Hyperventilation

What is diaphoresis?

-extreme sweating

What is hypocapnia?

-lack of carbon dioxide in the arterial blood system

What is the result of hypocapnia?

-respiratory alkalosis and cerebral vasoconstriction

What is tetany?

-twitching of the muscles or spasms, with sharp flexion of the wrist and ankle joints (also called carpopedal spasms)

What happens when the carbon dioxide is decreased during hyperventilation?

-vasoconstriction of the arteries and veins in many areas of the body, including the heart and brain

Hyperventilation respiration rate

22-40 respirations/minute

Optimal pH level for the blood

-7.4 which is slightly alkaline

What is the recommended medication if symptoms do not subside?

-Lorazepam in a dose of 1-2 mg IM -Diazepam in a dose of 2-5 mg IM -The oral dose of diazepam is 10-15 mg

What is a pulmonary embolism?

-a blockage of the pulmonary artery by some type of obstruction, such as fat, air, a tumor, or thrombus

What are the risk factors for a pulmonary embolus?

-abdominal/pelvic surgery -immobilization -recent lower limb trauma -pregnancy -previous deep vein thrombosis

What is Chvostek's sign?

-abnormal spasm of the facial muscles elicited by light taps on the facial nerve

What is the most common symptom of hyperventilation?

-abnormally prolonged rapid and deep respirations

What is respiratory alkalosis?

-an increase in the pH of the circulating blood

Asking the patient to breathe into his or her cupped hands is a method that serves what two purposes?

-breathe in carbon dioxide-enriched exhaled air -warm the patient's cold hands

What is hyperventilation syndrome?

-breathes faster and/deeper than normal -eliminates more carbon dioxide than is being produced

What happens when the patient interprets the sensations as a condition that is far more severe than hyperventilation?

-can cause further anxiety -magnifies the symptoms -vicious cycle occurs making the condition difficult to control

Why is breathing into a paper bag no longer recommended as treatment or hyperventilation?

-can cause suffocation and cardiac arrest

Hyperventilation is frequently a secondary complication to what kind of psychological events?

-family dispute (anger) -death of a family member -pain -excitement

What are the common precipitating factors in the dental setting that can cause hyperventilation?

-fear and anxiety

What is air hunger?

-feeling like you cannot catch your breath and are suffocating

Hyperventilation syndrome mostly found in?

-females; 30-40 age range

What are the common exposures that can cause hyperventilation?

-high altitudes -pregnant -take central nervous system-stimulatory drugs -have aspirin toxicity -experience anxiety states

What does progressive hyperventilation cause?

-hypocalcemia

When would the patient be transported by EMS to an emergency department?

-if the patient is suffering from a more serious condition, such as a pulmonary embolism

What symptoms are related to cerebral (brain) oxygenation?

-impair problem-solving abilities -motor coordination -balance -perceptual tasks

What is the basic premise for treatment of hyperventilation?

-increase blood carbon dioxide levels -addressing the psychological factors the patient is experiencing

What happens when the blood vessels in the heart are constricted?

-leads to a decreased cardiac output -reduced coronary blood flow which can give the patient the symptoms of heart palpitations and possibly chest pain

The vasoconstriction of the blood vessels in the brain can lead to what?

-lightheadedness -dizziness -impaired vision -seizures

What should the healthcare professional do if the condition does not improve?

-may consider intramuscular(IM) or oral administration of a benzodiazepine to help alleviate symptoms

Should oxygen be administered to a hyperventilating patient?

-no, becuase this can exacerbate the condition

What is circumoral parasthesia?

-numbness or tingling around the oral cavity

When can the paper bag rebreathing be implemented?

-only when myocardial ischemia can be ruled out, and the patient's oxygenation has been measured by arterial blood gases or pulse oximetry, which most often does not occur in a dental office.

What can the carpopedal spasms lead to?

-parasthesia or numbness in the extremities

What are the recommended steps in treatment of hyperventilation?

-place patient in an upright position or position of his/her choice -loosen tight clothing around neck region -(most important step) work with patient to control the rate of respirations -have patient count to 10 in one breath (breathing through pursed lips or the nose will help slow breathing or have them hold their breath for as long as possible) -monitor vitals -

The symptoms of hyperventilation can mimic what respiratory disorder?

-pulmonary embolism

What does pulmonary embolus and hyperventilation have in common?

-reduced arterial carbon dioxide levels

What is hypocalcemia?

-reduction in the calcium levels in the bloodstream

What are the two results hypocalcemia can lead to?

-tetany -Chvostek's sign

What happens when respirations increase?

-the pH will rise to 7.5 or higher -the carbon dioxide level can fall from a normal of 40mmHg to 30 or 25 mmHg in less than 30 seconds

Normal respiration rate for adults

12-20 respirations/minute

Some differences in pulmonary embolus compared to hyperventilation include what?

pulmonary embolus patients will not exhibit: -spasms of the hands and ankles -tingling in the mouth and fingers -two-thirds of all patients with pulmonary embolism die within two hours of onset