Chapter 27 Notes

Atrial Arrhythmia

The atria contracts before the next cardia cycle

Atrial Flutter

The atria is beating at an extremely rapid rate.

Blood Pressure Equipment

The equipment used when taking a patient's blood pressure are the sphygmomanometer and the stethoscope. To get an accurate reading, it is important to use the proper size cuff.

Diastolic

The heart muscle at rest when it is allowing the heart to take in blood to be oxygenated before the next contraction. Bottom Number.

Respiration

The process of inhaling or exhaling, or breathing. Rate: total number of breaths per-minute Rhythm: breathing pattern Depth: amount of air inhaled and exhaled

Radial Pulse Procedure

The radial artery is found close to the inside part of your wrist near your thumb. You will need a watch with a second hand to count your pulse. [Bend your elbow with your arm at your side. The palm of your hand should be up. Using your middle and index fingers, gently feel for the radial artery inside your wrist. You will feel the radial pulse beating when you find it. Do not use your thumb to take the pulse because it has a pulse of its own.]

Medical Considerations

The stress and anxiety of a dental procedure could possibly elevate a patient's blood pressure (Many drugs have adverse effects that can interfere with dental treatment) A patient who has been diagnosed with hypertension should be under the care of a physician during a treatment regimen.

Medical Consideration

The stress and anxiety of a dental procedure could possibly elevate a patient's blood pressure. Many drugs have adverse effects that can interfere with dental treatment. A patient who has been diagnosed with hypertension should be under the care of a physician during a treatment regimen.

Ventricular Tachycardia

The ventricles are beating at an extremely fast rate.

Ventricular Arrhythmia

The ventricles contract before the next cardiac cycle.

Ventricular Fibrillation

Total electrical dysfunction

Electrocardiogram

With each beat, an electrical impulse or wave travels through the heart. the ECG records a series of waves that move above or below a baseline value. This wave causes the muscle to squeeze and pump blood from the heart. Each deflection corresponds to a particular part of the cardiac cycle.

Carotid Pulse Procedure

Your arteries are found on the outer part of the right and left side of your neck. You will need a watch with a second hand to count your carotid pulse. [Using your middle and index fingers, gently feel the carotid artery on either side of you neck. Do not press down on both arteries at the same time. You will feel the carotid pulse beating when you find it.]

Electrocardiogram

A procedure that measures the electrical activity of the heartbeat. In dentistry, the ECG can be used as a preventive measure when a patient is undergoing general anesthesia or IV sedation in a hospital or outpatient setting. The chest loads are placed on the patient at specific locations. The machine then amplifies the natural electrical currents generated by the electrical impulse of the heart and the pattern is traced on graph paper.

Hypertension

is often referred to as the silent killer. one-third of all patients are un-diagnosed. 90% probability of developing hypertension if a 55 year old patient lives to their life expectancy. Affects 10%-20% of adult patients necessary for the dentist and medical provider to interact to ensure that the patient's blood pressure does not result in target organ damage as well as to ensure the safe delivery of dental care.

Stethoscope

is used to amplify Korotkoff sounds. [A series of sounds produced by the blood rushing back into the brachial artery, which has been collapsed by the pressure of the blood pressure cuff.] (As the pressure in the cuff is slowly released, the stethoscope picks up a distinct thumping sound that grows louder and then softens to a murmur.)

Advanced Monitoring Procedures

Additional patient monitoring techniques are being introduced into dental surgical procedures as a standard of monitoring a patient's health status in a noninvasive way. Monitoring patients during the preoperative, operative, and postoperative phases can occur as an expanded has completed a board-approved course in these procedures.

Blood Pressure

reflects the amount of work the heart has to do to pump blood throughout the body. Two pressures of the heart: Systolic Diastolic

Pulse Oximetry

works by passing a beam of red and infrared light though a pulsating capillary bed. Oxygenated blood is a bright red color deoxygenated blood is more blue-purple The oximeter detects the pulse, and then subtracts the intensity of color detected when the pulse is absent. The remaining intensity of color represents only the oxygenated red blood.

When to Discontinue TX

DDS is ultimately only person to decide this. ADA recommends refer MD at Stage 1 Hypertension 140/90 -- Can still treat at this point. Dentist's discretion when to not treat. Some will reschedule at this reading, others will continue with much higher readings. Depends on procedure pt is at office for.

Your Thumb

Do not use your thumb to take the pulse because it has a pulse of its own.

Why We Worry about BP

HBP increases risk of stroke, CVA Pt's normally have slightly HBP at MD.DDS offices due to stress When the body is reclined, BP rises slightly - When this is added to HBP and anxiety the risk of stroke increase exponentially.

Sphygmomanometer

Includes the blood pressure cuff and meter. The cuff is a cloth wrap that holds an inflatable rubber bladder. A rubber bulb is attached to the cuff with rubber tubing.

Pulse

Is the rhythmic expansion of an artery each time the heart beats.

Patient Education

It is estimated that 50 million Americans have high blood pressure. Approximately one fourth of that population is not aware of their medical condition. By taking a patient's blood pressure at every visit, not only are you gathering vital information for their treatment that day, but you may also be saving that person's life.

BP for PT Medically Compromised

Left arm is preferred for BP readings because the heart is situated slightly to the left in the chest. Opposite side if pt has Shunt for dialysis - Port for chemo - Pic Line If pt has had mastectomy ask what side the mastectomy was on the mastectomy was on if pt indicates this on HHX use opposite side. May need to take on leg. These pts normally know their BP.

Pulse Readings

Make sure the patient is positioned with his or her arm at the same level or lower than the heart. (The arm should be well supported and extended straight out). It is difficult to detect any possible arrhythmia in the heartbeat in times shorter than 30 seconds.

Asystole

No Heartbeat

Why DDS Offices Catch HBP

Patients com in for preventative treatment more than they see MD. Can be monitored easily twice a year or more often depending on treatment needs. Not all patients are happy with this.

Hyperventilation

Pt breathing too fast- reaction to having an axiety attack Do not leave pt- call for help- get paper bag for them to breath into- Do Not Give O2

Pulse Oximetry

Pulse oximetry is used for measuring the concentration of oxygen in the blood. [This procedure is of particular importance for monitoring oxygenation and pulse rate throughout anesthesia and during the recovery phase. Cannot be used on patients with polished nails. (Offices should have nail polish remover is using this equipment)

Sinus Arrhythmia

Rate or rhythm is altered

Pulse Characteristics

Rate: number of beats that occur during the counting period Rhythm: The pattern of the beats, such as an occasional skipping, speeding up, or slowing down of a beat. Volume: The force of the beat, such as a strong or a weak beat.

Systolic

Reflects of the amount of pressure it takes for the left ventricle of the heart to compress or push oxygenated blood out into the blood vessels. Top number