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5th yr- AMS > Complications and respiratory depression > Flashcards

Complications and respiratory depression Flashcards

1
Q

What can help us predict and avoid complications during sedation

A

A thorough medical history

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2
Q

What must we monitor during sedation treatment

A
  1. Oxygen saturations
  2. Heart rate
  3. Respiratory rate
  4. Non incase blood pressure
  5. AVPU
  6. Skin colour
  7. Airway
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3
Q

When can complications occurs

A

Before
During
After

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4
Q

What complications can occur before we sedate the patients

A
  1. Anxiety
  2. Cannulation
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5
Q

What complications can occur with cannulations

A
  1. Venospasm
  2. Haematoma/ thrombosis
  3. Phlebitis
  4. Extravascular cannula positioning
  5. Failed cannulation
  6. Intra arterial cannulation
  7. Nerve/ tendon/ ligament damage
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6
Q

What complications can occur during the sedation

A
  1. Cannula
  2. Respiratory depression
  3. Allergy
  4. Un/known medical problem
  5. Pharmacological
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7
Q

Give an example of a respiratory complication that rarely occurs in sedation

A

Laryngospasm

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8
Q

What is laryngospasm

A

Oral cords spasm leading to an inability to pass air leading to hypoxia

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9
Q

How can we manage laryngospasm

A

SEEK HELP AND EMERGENCY ASSISTANCE
suction
Extend neck
Jaw thrusts
Postive pressure ventilation

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10
Q

With which drugs is respiratory depression more likely

A

Opioids and polypharmacy

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11
Q

What is the severity of respirate depression usually related to

A

Dose related

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12
Q

How can we minimise the chances of repsiraoty depression

A
  1. Ensure oxygen saturation is more than 95%
  2. Titrate midazolam
  3. No bolus doses
  4. Caution with extreme age
  5. Be abate of drug interactions and co morbidity
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13
Q

State the normal respiratory rate for an adult

A

12-20

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14
Q

How do we manage respirate depression

A
  1. Ask them to take deep breath
  2. AVPU assesment
  3. Check airway perform head tilt chin lift as needed
  4. GET HELP and maintain airway with an oro or naso pharyngeal airway
  5. ABCDE assessment
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15
Q

Which masks can we use to deliver oxygen during respiratory depression

A
  1. Nasal prongs
  2. Non rebreather face mask
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16
Q

How much oxygen do we give through a non rebreather face mask

A

10-12L per min

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17
Q

How much oxygen do we give through nasal prongs

A

1-2L per min

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18
Q

What does ABCDE stand for

A

Airway
Breathing
Circulation
Disability
Exposure

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19
Q

State the 2 types of airway exposure

A

Partial and Complete

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20
Q

How do we assess airway obstruction

A
  1. Look for chest and abdominal movements
  2. Listen and feel for airflow at the mouth and nose
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21
Q

Give examples of noises that may indicate airway obstruction

A
  1. Inspiratory stridor
  2. Expiratory wheeze
  3. Gurgling
  4. Snoring
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22
Q

What does an Inspiratory stridor suggest

A

Obstruction of the laryngeal or above

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23
Q

What does an Expiratory wheeze suggest

A

Obstruction of the lower airway

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24
Q

What does an gurgling suggest

A

Suggest liquid accumulation in airways

25
Q

What does an snoring suggest

A

Partial occlusion of the airway usually by the tongue

26
Q

How might choking present

A
  1. Pt unable to speak but can respond by nodding
  2. Unable to breath
  3. Wheezing
  4. Silent cough
  5. Unconscious
27
Q

Define severe choking

A

Airway obstruction meaning pt in unable to cough effective

28
Q

Define mild choking

A

When the airway is obstructed but patient can cough effectively

29
Q

How do we treat mild choking

A

Encourage th patient to cough

30
Q

How do we manage severe choking

A

5 back blows
5 abdominal thrusts

31
Q

How do we carry out an airway assessment

A

Head tilt and chin lift
or
jaw thrust

32
Q

When do we use an oropharyngeal airway

A

When the patient unconscious and we suspect airway obstruction

33
Q

When do we use a naso pharyngeal airway

A

Can be used in a conscious or unconscious patient when we suspect airway obstruction

34
Q

How does sedation affect the central nervous system

A

It depresses it therefore reducing respiratory drive

35
Q

Name the main muscles of the respiratory system

A

Diaphragm
Intercostal muscles

36
Q

Which ribs keep the diaphragm innervated

A

C3,4,5

37
Q

How can a sedated patietn suffering from hypoxia or hypercapnia present

A
  1. Irritable
  2. Confused
  3. Lethargic
  4. Decreased conscious level
38
Q

How do we assess circulation

A

Assess heart rate

39
Q

Name the main causes of cardiac arrest

A
  1. Hypoxia
  2. Hypothermia
  3. Hyperkalaemia
  4. Hypovolaemia
  5. Toxins
  6. Tamponade
  7. Tension pneumothorax
  8. thrombosis
40
Q

Which of the main causes of cardiac arrest can be significant during sedation dentistry

A

Hypoxia

41
Q

List some symptoms of an allergic reaction

A
  1. Light headed/faint
  2. rash
  3. Clammy cold skin
  4. infusion
42
Q

Define anaphylaxis

A

A serious systemic hypersensitivity reaction usually rapid in onset and can be fatal

43
Q

If we suspect anaphylaxis shock what do we need to administer

A

Adrenaline 1:1000

44
Q

Where do we administer adrenaline

A

Either thigh or arm

45
Q

Which medical condition can potential cause complications during sedation

A
  1. Astha m
  2. Epilepsy
  3. Diabetes
  4. Adrenal insufficiency
  5. Cardiac
46
Q

How common is asthma

A

340 million affected worldwide

47
Q

What questions should we ask an asthmatic patient prior to sedation

A
  1. Have they been intubated
  2. Have they been hospitalised I the last year
  3. How many drugs do they take for their asthma (more than 3 is a concern)
  4. How reliant are they on their beta 2 agonist inhaler
48
Q

Talk through the presentation of severe asthma

A
  1. Pt can’t complete sentences in one breath
  2. Respiratory rate greater than 25per min (tachypnoeic)
  3. Heart rate greater than 100bmp (tachycardia)
49
Q

Talk through the presentation of life threatening asthma

A
  1. Cyanosis
  2. Respiratory rate less than 8 per min
  3. Heart rate les than 50bpm (bradycardia)
  4. Exhaustion and confusion
50
Q

How do we treat asthma

A

Salbutamol and aim for 94-98% oxygen saturation

51
Q

What questions should we ask a patient with epilepsy prior to sedation

A
  1. Have they ever been hospitalised
  2. Do they know how the seizure is imitated
  3. How does the seizure usually resolve
  4. What medications do they take
  5. How controlled is their epilepsy
52
Q

What questions should we ask a diabetic patient prior to sedation

A
  1. Type
  2. How controlled is it
  3. Do they know their HB1AC levels
53
Q

Give examples of some acute coronary syndromes

A
  1. ST elevated myocardial infarction
  2. Non ST elevated ACS
  3. Non ST elevated Myocardial infarction
  4. Unstable angina
54
Q

What is acute coronary syndrome

A

Chest pain/ discomfit due to myocardial ischaemia

55
Q

What causes angina

A

Can be:
1. Stress
2. Anxiety
3. Exertion
4. Pain

56
Q

What happens in angina

A

Release of catecholamines (noradrenaline and adrenaline

57
Q

Give some signs and symptoms of angina

A
  1. Tachycardia
  2. Vasoconstriction
  3. Hypertension
  4. Increased cardiac work
  5. Myocardial ischaemia
  6. pain
58
Q

What should we do if we suspect a patient is suffering from angina or ACS

A
  1. Aspirin 300mg orally crushed or chewed
  2. Check BP
  3. GTN sublingual
  4. Check oxygen saturation aiming for 94-98%
  5. 999

5th yr- AMS (11 decks)

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