Dental Emergencies_March 26 Flashcards
Where should you search for a list of emergency equipment to have available in your clinic?
eTG recommendations
What is the defining difference between urticaria (hives) and rash?
-Urticaria are discrete lumps rather than rash which is more generalised
How would you treat urticaria?
- Cease dental treatment and review case/cease allergen
- Give antihistamine
What is angioedema and how do you treat it?
- Swelling
- If not affect airway treat as per uticaria
- Otherwise treat as per anaphylaxis
What antihistamines should you use to treat allergies?
- Cetirizine: 6 years old + 10mg once daily, 2-6 5mg, 1-2 2.5mg
- Fexofenadine
- Loratadine
- Levocitirizine
- Desloratadine
(Little access to brain so non-sedative, but may still cause drowsiness in elderly or other vulnerable groups)
What are some adverse effects of antihistamines
Dry mouth
Drowsiness
Fatigue
Headache
What a re teh symptoms of anaphylaxis?
- Airway constriction
- Edema
- Urticaria
- Cardiovascular collapse
- Bronchoconstriction
- Itching of skin
- Pallor
- Feeling of impending doom
- Wheeze
What is the management of anaphylaxis?
- Stop what you are doing
- Remove allergen
- Call ambulance
- Lay patient flat or sit them down
- Intramuscular injection of adrenaline and repeat every 5 minutes if necessary (0.01mg/kg up to 0.5mg/1:1000)
What are the effects of adrenaline?
-Act on beta 1 and beta 2 receptors
- Increased CO
- Increased contraction strength
- Raised BP
- Bronchilor dilation
- Suppresses inflammatory mediators
What are the adverse effects of adrenaline?
- Restlessness
- Anxiety
- Weakness, dizziness, headache
- Cold limbs
- Sweating
- Pallor
- Nausea, vomitting
- Palpitations, tachycardia
- Heart palpitations if inject too quickly
-But short half life so will recover quick
What should you do if patient recovers?
- Observe patient for at least 4 hours
- Some may require overnight observation
- Be wary of biphasic reactions
- Document it
What should you do for patient with chest pain? What should you take into consideration for treatment?
- Administer glyceryl trinitrate
- It is a nitrate vasodilator
- Works by opening up veins, preventing blood coming back to the heart and thus reduces its workload
- Also opens up artery so heart doesn’t have to work as hard to open valves
- However, causes blood to pool in legs, so have patient sitting or lying or they will fall over
- If pt male, ask if they have had viagra or similar drugs within last 24-48 hrs, as this dramatically increases effect–>need to give smaller dose
-Also aspirin 300mg if chest pain severe and not already taking antiplatelet
What are the steps to managing chest pain?
- Stop what you are doing
- Measure patient’s BP + pulse rate, assess consciousness–>make sure their BP is not crap otherwise GTN will make it worse
- Ensure pt is sitting and administer glyceryl trinitrate 0.4mg spray sublingually, repeat every 5 minutes, up to max of 1.2mg
- Alternatively 0.6mg tablet sublingually, repeat every 5 minutes, up to a max of 1.8mg
and possibly 300mg aspirin
If patient not responding within 10 minutes, call ambulance
- If BP low AND chest pain, usually a bad sign
- Rest
- Reassurance
- Oxygen
- Lay them flat
- Hope ambulance arrives soon
How would you treat hypoglycaemia?
- Stop what you are doing
- Give oral glucose
- If patient unable to take things orally, indicates induced by insulin, administer glucagon 1mg injection using prefilled syrigne (similar to epipen), given intramuscular pt should respond within 10-15 mintues
- Give glucose after
*Call triple 000 if pt unresponsive to treatment or can not swallow
What are antiemetics?
-Anti-nausea/vomitting drugs
