2. Medical emergencies Flashcards
What is the dose of adrenaline used in a medical emergency?
Adrenaline, 1-ml ampoules or prefilled syringes of 0.5ml of 1:1000 solution for intramuscular (i.m.) injection
What is the dose of aspirin for a medical emergency?
Aspirin 300mg dispersible tablets
What is the dose of Glucagon in a medical emergency?
Glucagon, for i.m. injection of 1 mg
What is the dose of Glyceryl trinitrate (GTN) spray in a medical emergency?
GTN spray, 400 micrograms per metered dose
What is the dose of midazolam in a medical emergency?
Midazolam oromucosal solution, 5mg/ml, for topical buccal administration
What is the dose of Salbutamol inhaler in a medical emergency?
Salbutamol inhaler, 100 micrograms per actuation
What is the dose of cetirizine in a medical emergency of mild allergic reactions?
Cetirizine 10mg tablets or oral solution (5mg/5ml)
What is the dose of chlorphenamine in a medical emergency of mild allergic reactions?
4mg tablets or oral solution (2mg/5ml)
What is the dose of loratadine in a medical emergency of mild allergic reactions?
Loratadine, 10mg tablets or syrup (5mg/5ml)
What are the key signs of anaphylaxis?
- Marked upper airway (laryngeal) oedema and bronchospasm, causing stridor and wheezing.
- Tachycardia (HR >110 per minute) and increased respiratory rate.
What are the symptoms of anaphylaxis?
Abdominal pain, vomiting, diarrhoea and sense of impending doom.
Flushing, but pallor might also occur.
Patients may also display symptoms of mild allergy.
What is the management of anaphylaxis, prior to transferring pt to hospital as an emergency?
o Assess pt
o Call for ambulance.
o Secure the pt’s airway and help to restore blood pressure by laying pt flat and raising feet.
o Remove source of anaphylaxis if know, using suction as required.
o administer 100% oxygen – flow rate: 15 litres/minute
o administer adrenaline, 0.5ml (1:1000), i.m. injection, repeated after 5 mins if needed.
o If cardiac arrest follows an anaphylactic reaction, initiate BLS and carry out early defibrillation where defibrillator is available.
What are the key signs of mild allergy?
- Urticaria and rash, particularly of chest, hands and feet.
- Rhinitis, conjunctivitis
- Mild bronchospasm without evidence of severe shortness of breath.
What is the management of a mild allergic reaction?
- 1x Cetirizine tablet 10mg, or
- 1x Chlorphenamine tablet 4mg, or
- 1x Loratadine tablet 10mg.
- If pt displays signs of mild bronchospasm:
- Salbutamol inhaler, 4 puffs (100 micrograms per actuation), through a large-volume spacer, repeat as needed.
- Refer the pt to their general medical practitioner.
What should you warn patients of when taking cetirizine?
Although drowsiness is rare, advise patient not to drive.
In which patients should you be cautious giving cetirizine tablets?
Use with caution in patients with hepatic impairment or epilepsy.
What should you warn patients of when taking chlorphenamine?
Chlorphenamine can cause drowsiness. Advise patients not to drive.
In which patients should you be cautious giving chlorphenamine tablets?
Use with caution in patients with hepatic impairment, prostatic hypertrophy, epilepsy, urinary retention, glaucoma or pyloroduodenal obstruction. Avoid use in children with severe liver disease.
Do not give to children under 2 years, except on specialist advice, because the safety of the use of chlorphenamine has not been established.
What should you warn patients of when taking loratadine?
Although drowsiness is rare, advise patients not to drive.
In which patients should you be cautious giving chlorphenamine tablets?
Use with caution in patients with hepatic impairment or epilepsy.
How do you administer salbutamol inhaler for mild allergic reaction?
Salbutamol inhaler, 4 puffs (100 micrograms per actuation), through a large-volume spacer, repeat as needed.
What are key signs of life-threatening asthma?
- Cyanosis or respiratory rate <8 per minute.
- Bradycardia (HR <50 per minute)
- Exhaustion, confusion, decreased conscious level.
What are key signs of acute severe asthma?
- Inability to complete sentences in one breath
- Respiratory rate >25 per minute
- Tachycardia (HR >110 per minute)
What is the management of asthma?
Management – priority is to transfer a pt displaying symptoms of life-threatening asthma to hospital immediately as an emergency.
o Assess pt
o Sit pt upright
o Administer 100% oxygen – flow rate: 15 litres/minute
o Administer pt’s own bronchodilator (2 puffs); if unavailable, administer a salbutamol inhaler, 4 puffs (100 micrograms per actuation), through a large-volume spacer, repeat as needed.
- If a pt is suffering from a severe episode of asthma does not respond to treatment with bronchodilators within 5 minutes of administration, they should also be transferred to hospital as an emergency.
What are key signs of acute coronary syndromes (angina and myocardial infarction)?
o Progressive onset of severe, crushing pain in the centre and across the front of chest; the pain might radiate to the shoulders and down the arms (more commonly the left), into the neck and jaw or through the back.
What are key symptoms of acute coronary syndromes (angina and myocardial infarction)?
- Shortness of breath
- Increased respiratory rate
- Skin becomes pale and clammy
- Nausea and vomiting are common
- Pulse may be weak and blood pressure might fall
What is the management of acute coronary syndromes?
o Assess the pt
o Administer 100% oxygen – flow rate: 15 litres/minute
o Administer GTN spray, 2 puffs (400 micrograms per metered dose) sublingually, repeated after 3 minutes if chest pain remains
o IF PT DOES NOT RESPOND TO GTN TREATMENT THEN THE PRIORITY IS TO TRANSFER THE PATIENT TO HOSPITAL AS AN EMERGENCY.
o call for an ambulance.
o administer aspirin, 300mg dispersible tablet, orally.
o If pt becomes unresponsive, check for signs of life (breathing and circulation) and if there are no signs of life or no normal breathing, initiated BLS and carry out early defibrillation if defibrillator is available.
What are the key signs of cardiac arrest?
- Loss of consciousness
- Absence of normal breathing
- Loss of pulse
- Dilation of pupils
What is the management of a cardiac arrest?
Call an ambulance
Initiate BLS using 100% oxygen or ventilation - flow rate: 15 litres/minute.
> refer to resuscitation council (UK) guidance for details of BLS for adults and children
Where defibrillator is available, carry out early defibrillation
What are the key signs of epilepsy?
Sudden loss of consciousness, patient may be rigid, fall, might give a cry and become cyanosed (tonic phase)
Jerking movements of the limbs; the tongue might be bitten (clonic phase).
What are symptoms of epilepsy?
- Brief warning or ‘aura’.
- Frothing from the mouth and urinary incontinence.
NB: fitting might be associated with other conditions (e.g. hypoglycaemia, fainting)
What is the management of epilepsy?
o Assess the patient.
o Do not try to restrain convulsive movements.
o Ensure the patient is not at risk from injury.
o Secure the patient’s airway.
o Administer 100% oxygen – flow rate: 15 litres/minute.
The seizure will typically last a few minutes; the pt might then become floppy but remain unconscious. Once the pt regains consciousness they may remain confused.
However, if the epileptic fit is repeated or prolonged (5 minutes or longer), continue administering oxygen and:
o Administer 10mg midazolam (use 2ml oromucosal solution, 5 mg/ml) topically into the buccal cavity.
o After convulsive movements have subsided, place the pt in the recovery position and check the airway. Do not send the pt home until they have recovered fully.
o Only give meds if convulsive seizures are prolonged (last for 5 mins or longer) or recur in quick succession. In these cases, and if this was the first episode of epilepsy for the pt, the convulsion was atypical, injury occurred or there is difficulty monitoring the pt, call for an ambulance.
What are the key signs of a faint?
Pt feels faint, dizzy, light-headed
Slow pulse rate
Loss of consciousness
What are the symptoms of a faint?
Pallor and sweating
Nausea and vomiting
What is the management of a faint?
o Assess the pt
o Lay the pat flat and if the pt is not breathless, raise the pt’s feet. Loosen any tight clothing around the neck.
o Administer 100% oxygen – flow rate: 15 litres/minute until consciousness is regained
What are the key signs of hypoglycaemia?
- Aggression and confusion
- Sweating
- Tachycardia (HR >110 per minute)
What are symptoms of hypoglycaemia?
- Shaking and trembling
- Difficulty in concentration/vagueness
- Slurring of speech
- Headache
- Fitting
- Unconsciousness
What is the management of hypoglycaemia?
Assess the pt
Administer 100% oxygen - flow rate: 15 litres/minute
- If pt remains conscious and cooperative:
o Administer oral glucose (10-20g), repeated, if necessary, after 10-15 minutes. - If pt is unconscious or uncooperative:
o Administer glucagon, 1mg, IM injection, AND
o Administer oral glucose (10-20g) when the pt regains consciousness. - If pt does not respond or any difficulty is experienced, call for an ambulance.
What are the key signs of a stroke?
Facial weakness: one eye may droop, or patient may only be able to move one side of mouth.
Arm weakness
Communication problems; slurring speech; pt is unable to understand what is being said to them.
What is the management of a stroke?
Assess the pt
Administer 100% oxygen - flow rate: 15 litres/minute
If pt is unconscious and breathing, secure their airway, and place in the recovery position.
Call for an ambulance.
Why are dental patients more susceptible to choking and aspiration?
Dental pts are susceptible to choking and aspiration due to the presence of blood and secretions in their mouth for prolonged periods, suppressed pharyngeal reflexes due to local anaesthesia or the presence of impression material or dental equipment in their mouths.
What are signs and symptoms of aspiration and choking?
Pt may cough or splutter
Pt may complain of breathing difficulty
Breathing may become noisy on inspiration (stridor)
Pt may develop ‘paradoxical’ chest or abdominal movements
Pt may become cyanosed and lose consciousness
What is the management of aspiration?
o Encourage pt to cough vigorously.
o Administer 100% oxygen – flow rate: 15 litres/minute.
o Administer a salbutamol inhaler, 4 puffs (100 micrograms per actuation), through a large-volume spacer, repeat as needed.
o If you suspect that a large fragment has been inhaled or swallowed but there are no signs or symptoms, refer the pt to hospital for x-ray and removal of the fragment if necessary.
o If pt is symptomatic following aspiration, refer them to hospital as an emergency
What is the management of choking?
o Remove any visible foreign bodies in the mouth and pharynx.
o Encourage the pt to cough.
o If pt is unable to cough but remain conscious, commence back blows followed by abdominal thrusts.
o If the pt becomes unconscious, BLS should be started immediately; this may also help to dislodge the foreign body.
o Call an ambulance and transfer pt to hospital as an emergency.
