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LA > Emergencies Lecture 13 > Flashcards

Emergencies Lecture 13 Flashcards

1
Q

Causes of vasovagal syncope?

A

pain, anxiety, fatigue, fasting and high temperature or humidity

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2
Q

Signs and symptoms of vasovagal syncope?

A

Pallor, cold and moist skin, uncomfortable or agitated, yawning, hypotension, slow, weak pulse, dizziness, nausea on some occasions and loss of consciousness

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3
Q

Normal time periods of vasovagal syncope?

A

Usually a few senconds, 10-30minutes is uncommon, rare for 1-2 hours
If longer than 5 minutes then need to call ambulance
Hypotension returns to normal in 2 hours
Can report malaise, anxiety and weakness for 1-2 days

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4
Q

Management of vasovagal syncope?

A
  • DRSABC
  • lay patient flat
  • loosen any tight clothing (relieve compression on neck and maintain airway
  • Oxygen
  • Monitor pulse and respiration
  • Convulsions can occur if there is a delay in treating cerebral hypoxia
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5
Q

If recovery from vasovagal syncope is not rapid?

A
  • Consider other causes of collapse
  • Call for medical assistance
  • Monitor ABC and institute CPR if necessary
  • Check BSL
  • Continue monitoring heart rate and blood pressure
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6
Q

Prevention?

A
  • Previous history should not be ignored
  • Ensure patients have had something to eat
  • Professional manner
  • Lying patients down
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7
Q

Postural hyptoension most likely to effect?

A
  • Those on anti-hypertenisves
  • After prolonged periods of lying down
  • The elderly
  • Vasovagal tendency
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8
Q

Postural hypotension prevention

A

-In susceptible patients changing gradually from lying to standing

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9
Q

Hypoglycemia, causes?

A

Type 1 and type 2 diabetes, more common when the patient doesn’t eat.

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10
Q

Hypoglycemia signs and symptoms?

A
  • Sweating
  • Hunger
  • Agitation
  • Confusion
  • Coma
  • Drowsiness
  • Tremor
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11
Q

Hypoglycemia management?

A

Assume any diabetic with impaired consciousness has hypoglycemia until proven otherwise
- Rapid acting glucose/sucrose source followed up by long acting carbohydrates

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12
Q

Hypoglycemia prevention?

A
  • Early morning appointments
  • Ensure the patient have had normal food insulin intake
  • Ensure appointment runs on time
  • Check BSL prior to treatment
  • If haven’t eaten recently then give sugary drink prior to commencement of treatment
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13
Q

Common anaphylaxis causes

A
  • Penicilin
  • Latex
  • Additives to LA
  • Rarely LA
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14
Q

Signs and symptoms of anaphylaxis?

A
  • Usually occurs within a few minutes of exposure, but may be delayed for 30 minutes or more
  • Facial flushing, swelling, itching and paraesthesia
  • Generalised uticaria or itching
  • Wheezing and difficulty breathing
  • Loss of consciousness, rapid or weak impalpable pulse
  • Falling blood pressure
  • Pallor going on to cyanosis
  • Cardiac arrest
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15
Q

Main features of anaphlaxis

A
  • Uticaria
  • Bronchospasm
  • Hypotension
  • Tachycardia
  • Angiodema
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16
Q

Management of anaphylaxis?

A
  • Stop administration of drug
  • Call for help and ambulance DRASBC
  • Keep patient in most comfortable position for breathing (usually sitting up)
  • If loose consciousness or is hypotensive then lay flat with legs raised
  • Maintain the airway and give oxygen
  • 0.6mL 1:1000 adrenaline IM (600 micrograms), repeat in a few minutes if no improvement
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17
Q

Epilepsy triggers?

A
  • Flashing lights
  • Stress
  • Starvation
  • Alcohol
  • Medications
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18
Q

Signs and symptoms of Epilepsy?

A
  • Aura
  • Sudden loss of consciousness ( Rigid extended appearnce (tonic phase) alternate with Clonic phase generalised jerking movements
  • Frothing from the mouth
  • Urinary incontinence
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19
Q

Do patients automatically regain consciousness after a seizure?

A

No they may in fact remain unconscious and flaccid for some time

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20
Q

Status epilepticus?

A

Repeated fitting seizures lasting longer than 5 minutes is a medical emergency and requires urgent control. Call ambulance

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21
Q

Management of epilepsy?

A
  • Protect the patient from hurting themselves
  • Do not place anything in the mouth
  • Keep airway clear
  • Place the patient in the recovery position
  • Ensure ABC is observed
  • Allow the patient to recover
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22
Q

If ongoing epileptic convulsions?

A
  • Give oxygen
  • Call ambulance
  • Benzodiazepines can be given by trained individuals
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23
Q

When to transfer to hospital in epilepsy?

A
  • First seizure
  • Ongoing fitting
  • Injured themselves
  • Post seizure confusion greater than 5 minutes
  • Any post seizure breathing difficulty
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24
Q

Prevention of epilepsy?

A
  • Ensure the patient has taken their medication
  • Avoid stress and other triggers
  • Get patient to warn you they feel they are going to have a seizure (not all are aware of a fit coming on, but some are)
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25
Q

Acute chest pain causes?

A
  • Usually due to myocardial ischaemia
  • Varying degrees of atheromatous coronary artery occlusion
  • Angina usually experiences at times of increased cardiac workload such as stress and anxiety (adrenaline mediated)
  • Myocardial infarction occurs when there is a rupture of atheromatous plaque cap with formation of thrombus.
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26
Q

Main differential diagnosis for acute chest pain?
Precipitating factors?
Pain experienced?

A
  • Angina or Myocardial infartion
  • Stress, exercise, emotion and anxiety
  • Severe crushig restrosternal pain, that may radiate to the arm, neck or jaw (commonly the left side)
27
Q

Features suggestive of angina?

A
  • Pain is short lasting

- Relieved upon rest and glyceryl trinitrate

28
Q

Features suggestive of Myocardial infarction?

A
  • Pain is more severe and persistent and irreversible.
  • Breathlessness, nausea and even vomiting
  • Weak, irregular pulse
  • Loss of consciousness
29
Q

Management?

A

If angina: allow patient to take glyceryl trinate or their anti-anginal drugs. Once has resolved cease treatment and reschedule

  • If no relief then assume it is an infarct:
    - Send for help and call ambulance
    - Don’t lay patient flat if increases breathlessness
    - Give oxygen or entonox to relieve pain and anxiety
    - Give 300mg of aspirin (chewed or sucked
    - Re-assure the patient
    - Monitor consciousness
    - If lose consciousness commence basic life support
30
Q

Causes of respiratory distress?

A

Acute asthmatic attack, inhaled foreign body, hyperventilation and angiodema

31
Q

Signs and symptoms of asthma attack?

A
  • Breathlessness and a tight chest
  • Increased respiratory rate (>25)
  • Expiratory wheeze
  • Accessory muscles of respiration in action
  • Can’t complete sentences (If patient can’t speak you are dealing with a potentially fatal episode)
  • Tachycardia
32
Q

Managements of asthma?

A
  • Keep patient upright
  • Allow patient to take their bronchodilator (preferably through a spacer)
  • Oxygen if no bronchodilator
  • Reassure patient
  • If no improvement then call an ambulance
33
Q

Prevention of asthma?

A
  • Avoid anxiety, pain and known allergens

- Ensure patient has their bronchodilator with them.

34
Q

Signs and symptoms of upper airway obstruction?

A
  • Stimulate the cough reflex

- If the patient is choking the object is large enough to cause respiratory obstruction

35
Q

Signs and symptoms of lower airway obstruction?

A

The patient may be totally unaware they have inhaled a foreign body

36
Q

Management of airway obstruction:

a) If patient is not choking or having difficulty breathing?
b) If signs of partial obstruction?
c) Complete airway obstruction (patient cannot speak breathe or cough)?

A

a) If patient is not choking or having difficulty breathing:
- Check oral cavity and clothing for object
- If can’t find object or known to have gone into throat then put patient in supine patient with head down, allowing gravity to return the object to the oropharynx
- If still can’t be retrieved inform patient and refer to hospital for chest and abdominal x-rays. Surgery may be required to remove the object.

b) If signs of partial obstruction, if the object is larger and causing breathing difficulties or choking then:
- Encourage coughing to dislodge the object and call for ambulance

c) Complete airway obstruction:
- If patient in dental chair sit them up on the side of the chair
- Support chest with hand and give 5 sharp back blows between the shoulder blades with the heel of your hand
- If doesn’t dislodge then give 5 abdominal thrusts (Heimlich maneouvre)
- If unconscious then commence CPR with finger sweep between each cycle and consider cricothyroidotomy if no air entry

37
Q

Signs and symptoms of hyperventilation?

A
  • Hyperventilation
  • Tingling of lips and fingers
  • Tetanic spasms of the peripheries
  • Anxious or distressed
  • Flushed appearance
  • Dizziness
  • Rapid pulse rate
  • All of these symptoms lead to worsening anxiety
38
Q

Management of hyperventilation?

A
  • Calm, friendly reassuring manner
  • Get patient to slow and count their breathing
  • DO NOT re-breathe into bag as this actually makes things worse due to increased hypoxia
39
Q

Prevention of hyperventilation?

A
  • Minimise anxiety
  • Having a calm and reassuring manner
  • Talking through the patients anxieties with them
  • Pharmacological agents maybe required
40
Q

Adverse reactions to LA?

A
  • Faint (most common adverse reaction to LA
  • Intravascular injection
  • Intramuscular injection
  • Facial palsy
  • Cardiovascular reactions
  • LA overdose
  • Fractured needle
  • LA allergy
41
Q

Intravascular injection signs and symptoms?

A
  • Agitation
  • Palpitations
  • Failure of anaesthesia
  • Fits/Loss of consciousness
  • Drowsiness/confusion
42
Q

Management of intravascular injections?

A
  • Lay the patient flat
  • Maintain airway
  • Give oxygen
  • Give reassurance
    Most patients recover in half an hour. If fits or loss of consciousness then treat appropriately
43
Q

Intravascular prevention?

A
  • Use aspirating syringe
  • Aspirate correctly
  • Inject slowly
44
Q

Signs and symptoms of intramuscular injections?

A
  • Pain
  • Trismus
    Usually resolves over a few days
45
Q

Intramuscular injection management?

A
  • Gentle jaw exercises

- Analgesics

46
Q

Intramuscular injection prevention?

A

Correct LA technique

47
Q

Facial palsy signs and symptoms?

A
  • Facial palsy

- Diplopia

48
Q

Facial palsy management?

A
  • Reassurance
  • Explanation
  • Eyelid closed and protective dressing applied until LA wears off
49
Q

Facial palsy prevention?

A

Correct LA technique

50
Q

Cardiovascular reaction signs and symptoms?

A
  • Palpatations

- Tremor

51
Q

Cardiovascular reaction management?

A
  • Reassurance
  • Minimise anxiety
  • Usually resolves quickly
  • If reaction is severe then treat as chest pain
52
Q

Cardiovascular reaction prevention?

A

Correct LA technique

53
Q

LA overdose signs and symptoms?

A
  • Drowsiness to convulsions

- Respiratory failure and cardiac arrest

54
Q

LA overdose management?

A
  • Oxygen

- Call for assistance

55
Q

LA overdose prevention?

A

Correct LA technique

56
Q

Fractured needle management?

A
  • If protruding end of the broken needle is visible then grasp it with mosquito forceps and remove.
  • If not visible then immediate referral is required
57
Q

Fractured needle prevention

A
  • Correct LA technique
  • Do not insert needle to the hub
  • Avoid bending the needle
58
Q

LA allergy signs and symptoms

A
  • Facial flushing, swelling, itching and paraesthesia
  • Generalised and isolated urticaria and itching
  • Falling blood pressure
  • Wheezing and difficulty breathing
  • Loss of consciousness, rapid or weak pulse
  • Falling blood pressure
  • Pallor going to cyanosis
  • Cardiac arrest
  • Isolated rashes (added in for LA allergy)
59
Q

LA allergy management?

A
  • Stop administration of drug
  • DRSABC (call ambulance)
  • Place patient in most comfortable position to breathe (usually sitting up)
  • If hypotensive or lose consciousness then lay them down and raise legs
  • Maintain airway and give them oxygen
  • 0.6mL 1:1000 adrenaline IMI (600 micrograms) repeat in a few minutes if there is no improvement.
  • Also testing for LA sensitivities
60
Q

LA allergy prevention?

A
  • Avoidance of precipitating agents
61
Q

Post operative bleeding, treatment?

A

Pinch soft tissue between the walls of the socket. This usually stops the bleeding from the soft tissues, while bleeding from the socket will continue to well up.

62
Q

Aggressive or difficult behaviour, signs and symptoms?

A

Anxiety, confusion, aggression, disturbed or difficult behaviour

63
Q

Aggressive or difficult behaviour management?

A
  • Adapt a calm, understanding, reassuring and non-confrontational approach
  • If the patient is unresponsive or difficult then summon assistance
  • If the patient becomes very aggressive or disturbed call security or emergency services
  • Do not put yourself or others at risk of injury from an aggressive patient or escort
64
Q

Aggressive or difficult behaviour prevention?

A
  • Calm inviting reception with alert and friendly staff
  • Avoid keeping patients waiting
  • Discuss the patients anxieties with them
  • If anxiety is the main issue the use of a sedative suh as Temazapam 20mg 2 hours before surgery and 10mg the night before.

LA (4 decks)

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