What Are Multiple Systemic Disorders?
Systemic disorders are disorders that affect the whole body and not a single organ or tissue. For instance, conditions like high blood pressure or illnesses like the flu cause an impact on the entire body rather than a single organ or tissue and are therefore systemic.
How Are Systemic Disorders Managed in Clinical Practice?
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Congestive Heart Failure - It is a cardiac condition in which due to pathological alterations in the myocardium, the heart is unable to pump enough blood to meet the body's metabolic needs. Heart failure occurs as a result of ventricular dysfunction. The ventricles can be affected jointly or individually. Left ventricular (LV) failure results in shortness of breath and tiredness, and right ventricular (RV) failure results in peripheral and abdominal fluid accumulation.
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Treatment
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Digitalis (Digoxin) is given to increase heart muscle contraction.
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Management
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Supine position during treatment is avoided.
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The assessment of medical risk.
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Every attempt is made to reduce the patient’s anxiety.
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Oxygen is arranged and provided whenever needed.
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General anesthesia should be avoided.
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The use of Epinephrine should be avoided in patients on Digitalis. It increases muscle contractility, arrhythmia, ventricular fibrillation, and even death.
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Nonsteroidal anti-inflammatory drugs including Aspirin should also be avoided in patients with digitalis as it decreases the Digoxin excretion from the body and causes toxicity by increasing the Digoxin concentration in the blood.
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In patients with Digitalis; plain anesthesia, and antibiotics like Penicillin and Clindamycin are given. Acetaminophen is the drug of choice in analgesics.
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Angina Pectoris - Chest discomfort caused due to reduced blood supply to the heart is the cause of angina. It is a sign of coronary artery disease. Squeezing, pressure, heaviness, tightness, or discomfort in the chest are commonly felt in anginal pain.
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Management
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Assessment of medical risks is done.
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To carry out any sort of medical treatment, patient evaluation is a must.
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The anxiety of the patient is reduced.
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Nitroglycerine tablets are kept ready to administer whenever necessary.
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Vital signs and verbal signs are monitored.
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Myocardial Infarction - A myocardial infarction, often known as a heart attack, is a very hazardous ailment that develops when the blood supply to the heart muscle is cut off. Although there are many reasons for the lack of blood flow, a blockage in one or more of the heart's arteries is typically the most common one.
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Management
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Patient evaluation and medical assessment are done.
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The anxiety of the patient is reduced.
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The patient is checked for anticoagulants.
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Plain anesthesia is administered to the patients.
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Nitroglycerine tablets are kept ready in case of emergencies.
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Hypertension - Normal blood pressure is maintained by cardiac output and peripheral resistance. Any changes in these factors leads to hypertension.
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Management of Hypertension
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The patient is evaluated to diagnose the stage of hypertension.
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Medical advice is recommended if systolic blood pressure is more than 160 mmHg and diastolic is more than 100 mmHg.
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All surgical procedures and dental treatment procedures are stopped in case the systolic blood pressure is more than or equal to 180 mmHg and diastolic blood pressure is 100 mmHg.
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Anxiety should be reduced in patients.
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Quick posture changes should be avoided.
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Epinephrine should be avoided in hypertensive patients.
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During emergencies, IV Furosemide is administered as antihypertensive medication.
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Anemia- A decrease in the number of red blood cells is called anemia. It decreases the oxygen-carrying capacity of the blood. The average value of hemoglobin in females is 12 to 16 gm/dl and in males, it is 14 to 18 gm/dl.
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Hemolytic Anemia - Reduction in the number of red blood cells due to their increased destruction causes hemolytic anemia. It causes an increased risk of hemorrhage, delayed healing, and greater chances of infection.
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Management
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Risk assessment and evaluation of the patients are carried out.
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Every effort is made to decrease anxiety in patients.
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Strong narcotics and barbiturates are avoided.
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For pain control, local anesthesia is administered. The use of general anesthesia is avoided.
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Leukemia - It is a neoplastic condition that is characterized by defective white blood cells. Both platelets and neutrophil counts are decreased. Bone marrow is suppressed as a result of chemotherapy. As a result, the chances of bleeding and infection increase.
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Management
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For dental treatment, nerve blocks are avoided as they can lead to hematoma formation. Any dental treatment if required should be done before the patient becomes immunosuppressant.
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To control bleeding in the patients, hemostatic measures should be carried out immediately.
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For all high-risk patients, dental treatment should be avoided.
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Patients on Anticoagulants - The most anticoagulants are Warfarin and Aspirin. Anticoagulants are drugs stop blood clots from forming. They are administered to those with a high blood clot risk to lower their risk of suffering from major illnesses including heart attacks and strokes.
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Patients on Warfarin-
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Prothrombin time needs to be increased by 2 to 2.5 times the normal range.
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Before any surgical procedure, the anticoagulant dose should be decreased or stopped.
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Patients on Heparin - It is commonly given to patients who are hospitalized.
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For any dental treatment, the administration of the drug should be stopped four hours before beginning the process.
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Patients on Aspirin - Drug administration should be stopped two to five days before the surgical procedure. It should be continued only after 24 hours post-surgery.
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Thyroid Dysfunction - The hormones secreted by the thyroid glands are T3 (triiodothyronine), T4 (thyroxine), and calcitonin. The major dysfunctions of thyroid glands are hyperthyroidism and hypothyroidism.
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Management of Patients:
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Before the Beginning of Dental Treatment:
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Medical advice is taken from the physician.
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Stress management to decrease the stress of the patient.
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Heart rate and blood pressure need to be constantly monitored.
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Patients with atrial fibrillation are kept on anticoagulant therapy and antibiotic prophylaxis is recommended for them before any invasive treatment.
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After Dental Treatment:
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Pain management is done and nonsteroidal anti-inflammatory drugs are used with precautions in both hyperthyroidism and hypothyroidism patients. Opioid analgesics are the drug of choice.
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Anticoagulants are avoided.
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Diabetes - It is a chronic disease that develops either when the body cannot adequately use the insulin that the pancreas generates or when it does not create enough of it.
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Management of Patients With Diabetes
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In patients for whom the diabetes is controlled, any dental or surgical procedure can be carried out without any major precautions.
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Any dental treatment should be carried out in the early morning appointments.
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Insulin intake is not altered. No diet alterations are instructed.
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Both preoperative and postoperative antibiotic prophylaxis is instructed for patients with diabetes.
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Corticosteroids are avoided and mild analgesics are recommended.
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Management of Patients in Hypoglycemia
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Conscious patients are made to sit in an upright position and are given a drink that is rich in sugar content.
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Unconscious patients are made to lie in the supine position and medical assistance is summoned immediately.
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The airway path is opened and maintained.
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Continuous breathing is ensured.
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Pulse rate and heart rate are monitored continuously.
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Conclusion
Managing systemic diseases in clinical practice is crucial to avoiding medical emergencies and thus contributing to the patient’s health and condition. It is important for healthcare workers to remain calm during such emergencies and take all the necessary steps that would help mitigate the patient’s issue.
