CPR Forth Year

1. ALTERED CONSCIOUSNESS

2. GENERAL CONSIDERATIONS




Terms
Confusion intermingling of ideas
Delirium illusions ,delusions
Dizziness
a disturbed sense of relationship to space
unsteady-------
Causes

drug overdose…..alcohol……local anesthesia, sedat…

Hyperventilation

Hypoglycemia

Hyperglycemia

Hypothyroidism

Hyperthyroidism

cerebr vasc acc


3. ALTERED CONSCIOUSNESS
Confusion intermingling of ideas
Delirium illusions ,delusions
Dizziness
a disturbed sense of relationship to space
unsteady-------

5. Predisposing factors
Drugs
alcohol;
local anesth sed,
 Hyperventilation
 Diabetes mellitus
 Thyroid gland dysfunctions


6. prevention
Early recognition
 Avoid drugs
 medical history
 clinical exam


7. Clin manif

Depend on cause
in Hyperventilation: rapid respir rate
 in Hypoglycemia
: cold wet skin
 in Hyperglycemia : hot dry skin

in Hypothyroidism: weakness fatigue
 in Hyperthyroidism : restlessness
 in cerebr vasc acc: sudden loss of consc


8. management
1-Recognize
 2- terminate dental procedure
 3-P-----depend on cause

supine position is accepitable…….

in diabetic & thyroid dis--- upright

in cerebrovasc acc---- can upright to dec bl pr
 3- A

B

C
 4-definitive care

m- monitor vital signs

m- manage signs & symptom

d-defin tt depend on cause


10. DIABETES MELLITUS [dm.]
Definition

a disorder of glucose metabolism --
hyperglycemia due to decr insulin secretion
or decr its activity or both
 Normal glucose level

80----100 mg /100ml blood

decr 50 mg------------hypoglyc in adults

decr 40 mg-----------hypoglyc in children


12. Fasting
glucose
level

13. complication
Acute complications
hypoglycemic coma….more acute& danger
hyperglycemic coma….less acute & ??
 chronic complications
Affecting large bl vessels------arteriosclerosis
Affecting small bl vessels--- microangiopathy
Affecting interstit tissue…..incr infections
periodontal infections


15. Affecting large bl vessels-----arteriosclerosis
Affecting small bl vessels--microangiopathy
Affecting interstit tissue…..
infections

27. Predisposing factors
Genetic factor

if both parent --------100%offsprings
 Disorders destroying islets of langerhans
 Other endocrine dysfunctions

corticost ttt ----iatrogenic diabetes


28. Classification of diabetes
Depending on age

adult onset DM

juvenile onset DM
 Depending on insulin injections

insulin dependent DM

non insulin dependent DM
 NOW we have these types


30. Type I DM
 Type II DM
 Impaired glucose tolerance I G T
 Impaired fasting glucose I F G
 Gestational diabetes


31. Type I, juvenile, IDDM
Genetically determined
8%
 Usually start in young
 There is no insulin in pat blood ie
[ insulinopenic]

glucagon is high

pancreatic B-cells are non responsive


32. Genetically determined
8%
Usually start in young
There is no insulin in pat blood ie
[ insulinopenic]
glucagon is high
pancreatic B-cells are non
responsive

33. GENETICALLY
human lymphocytic antigens on the
lymphocytes determined by chromosome
6 are impaired
 Immunologically
may autoimmune response as there
are antibodies…
 Other causes infect, drugs


34. Type II, adult, NIDDM
milder
 80 %
 Usually start in adults
 There are enough insulin [ to avoid
ketoacidosis]
 usually don’t need exogenous insulin



35. 



May be duo to lack of insulin receptors in
peripheral tissues
is divided into
Non obese type
Obese type

36. Non obese
obese

37. Clinical manifestations
D M ----- may be presented as
hyperglycemia
or hypoglycemia
NB hypoglycemia is more dangerous
D M ----- may be presented as
one or more of its complications


38. 
In hyperglycemia
There is syndrome of poly
polyurea, polydipsia ,polyphagia
,blurred vision ,pruritus….
 Start by nocturnal enuresis with loss of w --coma
 Other S/S…..


39. Hyper
glycemia

40. 
In hypoglycemia
In Early –CNS : hunger, nausea, hyperactive
 In Moderate--- adrenaline is released...>

sweating ,bizarre behavioral patterns
 In severe: unconsc, seizures ,hypotention
&hypothermia
 Acute complications are common


41. hypoglycemia

42. Control of DM
Self monitoring
 Diet control
 Physical activity
 Oral hypoglycemic drugs

a)sulfonyureas

tolbutamide

Glyburide

b)biguanide metformin
 Insulin treatment

43. Prevention
Preliminary patient evaluation
 Physical exam
 DENTAL observations

-if any doubt--- physician

Type II can tolerate dental care

Type I should be cared
 Observe ttt & complications
 Adjust dose of local anesth, insulin


44. Diabetic patients can tolerate
hyperglycemia more than hypoglycemia
 So after extensive dental procedures

type I DM ---check blood
glucose level in the next few days….

Antibiotic cover is important


45. management









I- recognition
Sign & sy of hypoglycemia
early: hunger ,nausea, Weakness & dizziness
moderate :[adren rel],hot moist Pale skin
late : anxiety , Headache
Altered consc
Sign & sy of hyperglycemia…..poly syndrome…
blood glucose > 250 [non fasting]
Acidosis ph < 7.3
Dry [loss of water],warm skin
Abnormal respir [ Kussmaul’s ]
Rapid weak pulse
Altered consc

46. D/D hypoglycemia &hyperglycemia





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In hypoglycemia
onset : rapid [ min]
Skin
: cold & wet
Breath : no odour
In hyperglycemia
onset
: slow [ hours & days ]
Skin
: hot & dry
Breath : acetone


If still in doubt----------apply PABC till medical assist
DM patient with imp consc should be managed as
having hypoglycemia until proved otherwise

47. Manag of hypogly a-consc
1-recognition of hypoglycemia
 2-terminate dent proc
 3-p
 4-A, B,C
 5-definitive care

oral CHO

orange juice
 6- recovery

observe for at least 1h


48. Manag of hypogly b-unconsc

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
1- no time for recognition of hypoglycemia
2-terminate dent proc
3-p
4-A, B,C
5-definitive care
summoning of medical assistance
IV CHO
50% dextrose
1mg glucagon
.5mg epinephrine
6- recovery
oral CHO after recovery

49. Manag of hypergly a-consc
1-recognition of hyperglycemia
 2-avoid any dental pro & terminate any
one


50. Manag of hypergly b-unconsc
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1-R
2-terminate dent proc
3-p
4-A, B,C
7-definitive care
medical assistance
IV CHO
5% , 5% , 5% . 5% . 5% dextrose
?? insulin in emergency
give O
8- transport to hospital