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Human diseases stage 3 > contraindications, emergencies > Flashcards

contraindications, emergencies Flashcards

1
Q

If someone on bisphopshantes, what to do if have to have it extracted. Do you need prophylaxis?

A

-ideally avoid extraction, do RCT
-discuss risks and benefits
-if need extraction, no need for antiobitc prophylaxis unless required for another reason. follow-up after 8 weeks then refer to secondary care if it was not healing

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2
Q

What is the platelet count below where you avoid extraction

A

<100 x 10^9 per litre
-if so, refer to secondary care
<50 delay elective procedures

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3
Q

What is first line for fungal angular chelitis

A

miconazole ointment, but avoid in hepatitis or if on warfarin

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4
Q

How osteoradionecrosis is caused and why extraction needs to be avoided. What to do if need extraction

A

-caused by radiotherapy of head and neck region. It obliterates arteries, impairing blood supply. So if have extraction, then poor healing so avoided.
-if need extraction, send to secondary care where they will need to make it as atraumatic as possible and not use vasoconstrictor in LA. Pre and post op co-amoxicillin is advised

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5
Q

How to treat dry socket (first line)

A

Irrigate with saline and pack with alveogyl

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6
Q

What to do if someone has swelling around the ear and parotid, likely due to mumps

A

recommend paracetamol, tell them to isolate, go see GP to confirm it is mumps

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7
Q

If someone has prothetic heart valves and has had previous IE, that needs RSD, what do you do before hand

A

they are high risk so consult the cardiologist regarding prophylaxis

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8
Q

which antifungals to avoid or reduce with warfarin & hepatitis. which one can you use

A

-lower dose of fluconazole
-avoid miconazole
-can use nystatin

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9
Q

Which antibiotics to avoid with warfarin. and therefore which is used for abscess

A

-avoid penicillins, metranizadole, erythromycin, rifampicin
-clindamycin is used

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10
Q

If someone comes in with vesicles on mouth due to herpes that has been there for a day, what to do

A

=gingivostomatitits and risk of herpetic whitlow
-send them away, advise to take fluids and paracetamol rest
Recommend getting topical acyclovir, only systemic acyclovir if immunocompromised

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11
Q

Which LA to avoid in liver disease.

A

Avoid amides (lidocaine, prilocaine, articaine.) as they are broken down in liver
So ideally give esters (Benzocaine, procaine)
-but if ester allergy, give prilocaine or articaine reduced to 2 cartridges as less broken down in liver

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12
Q

What to do if 1-2 sprays of GTN sublingual spray doesn’t work

A

-repeat every 3-5 mins. Max 3 times
-100% oxygen 15l/min
-If no working could be MI so 300mg aspirin, call 999
-could be MI

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13
Q

Which antibiotics to avoid if pregnant, breastfeeding or risk of preterm

A

-Breastfeeding: clindamycin caution
-Pre-term: co-amoxiclav and metranidazole avoid
-Pregnacy: metronidazole, tetracycline

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14
Q

Which antibiotics to avoid if liver disease. which is safest

A

penicillins safest
-avoid tetracyclines, clindamycin, erythromycin
-reduce metronidazole or avoid

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15
Q

Which antibiotics to avoid or reduce dose if kidney disease

A

-Avoid=tetracyclines
-Reduce= erythromycin, amoxicillin

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16
Q

When must INR be checked before treatment, if stable and unstable with warfarin. What values it needs to be.

A

-take INR within 72hrs if stable, within 24hr if unstable
-INR <4 can be treated

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17
Q

What to do if warfarin patient has INR >4 and need extraction

A

-Inform GP, delay treatment until it is below 4. May need vitamin K and prothrombin
-Once <4, use local measures to achieve haemostasis

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18
Q

When someone would need to stop their DOAC before a dental procedure

A

-don’t need to stop treatment for 3-4 simple extractions and other low risk procedures
- if high risk procedure (surgical etc.) advise to miss morning dose dabigatran/apixaban, and delay rivaroxiban. And take >4 hours after haemostasis
-But never interrupt it if DVT or PE in last 3 months, or on med for cardioversion, stent, prosthetic heart valve

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19
Q

What to give a hypoglycaemic patient. what if uncooperative. What to do if unconscious in dental setting

A

-give oral glucose tablet or drink
-buccal hypostop for uncooperative
-inconscious = IM glucagon 1mg

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20
Q

Steroid cover for adrenal insufficiency (Addison’s) for minor and major procedures

A

-Minor surgery under LA – no change to steroid dose
-Major surgery LA, or GA -double dose hydrocortisone 24hrs before & after.
OR 100-200mg hydrocortisone IM 30 mins before, or IV instantly

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21
Q

What to give if bacterial angular chelitis

A

2% fusidic acid

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22
Q

What angular chelitis looks like and causes

A

-soreness, erythema, fissuring in corners of mouth
-assoicated with iron deficiency, dentures, reduced OVD, HIV, crohn’s
-either bacterial or fungal

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23
Q

What to do in acute adrenal crisis

A

-hypotensive, hypoglycaemia, hyponatraemic
lay flat, ABCDE, IV electrolytes and glucose. 200mg hydrocortisone

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24
Q

Management and medication for cardiac arrest with 1) no heart beat and 2) chaotic rhythm

A

with no heart beat= not shockable. 1mg IV adrenaline
With chaotic rhythm: DC shock. If fails, Adrenaline + amiodarone. Lidocaine. Atropine

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25
Q

What pain killers to give to liver and kidney disease patients

A

-kidney = avoid NSAIDs. Paracetamol fine
-liver = NSAIDs fine, reduce paracetamol

26
Q

Contraindications for NSAIDs (aspirin and ibuprofen)

A

Gastric ulcers, kidney disease, asthmatics
aspirin= avoid warfarin

27
Q

What to prescribe for ANUG

A

1st line=metronidazole (400mg for 3 days)
2nd line= amoxicillin (500mg for 5 days)

28
Q

What meds can cause xerostomia, potentially causing angular chelitis. what to do

A

B blockers, diuretics, ACE inhibitors, Ca blockers, anti-parkinonians, anxiolytics, antidepressants, carbamazepine
liase with GP to ask for potential alternative drugs

29
Q

What drugs can cause lichenoid reactions

A
  • ibuprofen
  • β-blockers
  • Diuretics (indapamide)
  • Oral hypoglycaemics
  • Statins
  • Antimalarials
  • Sulphonamides
30
Q

3 causes of angioedema. management

A
  1. C1 esterase deficiency (genetic)
  2. Drug induced= ACEI, nicorandil (anti-anginal)
  3. Allergy

-Management – change medication. If lots of tongue odema, patient should be admitted to hospital and intubated until swelling gone down

31
Q

Can you treat someone after recent CABG, stent, angioplasty, valve surgery

A

-Procedures do not pose any contraindication
-Avoid immediate postoperative period until suture line reendothelialises
-Always check if patient’s symptoms may have abated after their surgery
-monitor high risk patients with signs, symptoms, BP, ECG, pulse oximetry

32
Q

What dental treatment to avoid with pacemaker patients

A

-Don’t use diathermy or electrosurgical units, unless know safe to do so
-Ultrasonic scalers may interact – use hand scalers
-Sudden defibrillation: risk of injury

33
Q

Do you give dental treatment to someone with acute MI, unstable angina, cardiac failure

A

-Acute MI: postpone elective treatment till 3-6 months later. If urgent, refer patient to dental hospital or maxfax unit
-Unstable angina: dental care in suitable facilities/postpone (don’t treat in general practice)
-Cardiac failure: dyspnoea= difficulty breathing (do not lie flat) So maybe refer too

34
Q

Use of LA in CVD patients

A

-Patients with mild to moderate CVS disease can have LA containing adrenaline. As there is a risk of it being more painful (as vasoconstricts so keeps it localised)= not good for heart
-Severe CVS disease (unstable angina, recent MI, dysrythmias) may be considered relative contraindications to LA

35
Q

How to distinguish the different causes of chest pain

A

-angina: central crushing pain on exertion, relieved by GTN
-MI: central crushing pain at rest, not relieved by GTN
-gastro-osophageal reflux disease: burning due to regurgitation. GTN can releive causing misdiagnosis
-pleuritic pain: when breathing
-pulmonary embolism: sharp pain, associated with calf pain due to DVT
-musculoskeletal
-referred pain from abdomen

36
Q

Prevention of inhaled foreign bodies. signs of mild choking and severe obstruction

A

-prevention= rubber dam, mouth sponges, instrument chains
-Mild=ask if they are choking, they respond and can speak, breath, cough
-severe= no response, unable to breath, silent cough, unconscious, clutching neck

37
Q

How to treat someone who has choked and it is: mild, severe and conscious, and severe and unconscious

A

-if mild and can reply: encourage coughing, lean forward, monitor dislodged object
-conscious= 5 back blows between shoulder bladed, 5 abdominal thrusts (if <1 year old do chest thrusts)
-unconscious= call 999, CPR, cricothyroidectomy if trained

[indications for CPR= No breathing or limited breathing. Or No Pulse]

38
Q

How long to dentally treat someone after an MI

A

at least 6 months, otherwise they are at high risk of another MI

39
Q

How to treat opioid addiction. and overdose

A

-addiction= methadone
-overdose= oxygen, naloxone

40
Q

explain ABCDE

A

A=airways: head tilt chin lift. Or jaw thirst if worried about cervical spine. Finger sweep. Suction. Guedel airways as adjuncts
B=breathing: look listen and feel for 10s
C-circulation: only check carotid pulse if competent. Not essential as not breathing is the reason for CPR
D-disability: ask if they can hear you to check if they are conscious
E-exposure: examine for rash/ application of defibrillator paddles, extent of injuries

41
Q

How to position patient if 1) lose consciousness 2) struggling to breath 3)anaphylaxis 4)unconscious and pregnant

A
  1. lie flat and raise legs to return circulation to brain
  2. keep patient sitting or leaning forward
  3. Need to lie flat
    4.. Left lateral position to prevent IVC obstruction
42
Q

List drugs that should be in emergency drug box in a dental surgery [checked every week]

A

-adrenaline epipen (1:1000) [anaphylaxis]
aspirin (300mg) [MI, stoke]
-glucagon 1mg [hypoglycaemia]
-GTN tabs or spray [angina]
-oxygen cylinder 15l/minute [cardiac arrest, acute asthma attack, acute coronary artery syndrome, epilepsy, faint, hypoglycaemia, stroke]
-salbutamol inhaler [asthma attack]
-midazolam buccal liquid or injection [epilepsy]
-oral glucose

43
Q

Symptoms of vast-vagal syncope. How to manage

A

-feels faint, dizzy, light-headed, pale, sweating, nausea
-initially fast pulse, then slow
-lie flat, open window, raise legs, loosen tight clothing, assess ABCDE
-most recover quickly. If not, ABCDE and consider other causes. Perhaps hypoglycaemia

44
Q

Symptoms of anaphylaxis. Management

A

-urticaria’s, erythema, rhinitis, conjunctivitis, abdominal pain, vomitting, diarrhoea, flushing
-vasodilation leading to hypovolaemia

-stridor, wheeze, hoarnseess, struggling to breath, airway swelling, faint, pale, clammy, cyanotic, confusion = call 999, lay flat, 0.5ml adrenaline 1:1000 IM on lateral thigh for 10s, oxygen
-prevents respiratory arrest then cardiac arrest
-can also use salbutamol inhaler and antihistamines (chlorphenamine)

45
Q

Symptoms and management of panic attack

A

-ABCDE to avoid mistaking for anaphylaxis
-hyperventilation =breathing out too much CO2, becoming ankylotic
-anxiety, weak, dizzy, palpitations, paraesthesias, anxiety rash, carp-pedal spasms

-rebreathing same air, using paper bag of spacer device with hand covering other end

46
Q

Signs and management of an acute asthma attack

A

A- Inability to complete sentences in one breath
B- Respiratory rate > 25 per minute
C- Tachycardia (pulse> 110 beats per minute)

-sit up
-2 puffs of beta agonist inhaler. Repeat if no rapid response using spacer, every 10 mins, up to 10 puffs
-ABCDE if no response. call 999

worrying sings= cyanosis, resp rate <8 per min, bradycardia, confusion, exhaustion, reduced consciousness

47
Q

Management of angina attack

A

ABCDE
GTN spray - 2 puffs, repeat after 5 mins, up to 3 times
Oxygen
Aspirin if MI
entonox (nitorus oxide) can be helpful
999 as possibly MI

48
Q

Management of epilepsy seizure lasting >5 mins

A

-could be mistaken for hypoglycaemia
-ABCDE
-10mg buccal midazolam
-In children, rectal diazepam

49
Q

Difference in ABCDE and CPR in infant or child

A

-For opening airway, don’t overextend cervical spine in infants and young children as this can obstruct the airway so put in neutral position
-expect higher normal respiration rates and HR
-Initial ventilation = 5 rescue breaths before compressions (usually airway origin rather than cardiac) Then 15:2
-for compressions use 2 fingers in infant, 1 or 2 hands in child
-usually don’t need AED as due to airway problems so un-shockable type of arrest

50
Q

Managing choking in infants and children

A

-Adult guidelines suitable for children over 1 year of age (5 back blows, 5 abdominal thrusts)
-Chest thrusts instead of abdominal thrusts for infants <1
=Put infant across lap with head under, lower than chest. 5 sharp inter-scapular blows. If fails try 5 chest thrusts with patient supine (but head lower than chest), one every 3 seconds. Repeat. Call 999 early. If unconscious, start CPR.

51
Q

Shockable and un-shokable arrhythmias

A

-shockable= ventricular fibrillation, pulseless ventricular tachycardia
-non-shockable= asystole (flat line), PEA (pulseless electrical activity)

52
Q

What are the reversible aetiology factors in a pulseless electrical activity (PEA) arrest (4 Hs, 4 Ts)

A

Hypoxia
Hypovolaemia
Hyper/hypokalaemia/metabolic
Hypothermia
Tension pneumothorax
Tamponade (cardiac)
Toxins
Thrombosis (coronary or pulmonary)

53
Q

Signs of cardiac arrest

A

loss of consciousness
absence of normal breathing
loss of pulse
dilation of pupils

54
Q

Who on bisphosphantes are considered low and high risk

A

-low: taken orally or IV for <5 years, with no systemic glucocorticoids
-high: >5 years, or for any time with systemic glucocorticoids. or have had previous MRONJ

55
Q

Early management of Bell’s palsy

A

-paralysis or weakness in one side of face
-eye-patch to protect eye, eye lubricants, prednisolone

56
Q

Initial management of osteonecrosis

A

-recommend analgesia
-recommend rinse mouth with chlorhexidine
-if recent onset get them to seek urgent care. If chronic get them to seek non-urgent care

57
Q

Early management of peri-implantitis

A

-recommend analgesics, and good OH
-advise patient to seek non-urgent care, or urgent if analgesia not effective

58
Q

Symptoms and management of sepsis

A

-Slurred speech
Extreme shivering or muscle pain
Passing no urine (in 24hr period)
Severe breathlessness
It feels like you’re going to die (impending sense of doom)
Skin mottled or discoloured

-O2 (15L/min) to keep sats >94%
Give IV antibiotics
Give a fluid challenge - IV

Take blood cultures (full blood count)
Measure lactate
Measure urine output

59
Q

Early management of stroke

A

-Urgent assessment in a hospital - neurological assessment, ECG, bloods
-CT to asses if ischamic or haemorrhagic
-Haemorrhagic= stop any anticoagulants, control BP
-Ischamic= IV Thrombolysis within 4.5hrs. Then aspirin and clopidogrel
-Close monitoring

60
Q

Explain the medical risk assessment categories (ASA I to VI)

A

ASAI= Healthy
ASAII= Mild systemic disease (function ok). eg. controlled asthma, angina, diabetes, epilepsy etc. Drug allergy. Smoker, alcoholic, pregnant. Or >60 years old. BMI>30. BP <160/95
ASAIII= Severe systemic disease
(definite functional limitation) - uncontrolled. BMI>40

ASA IV - Severe disease (constant threat) - sepsis. 3 months post MIA/CVA/TIA/stents
ASA V -Moribund. Risk of death if no surgery in 24 hours
ASA VI - Brain dead (organ donor)

61
Q

ACVPU system is used to assess a patient’s neurological condition in a medical emergency. What are you assessing. (It is the disability part of ABCDE)

A

A - Alert
C - confusion
V- Voice (verbal response)
P - Pain response
U - Unresponsive

=assessing how conscious they are

62
Q

What pre, peri and post extraction treatment is given to severe type A or B haemophilia patients.
Prophylaxis treatment for mild A

A

-pre: given factor concentrates (8/9) then measure plasma levels
-peri: avoid IDB due to deep tissue injury. PDL or intraosseous better. Articaine better for mandibular infiltrations. Surgicel and sutures
-post: tranexamic acid mouth rinse, gauze, post-op instructions. Keep patient for 30 mins before discharging

-mild A: given DDAVP 30-60 mins before which raises factor 8 and wWF

Human diseases stage 3 (9 decks)

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