized exam to determine college credit.
High school students must attain a C (73) or better on standardized exam to earn college credits. The Rutgers grade listed on transcript will be comprised of 50% of the Rutgers, SHP standardized exam grade and 50% high school grade.
Health Science Careers Program Grading System
Weighted Average of All Requirements / FinalLetter
Grade
93-100 / A
90-92.9 / A-
87-89.9 / B+
83-86.9 / B
80-82.9 / B-
77-79.9 / C+
73-76.9 / C
70-72.9 / C-
67-69.9 / D+
63-66.9 / D
Less than 63 / F
Faculty/Student Honor Code:
(Refer to the Rutgers Student Handbook at http://rutgers.SHP.edu/current_students/handbook.pdf)
The faculty of Rutgers, School of Health Related Professions believe that students must observe and support high standards of honesty and integrity in all aspects of education, practice, and research. For this reason, all matriculated and non-matriculated students in this course are expected to abide by the School's Faculty/Student Honor Code and accept responsibility to help ensure that these standards are maintained by reporting violations of the Honor Code observed in others. All violations will be considered with gravest concern and may be punishable with sanctions as severe as suspension or dismissal.
General Learning Resources
Required Textbook(s):
Malamed. Medical Emergencies in the Dental Office. Mosby, Inc., an affiliate of Elsevier Inc. 3251 Riverport Lane, St. Louis, MI. 7th Edition. 2015. ISBN: 9780323171229
Highly Recommended:
Lippincott Williams & Wilkins' Comprehensive Dental Assisting. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012. (ISBN:13:978-1-582-55815-8)
Other Required Learning Resources
Various website links will be provided in the Learning Resources section for each unit in the Course Schedule. Students are required to access these websites for completion of assigned readings and activities.
Course Units/Schedule
Note: this schedule is a plan only, subject to change by the instructor as deemed necessary to achieve the course goals. Whenever possible, you will be notified in advance of any changes, especially those affecting course requirements or grading.
Unit/Begin Date / Topical Outline / Activities/Assignments / NJCCCS
Unit 1 / INTRODUCTION, PREVENTION, and PREPAREDNESS
· Discuss factors increasing risk during dental treatment
· Identify methods of classification of life-threatening situations
· Identify the most common medical emergencies in a dental office
· Explain why medical history is important in preventing an emergency;
· State the significance of vital signs;
· Define ASA classification;
· Describe stress reduction protocol.
· Identify emergency plans for the dental office;
· List the items included in a medical emergency kit;
· Explain which emergency drugs are necessary in the office and describe the use of each drug. / Introduction
1. Reading Ch 1
2. Video Introduction -
3. Lesson – Cornell Notes
4. Guided Reading 1.1
5. Define Key Terms 1.1
6. Discussion
7. Quiz 1.1
Prevention
1. Video Discussion – Types of Death
2. Lesson – Cornell Notes
3. Guided Reading 1.2
4. Define Key Terms 1.2
5. Web Quest – Medical History
6. Recall Vital Signs
7. Group Activity - Medical History Scenarios
8. Worksheet – ASA Classifications
9. Quiz 1.2
Preparation
1. CPR Review Worksheet
2. PPT Lesson
3. Guided Reading 1.3
4. Define Key Terms 1.3
5. Role Play Emergency Team Drills p65-66
6. Quiz 1.3
Unit Test 1 / 9.3.HL.1
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Unit 2 / UNCONSCIOUSNESS
· Recognize unconsciousness based on the three assessment criteria;
· Manage the unconscious victim;
· Explain the importance of baseline blood pressure;
· Discuss the physiological consequences of hypotension;
· List the steps in the management of hypotension;
· Discuss the causes of hypotension;
· State ways to prevent hypotensive episodes in the dental office.
· Name what other disorders can mimic adrenal insufficiency;
· Describe the anatomy of adrenal gland;
· Explain steroid therapy and rule of twos;
· Dental treatment complications and considerations;
· Discuss emergency management protocol for an adrenal related emergency;
· List the predisposing factors to acute adrenal insufficiency;
· Discuss the differential diagnosis of adrenal insufficiency;
· Explain the use of corticosteroid therapy for adrenal disorders. / Unconsciousness
1. Video Discussion -
2. Lesson - Notes
3. Define Key Terms 2.1
4. Practice Skills Introduction
5. Quiz 2.1
Vasodepressor Syncope and Postural Hypotension
1. Video Discussion -
2. PPT Lesson 2.2
3. Practice Skills Rubrics
4. Quiz 2.2
Adrenal Insufficiency
1. Discussion - Stress
2. PPT Lesson
3. Guided Reading
4. Emergency Protocol / 9.3.HL.1
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Unit 3 / RESPIRATORY DISTRESS:
· Define terms related to respiratory distress;
· Discuss potential causes of respiratory distress:
· and list the basic steps to manage most types of respiratory distress.
· Define hyperventilation
· Discuss causes of hyperventilation
· State the signs and symptoms of hyperventilation
· Discuss prevention of hyperventilation
· State management protocol of hyperventilation in the dental office
· List conditions that may mimic hyperventilation
· List signs and symptoms of wheezing
· Define asthma
· State what may cause respiratory distress
· List the signs and symptoms of asthma
· Name the medications that may be used to manage asthma
· Discuss the steps for prevention of an asthmatic episode
· Discuss the protocol for management of an asthmatic episode
· Define status asthmaticus
· State the protocol for management of status asthmaticus
· List other conditions that may mimic asthma
· Define dyspnea
· State the signs and symptoms of dyspnea
· Discuss causes of dyspnea
· State the dental treatment modalities for MI, angina, CHF
· Define angioplasty
· Discuss necessity for angioplasty
· Define bypass surgery
· State the rationale for medical consult protocol
· Discuss valvular disorders
· Define regurgitation
· Explain the rationale for antibiotic premedication
· Define SBE
· Define Congestive Heart Failure
· Discuss causes of congestive heart failure
· Discuss physiological effect of Congestive Heart Failure
· List medications of Congestive Heart Failure patient
· Discuss treatment modifications for the CHF patient / Respiratory Distress and Foreign Body Airway Obstruction
1. CPR Review Worksheet
2. PPT Lesson 3.1
3. Guided Reading 3.1
4. Define Key Terms 3.1
5. Google Classroom – Essential Question discussion
6. Quiz 3.1
Hyperventilation
1. Video Discussion -
https://www.youtube.com/watch?v=p97HeXx0vN0#t=59
2. PPT Lesson 3.2
3. Practice Skills Rubric 3.2
4. Google Classroom – Edpuzzle video with questions
Asthma
1. Video Discussion -
http://www.mayoclinic.org/diseases-conditions/asthma-attack/multimedia/asthma/vid-20084746
2. PPT Lesson 3.3
3. Key Terms 3.3
4. Practice Skills Rubric 3.3
5. Google Classroom – Edpuzzle video with questions
6. Quiz 3.2-3
Heart Failure and Acute Pulmonary Edema
1 Video Discussion - http://www.pbs.org/wgbh/nova/body/map-human-heart.html
2 PPT Lesson 3.4
3 Define Key Terms 3.4
4 Google Classroom – Heart Failure Webquest
5 Google Classroom – Edpuzzle video
6 Quiz 3.4 / 9.3.HL.1
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Unit 4 / ALTERED CONSCIOUSNESS
· Define altered mental status
· Discuss various causes of altered mental status
· Describe the physiology of the pancreas
· Describe abnormalities that may occur in the pancreas
· Differentiate between the types of diabetes
· List the medications used to manage diabetes
· Discuss physiological manifestations of diabetes
· Discuss management of hypo or hyperglycemic episode in the dental office
· Discuss anatomy and function of thyroid gland
· List Signs and symptoms of hypo and hyperthyroidism
· Discuss the importance of a thorough medical history review
· State the dental treatment protocol: Medical history consult, Dental contraindications, and Epinephrine use
· Discuss management of thyroid emergency in the dental office
· Define stroke
· Discuss causes of stroke
· Define TIA
· Differentiate between the types of stroke: Hemorrhagic and Occlusive
· Discuss the important and rationale of a medical consult
· Discuss proper waiting period before treating patient with history of stroke
· List signs and symptoms of stroke
· Describe the steps necessary to manage a stroke in the dental office: ABC, BLS, and EMS / Altered Consciousness and Mental Status
1. PPT Lesson 4.1
2. Define Key Terms 4.1
3. Google Classroom – Ingestion or Administration of Drugs Essential Question
Diabetes Mellitus
1 Video Introduction - https://www.youtube.com/watch?v=4YZrDJB6_GQ
2 PPT Lesson 4.2
3 Guided Reading 4.2
4 Practice Skills Rubric 4.2
5 Quiz 4.2
Thyroid Disorders
1 PPT Lesson 4.3
2 Define Key Terms 4.3
3 Guided Practice – Clipboard Review. Divide students into 4 teams. Give each team a copy of the “Clipboard Relay” handout on a clipboard. As the clipboard is passed down the row, each student is to write in a sign or symptoms of thyroid emergencies.
Cerebrovascular Accident
1. PPT Lesson 4.4
2. Define Key Terms 4.4
3. Practice Skills Rubric 4.4
4. Quiz 4.4 / 9.3.HL.1
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UNIT 5 / SEIZURES
· Discuss the types of seizures
· Identify clinical signs and symptoms
· State predisposing factors for a seizure
· Discuss the importance of a medical history review
· State dental therapy considerations
· Explain the management of an epileptic seizure in the dental office
· Discuss Status epilepticus
· Explain why a static GTCS is a true medical emergency
· Discuss the management of status seizures in dental office
· State medications to administer in the event of a static seizure / Seizures
1. Video - http://www.epilepsy.com/atom/8041
2. PPT Lesson 5
3. Define Key Terms 5
4. Webquest -
http://www.epilepsy.com/get-help/managing-your-epilepsy/understanding-seizures-and-emergencies/warning-signs-seizures
5. Practice Skills Rubric 5
6. Quiz 5 / 9.3.HL.1
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UNIT 6 / DRUG RELATED EMERGENCIES
· Drug Overdose Allergy and Anaphylaxis
· Discuss what IgE is and its role in allergic reactions
· Name the types of allergies and their differences
· Define anaphylaxis
· State the signs and symptoms of anaphylaxis
· Name the causes of an anaphylactic reaction
· Explain the management of allergic reactions
· Discuss the importance of a medical history in the prevention of an allergic reactions
· List drugs that may cause allergic reactions