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

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 .