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Hospital Patient-Difficult Patient

Hospital Patient-Difficult Patient . What kinds of patients seen in hospital setting Elements of hospital experience What constitutes a difficult pediatric patient Classification of sedation agents Considerations for use . Hospital Experience -Elements . Out patients clinics

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Hospital Patient-Difficult Patient

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  1. Hospital Patient-Difficult Patient • What kinds of patients seen in hospital setting • Elements of hospital experience • What constitutes a difficult pediatric patient • Classification of sedation agents • Considerations for use

  2. Hospital Experience -Elements • Out patients clinics • Consulting – Teams • Education • General anesthesia

  3. ASA Classification • 1_ - no systemic disease, normal healthy patient • 2 - one mild systemic disease- ( cold, asthma, heart murmur) • 3 -severe systemic disease that limits activity but not incapacitating • 4 - incapacitating dss constant threat to life • 5- moribund patient- survival without treatment questionable

  4. General Anesthesia - Questions ??? • Kinds of individuals treated • Criteria • Process an individual goes through • Induction methods • Safety precautions • Common complications • Common post operative psychological complications

  5. General Anesthesia • Methods to reduce post-operative complications • Methods to decrease psychological effects

  6. Primary goal of sedation • Facilitate provision of quality care by diminishing anxiety and managing disruptive behavior • produce a positive attitude toward dental care

  7. If the only tool is a hammer • Then every problem is a nail

  8. General consideration • Nature of treatment challenge • Planned dental procedure duration invasivity technical @ equipment • Ability of care giver to provide post-operative care

  9. Sedation • Defn: - A controlled pharmacologically induced, minimally depressed level of consiousness • Patient retains ability to maintain a patent airway independantly and continually- intact reflexes • Responds to physical, or verbal stimulation

  10. Sedation _Indications • Differentiate between mild conscious sedation and heavy sedation \or • Preventive - anxiolytic sedation and Management sedation

  11. Preventive sedation

  12. Ideal requirements • Safe • rapid onset • well tolerated • minimal side effects • reversible • rapid dissolution

  13. Management medication

  14. Why do we fail :

  15. RCDS Guidelines Undergrad education

  16. Some of the commonly used drugs in pediatrics • Nitrous oxide • antihistamines - hydroxazine - vistaril • anxiolytics - medazolam - valium - diazepam derivatives • sedative-hypnotics - chloral-hydrate • dissociatives - ketamine • narcotics - Demerol

  17. Routes of administration • Oral • Intra-nasal • Sublingual • Rectal • IM • IV

  18. Antihistamines • Adv.. - sedative, antihistaminic, antiemetic, anticholinergic - • Disad. - non-analgesic, non-amnesic, non- anxiolytic

  19. Atarax -Indications • Preschool and younger children • Timid highly anxious , high strung • Preventive medication • Extensive amount of treatment required

  20. Atarax- Contraindications • Previous history of hypersensitivity • glaucoma • Inability to obtain communication

  21. Atarax • Dosage : .5-2.5mg\kg// 1mg/lb PO Divided dosages - 1and2 hrs prior to apt. • 2yr old - 20lbs - 20mg • 3yr old - 30lbs -30 mg • 4yr old - 40lbs - 40mg • 5yr old - 50lbs - 50mg max dose

  22. Hydroxazine -Atarax • Actions • calming effect -sedative properties • subdues exaggerated responses to stimuli without dulling the senses • antiemetic • antispasmodic - acts on hypothalamus • effects within 30 minutes • action 3-4 hrs WIDE MARGIN SAFETY

  23. Any Behavior Management technique should produce a positive psychologic response to treatment by helping the child get through a difficult treatment without a negative response .

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