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Human Diseases > 26.3 Medical emergencies in dentistry > Flashcards

26.3 Medical emergencies in dentistry Flashcards

1
Q

What are the 3 levels of training for medical emrgencies in dentistry?

A
  • BLS: annually for all dentists
  • ILS: for dentists providing sedation
  • ALS: highest level of training, for dentists working in a hospital setting, 2 day course and exams
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2
Q

What medical emergencies might occur in dental practice?

A
  • Vasovagal syncope (most common), fainting
  • Angina
  • Hypoglycaemia
  • Epileptic seizures
  • Choking
  • Asthma attack
  • Anaphylaxis
  • Cardiac arrest
  • Adrenal insufficiency
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3
Q

What are the normal obs for adults and children?

A
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4
Q

What system do hospitals use to detect deteriorating patients?

A

National early warning score (NEWS)

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5
Q

How do you assess airway obstruction?

A
  • Look for signs of obstruction e.g. use of accessory muscles, see-saw respirations, central cyanosis
  • Complete airway obstruction = no noise
  • Partial obstruction:
    Inspiratory stridor: obstruction at laryngeal level
    Expiratory wheeze: obstruction of lower airways
    Gurgling: liquid or semi-solid in upper airway
    Snoring: partial occlusion of pharynx
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6
Q

How can you see if anything is blocking the throat?

A

Look down the airway, use suction to improve visibility

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7
Q

Describe the airway opening manoeuvres.

A
  • Head tilt/chin lift or jaw thrust (Not if C-spine fracture suspected)
  • Remove visible foreign body (suction)
  • Simple airway adjuncts e.g. oropharyngeal airway (Guedel airway- measured from mouth to angle of mandible) nasopharyngeal airway
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8
Q

How should oxygen be delivered to patients?

A

If oxygen saturation is 92% or below give 15 litres of oxygen per minute via non-rebreather mask.

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9
Q

What are signs of respiratory distress?

A
  • Sweating
  • Central cyanosis (blue tinge to membranes)
  • Use of accessory muscles of respiration
  • Chest expansion unequal, shallow breaths
  • Breath sounds: gurgling, stridor, wheeze
  • Oxygen saturations
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10
Q

What is the difference between a rebreather mask and a bag valve mask?

A
  • Rebreather: conscious/breathing patients
  • Bag valve mask: patient is not breathing at all, used in cardiac arrest, should be able to see chest rising
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10
Q

What is the difference between a rebreather mask and a bag valve mask?

A
  • Rebreather: conscious/breathing patients
  • Bag valve mask: patient is not breathing at all, used in cardiac arrest, should be able to see chest rising
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11
Q

How do you assess circulation?

A
  • Colour: blue/pink/pale/mottled
  • Is limb temperature cool or warm
  • Capillary refill: pressure for 5 seconds on chest, colour should return in 2 seconds
  • Central capillary refill: press collarbone until it blanches, colour should return in 1-2 seconds
  • Peripheral capillary refill: press fingernail, colour return in 3 seconds
  • Radial or carotid pulse
  • Blood pressure
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12
Q

How do we assess disability/consciousness?

A
  • Glasgow coma scale (medicine not dent)
  • CAVPU: confusion, alert, voice, pain, unresponsive
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13
Q

After reaching D in ABCD what should you do?

A
  • Review and treat ABCs
  • Check pt drug record to see if there is a reason they have become unwell
  • Check pupils: size, equal, reactive to light
  • Assess blood glucose
  • If unconscious, place in recovery position
  • Temperature
  • Rashes, bruises, bleeding
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14
Q

What should you do if a patient goes intro adrenal crisis?

A
  • Not enough corticosteroids
  • Symptoms: extreme weakness, significant drop in BP, drowsiness, mental confusion
  • Call 999 and state addisonian crisis
  • If you are competent and pt carries emergency kit, deliver IM hydrocortisone 100mg
  • Surgery is a major physiological stressor, patients with adrenal insufficiency normally double their steroid dose before treatment
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15
Q

What is anaphylaxis, how does it present?

A
  • Severe, life threatening, generalised type 1 hypersensitivity reaction
  • Tachycardia, increased resp rate, hypotension, bronchospasm, urticarial rash and angiodema
  • Vasodialtion causes hypovolaemia leading to low BP = collapse
  • Upper aiway oedema and bronchospasm = stridor, wheeze, hoarse voice
  • Respiratory arrest can lead to cardiac arrest
  • Abdominal pain, vomiting, diarrhoea, sense of impending doom
16
Q

How do you manage anaphylaxis?

A

IM adrenaline

17
Q

IM adrenaline for adults and children over 12.

A

500 micrograms IM (0.5ml)

18
Q

IM adrenaline for children aged 6-12.

A

300 micrograms IM (0.3ml)

19
Q

IM adrenaline for children aged 6 months - 6 years.

A

150 micrograms IM (0.15ml)

20
Q

IM adrenaline for children under 6 months.

A

100-150 micrograms IM (0.1-0.15ml)

21
Q

When should you repeat adrenaline in anaphylaxis?

A

At 5 minute intervals if the patient is not responding

22
Q

How is IM adrenaline delivered?

A
  • Snap glass vial open
  • Draw up dose
  • Inject into vastus lateralis muscle (thigh)
  • Don’t aspirate for IM injection
  • Insert needle at 90 degree angle using dart like action
  • Call 999 as soon as anaphylaxis is recognised
23
Q

What are the signs of an asthma attack?

A
  • Increases heart rate
  • Increased resp rate (greater than 25)
  • Cannot complete sentences
24
Q

What are the signs of a life-threatening asthma attack?

A
  • May have silent chest
  • Cyanosis
  • Poor respiratory effort
  • Arrythmia
  • Hypotension
  • Exhaustion
  • Altered consciousness
25
Q

How is an asthma attack treated?

A
  • Salbutamol/Ventolin inhaler: 1 puff every 60-90 seconds
  • Use a spacer
  • Oxygen (15 litres per minute)
  • Depending on setting (e.g. hospital) may provide a nebuliser
  • Call 999 if severe/life threatening, or if unsatisfactory/no response to tx
26
Q

What is angina?

A
  • Partial obstruction of the coronary arteries
  • Causes central crushing pain which may radiate to the back or down the arm (women tend to have back pain)
  • If GTN spray resolves pain it is likely angina rather than MI
27
Q

What is an MI?

A
  • Complete infarction of coronary vessels, no blood flow to the heart
  • Life threatening
  • If GTN spray has no effect assume MI
  • Oxygen and 300mg aspirin (chew)
  • Hospital setting: analgesia, IV morphine and anti-emetic
28
Q

How do you manage a choking patient?

A
  • Recognise choking: pt can’t talk, absent cough, looks panicked, may walk off
  • 5 back blows, 5 abdominal thrusts
  • If they lose consciousness, begin CPR
29
Q

What are the causes of seizures?

A
  • Febrile convulsions in paediatric patients (fever)
  • Epilepsy/status epilepticus
  • Neurological event e.g. stroke
  • Faint
30
Q

What is the management for a patient having a seizure?

A
  • Remove any danger surrounding the patient to ensure their safety
  • Administer high flow oxygen (15 litres per minute)
  • Cool them down if they are warm
  • Monitor and maintain ABC
  • Seizures lasting longer than 5 minutes, or having several repeated seizures, require buccal midazolam (a benzodiazepine):
31
Q

What is classed as hypoglycaemia?

A

Blood sugar <4mmol/L

32
Q

What are the symptoms of hypoglycaemia?

A
  • Sweating
  • Shaking
  • Hunger
  • Palpitations
  • Headache
  • Nausea
  • Confusion
  • Drowsiness
  • Odd behaviour
  • Speech difficulty
  • Incoordination
    Pts often self recognise symptoms
    Take capillary blood glucose if available.
33
Q

What is the management for hypoglycaemia in conscious patients?

A
34
Q

What is the management for hypoglycaemia in unconscious patients?

A

IM glucagon must be given through the skin, cut clothes off if necessary.

35
Q

How do you manage vasovagal syncope?

A
  • Very common (stress, patients on anti-hypertensives, Beta blockers)
  • Caused by an initial tachycardia, then the vagus nerve kicks in, over does it causing a massive hypotension
  • Some patients can have seizures in bad faints
  • Lay flat
  • Raise legs
  • Glucose drink
36
Q

What is red-flag sepsis?

A
  • Extreme, life-threatening response to infection
  • Immune system overreacts
  • Can lead to organ failure
  • E.g. dental abscess/infection can lead to sepsis
  • Call 999
37
Q

What is the difference between red flag and yellow flag sepsis?

A
38
Q

How do you manage cardiac arrest?

A
  • Call 999
  • Start CPR immediately
  • If indicated, defibrillation should be attempted as soon as possible (within 3 minutes)

CPR at 100bpm, 2/3rds the depth of the chest.
Adults: 30 compressions, 2 breaths
Children: 15 compressions, 2 breaths
Alternative defibrillator pad placement if pt has a pacemaker. Cannot place pad directly on that area.
Pads need to go on dry skin. Excess hair needs to be shaved.

Human Diseases (47 decks)

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