Medical emergencies in the dental office-Heart failure and acute pulmonary edema

这类病人口腔科室常常会遇到一些，尤其是颌面外科，对于心血管系统的关注一向是重点，了解也比较多。所以只捡重点作为笔记。

心功能评估

患者病史以及用药情况
心功能对日常生活的影响
1. 日常活动能力：
  - ASA 1 patients (normal, healthy patients) can climb one flight of stairs or walk two level city blocks without having to pause because of shortness of breath, undue fatigue, or chest pain.
  - ASA 2 patients can climb one flight of stairs or walk two level city blocks without distress but must stop once they complete either task because of distress. Patients with heart failure most likely experience shortness of breath or undue fatigue.
  - ASA 3 patients can climb one flight of stairs or walk two city blocks but must stop and rest before completing the task because of distress.
  - ASA 4 patients cannot negotiate a flight of stairs or walk two level city blocks because of shortness of breath or undue fatigue present at rest.
2. 有无夜间憋醒的情况，有无端坐呼吸的情况，有无短期体重异常增加的情况等。
体格检查

通过上述手段，来得出对患者进行口腔治疗的大致风险情况，并根据对风险的评估，来制定合适的牙科治疗方案。

口腔治疗方案考量

ASA 1: The patient does not experience dyspnea or undue fatigue with normal exertion.
- Comment: If all items of the medical history are negative, this patient may be considered normal and healthy. No special modifications in dental treatment are indicated. Patients with heart failure are not ASA 1 risks.
ASA 2: The patient experiences mild dyspnea or fatigue during exertion.
- Comment: As with the ASA 1 patient, the ASA 2 patient may be managed normally if the remainder of their medical history and physical examination prove to be noncontributory. In addition, use of the stress reduction protocol should be considered if any physical or psychological stress is evident or anticipated.
ASA 3: The patient experiences dyspnea or undue fatigue with normal activities.
- Comment: This patient is comfortable at rest in any position but may demonstrate a tendency toward orthopnea and have a history of paroxysmal nocturnal dyspnea. The ASA 3 patient with heart failure is at increased risk during dental treatment. Before starting any treatment, medical consultation and use of the stress reduction protocol and other specific treatment modifications should be given serious consideration.
ASA 4: The patient experiences dyspnea, orthopnea, and undue fatigue at all times.
- Comment: The ASA 4 patient represents a significant risk. Even at rest this patient’s heart cannot meet the body’s metabolic requirements. Any degree of stress further increasing metabolic demand may exacerbate the condition and possibly provoke acute pulmonary edema. Invasive dental care should be withheld for all elective procedures until the patient’s cardiovascular status improves or is controlled. Dental emergencies (e.g., pain or infection) should be managed noninvasively, with medication, if at all possible. If physical intervention becomes necessary, this patient should be treated in a controlled environment, such as in a hospital dental clinic, and be under a physician’s care before, during, and immediately following the dental procedure.