02-03-2013, 10:45 AM
MANAGEMENT OF HYPOTENSIVE PATIENTS IN DENTAL CLINIC
MANAGEMENT OF HYPOTENSIVE.pptx (Size: 329.46 KB / Downloads: 54)
DEFINITION
Blood pressure is generated by the heart pumping blood into the arteries and is regulated by the response of arteries to the flow of blood.
Pathophysiology
Blood pressure is continuously regulated by the autonomic nervous system, using an elaborate network of receptors, nerves, and hormones to balance the effects of the sympathetic nervous system, which tends to raise blood pressure, and the parasympathetic nervous system, which lowers it. The vast and rapid compensation abilities of the autonomic nervous system allow normal individuals to maintain an acceptable blood pressure over a wide range of activities and in many disease states.
PREDISPOSING FACTORS:
Administration and ingestion of drugs
Prolonged period of recumbency or convalescence
Inadequate postural reflex
Pregnancy
Advanced age
Venous defects in legs (e.g. Varicose veins)
Recovery from sympathectomy for “essential” hypertension
Addison’s disease
Physical exhaustion and starvation
Chronic postural hypotension (Shy-Drager syndrome)
Signs and symptoms
The cardinal symptoms of hypotension include lightheadedness or dizziness.[citation needed] If the blood pressure is sufficiently low, fainting and often seizures will occur.
Low blood pressure is sometimes associated with certain symptoms, many of which are related to causes rather than effects of hypotension:
Clinical criteria
Symptoms develop when individual stands
Standing pulse increases atleast 30 beats/min
Standing systolic blood pressure decreases atleast 25mm Hg
Standing diastolic blood pressure decreases atleast 10mm Hg
MEDICAL HISTORY
Are you taking,
Medications, drugs, over-the-counter medicines (including aspirin), natural remedies
Have you experienced
Dizziness, fainting spells, seizures
The names of any medications patient may be taking to assist in the maintenance of adequate blood pressure
Ephedrine, fludrocortisone acetate
Dental considerations
Basic precautions should be taken in the following patients :
Patients with history of postural hypotension
Patients receiving sedation (inhalation I.V/I.M/Intranasal) during dental treatment.
Patients who have been reclined in the dental chair for a long period
HYPOTENSIVE EMERGENCY
PROBLEM:
Hypotension results from variety of causes ranging from simple syncope
RECOGNITION:
It is detected by taking blood pressure
The pulse maybe weak and bradycardia may exist with associated shock patient may show restlessness, agitation, confusion, nausea, stupor and coma.
The amount of systolic pressure drop is more important than actual systolic blood pressure