Hospital Patient-Difficult Patient

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

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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

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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

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General consideration

• Nature of treatment challenge
• Planned dental procedure
• duration
• invasivity
• technical _at_ equipment
• Ability of care giver to provide post-operative
  care

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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

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Sedation _Indications

• Differentiate between mild conscious sedation and
  heavy sedation \or
• Preventive - anxiolytic sedation and Management
  sedation

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Preventive sedation
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Ideal requirements

• Safe
• rapid onset
• well tolerated
• minimal side effects
• reversible
• rapid dissolution

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Management medication
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Why do we fail
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RCDS Guidelines Undergrad education
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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

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Routes of administration

• Oral
• Intra-nasal
• Sublingual
• Rectal
• IM
• IV

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Antihistamines

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

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Atarax -Indications

• Preschool and younger children
• Timid highly anxious , high strung
• Preventive medication
• Extensive amount of treatment required

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Atarax- Contraindications

• Previous history of hypersensitivity
• glaucoma
• Inability to obtain communication

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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

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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

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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 .