Conscious Sedation/Medical Emergency

Question 1

What is the MOA of nitrous? (3 effects)

Answer 1

 Analgesic effect
* Initiated by release of endogenous opioid peptides
 Anxiolytic
* Activation of GABA through benzodiazepine binding site
 Anaesthetic
* Inhibition of NMDA-glu receptors

Question 2

Indications and contraindications of NO?

Answer 2

• Indications
  o Anxiety
  o Uncomfortable procedures
  o Paediatric patients
  o Gag reflex
• Contraindications
  o Patients unable to breathe through nose
   Rhinitis
   Severe sinusitis
   Pulmonary conditions
   Deviated nasal septum
  o Recent eye surgery
  o Unable to tolerate nasal mask
   Psychiatric patients
   Cognitive impairment
   Paediatric patients
  o Pregnant women

Question 3

What are non technical skills in a medical emergency?

Answer 3

• identify a leader
• Follow flip charts
• Graded assertiveness - everyone speaks up if there has been a mistake
• Closed loop communication - ensuring you were understood and tasks are completed
• Don’t get stuck on one thing
• Delegate tasks
• Call for help early
• Always reassess and reevaluate the situation as you go
• Support team - swap positions if they are struggling with a directed task

Question 4

What is normal range:
- RR
- HR
- BGL
- BP

Answer 4

RR = 12-20
HR = 60-80
BGL = 5-12
BP = 120/90 +/-20

Question 5

Overview of how to manage a medical emergency?

Answer 5

Check for danger and responsiveness
A) If responsive –> Problem specific scenario OR go through ABCD to determine
B) If unresponsive –> DRSACBD (Basic life support) - Send for help, Airway, Breathing, CPR, Defib

Question 6

What are the doses for adrenaline (IM and epipen)?

Answer 6

IM:
- >12 years = 0.5mL
- 6-12 years = 0.3mL
- <6 years = 1.15mL

Epipen
- >30kg = 0.3mL
- <30 kg = 0.15mg

Question 6

What are the doses for adrenaline (IM and epipen)?

Answer 6

IM:
- >12 years = 0.5mL
- 6-12 years = 0.3mL
- <6 years = 1.15mL

Epipen
- >30kg = 0.3mL
- <30 kg = 0.15mL

Note: Adrenaline 1:1000 = 1mg in 1mL

Question 7

How to manage a cardiac emergency?

Answer 7

1. Call for help
2. Position patient semi supine (approx 45 degrees)
3. Taker vitals
4. NONA
   - Glyceryl trinitrate (sublingual spray 400mg) –> DO NOT if systolic BP <90 or radial pulse not present or patient has taken viagra (<24hr) or cialis (<5 days)
   - Oxygen and nitrous oxide (analgesic)
5. After 3 rounds every 5 mins –> No improvement, provide 300mg chewable aspirin