emergency in dent

Question 1

equipment

Answer 1

Blood pressure monitor
Blood glucose monitor
Pulse oximeter
Automated external defibrillators

Question 2

list some drugs in medical emergency

Answer 2

GTN
ventolin puffer
insulin?
corticosteroid
epipen
supplementary o2

Question 3

causes of syncope

Answer 3

Vasovagal
Orthostatic (drugs or hypovolaemia)
Cardiac dysrhythmias
Cardiac disease

Question 4

what to do in syncope

Answer 4

Stop treatment
Lie down, raise legs (recovery position)
Measure BP and pulse

if no recovery of consciousness, call 000 and perform BLS

Question 5

what are 2 types of coronary ischemia

Answer 5

Angina and Acute MI

Question 6

management of acute MI or angina

Answer 6

B4 treatment, patient should have their GTN readily accessible
When episode is occurring,
1. Stop treatment
2. Measure vitals (bp, pulse + O2 saturation)
3. relieve using GTN
- 400mg GTN spray sublingual, repeat every 5 minutes 3 times max
- 300-600mg GTN tablet sublingual. Repeat every 5 minutes 3 times max
- If 2 dose is not enough, administer 1 more, and continue the management as severe chest pain
- if patient recover, leave treatment for another day, and refer to a GP even if patient looks well

Question 7

management of severe chest pain

Answer 7

call 000
give GTN
measure vitals
supplementary O2 if oxygen saturation is less than 90%, and bring it up to 96% if possible.
reassure patient
BLS if patient lose consciousness

Question 8

cardiac arrest management

Answer 8

stop treatment
Call 000
BLS

Question 9

what to do in asthma

Answer 9

medical hx is taken, and assess severity of asthma
manage asthma depending on severity

Question 10

assessment of asthma

Answer 10

Mild - can speak full sentence
Severe
- need to use accessory muscle
- Abdominal breathing
- SaO2 - 90-94%
Life-threatening
- SaO2 below 90%
- Cyanosis

Question 11

management of mild asthma

Answer 11

1) 4 puff of salbutamol inhaler via a spacer. Shake inhaler before each puff
2) Take 4 breaths in and out before each puff. Wait 4 minutes before next puff

Question 12

management of severe/life threatening asthma

Answer 12

Call 000
Start supplement O2
Salbutamol inhaler via spacer
- Adult : 12 puff
- Below 6: 6 puff
If no spacer, can use nebuliser to administer 5mg salbutamol
While waiting for ambulance
- Repeat salbutamol every 20mins
- Life-threatening continuously give salbutamol

Question 13

prevention of inhalation of objects

Answer 13

with rubber dam
Patient recline, not supine
Tie safety floss when applicable
Place gauze at back of the tongue for object that may be dropped
High volume suction to retrieve

Question 14

management of inhaled object

Answer 14

Stop treatment
Check for object
If suspect in patient, put pt upright
Most object can pass through GI no problem, so can reassure pt that. However, pcpc would want us to refer to medical for assessment and management. If asymptomatic, complete dental procedure before refer
If symptomatic
- Encourage patient to relax and cough out object
- If ineffective, give 5 back blows between shoulder blade
- If unsuccessful, 5 chest thrust
- Alternate between the two until help arrives
if Unconscious
Call 000
Inspect back of throat, try remove object if possible
CPR

Question 15

signs of stroke

Answer 15

transient LOC
one-sided difficulty moving
difficulty in speech

Question 16

management of stroke

Answer 16

Stop treatment
Call 000
Measure vitals
Make SaO2 to 96%
Maintain airway
BLS if required
DON’T GIVE ASPIRIN because it is hard to tell if it is haemorrhagic or ischaemic

Question 17

seizure (not status epilepticus) management

Answer 17

Stop treatment
Ensure pt not in danger
Turn patient to the side - reduce risk of aspiration
Don’t restrain patient, unless its needed to prevent injury to self
Wait for seizure to stop
Assess consciousness
Maintain airway
Remove vomit using high volume suction

Question 18

management if status epilepticus

Answer 18

call 000
maintain airway
monitor till help comes

Question 19

Management of facial paralysis

Answer 19

Stop LA and dental treatment
Explain what happen and reassure
Advise pt not rub eye
Close eye and cover with eye patch
Keep pt under observation. Should wear off within 1 hr, depending on dose given
Advice pt not to drive, best be escorted home
Check pt by phone review. If not okay by 12 hours, medical review to be done

Question 20

management of hypoglycemia

Answer 20

Stop treatment
Give glucose
- Kids Below 25kg: 5g
- Kids Above 25kg:10g
- Adult: 15g
If no glucose, give food/drink with fast acting glucose
15 minutes, symptoms not improve re-give
If >3 dose needed to stabilize, seek medical advice
After improvement, eating a long-acting glucose such as sandwich to prevent recurrence of hypoglycemia
Observe patient until recover. Don’t let them drive home. Strongly advice medical review
If patient drowsy, uncooperative/unconscious
- Stop treatment
- Call 000
- BLS

Question 21

how to differentiate between stroke and adrenal crisis

Answer 21

To differentiate between this and stroke, onset of stroke is a lot more rapid. If it is adrenal crisis, it is likely already taking place when patient comes in the practice

Question 22

management of adrenal crisis

Answer 22

000
Give corticosteroids. If patient brought their own, give them that
If pt is unconscious and no immediate help, administer 200mg hydrocortisone IM or IV

Question 23

management of mild urticaria

Answer 23

Stop treatment
Remove allergen whatever it maybe
Recommend oral antihistamine

Question 24

Management urticaria/angiooedema with swellings

Answer 24

Stop treatment
Remove allergen whatever it maybe
Refer for medical attention. Corticosteroid maybe indicated

Question 25

Management urticaria/angiooedema associated with hypotension and evidence of anaphylaxis

Answer 25

Stop treatment
Remove allergen whatever it maybe
Call 000
IM adrenaline

Question 26

Management of anaphylaxis (severe)

Answer 26

Stop
Remove allergen
Pt flat
IM adrenaline
* 10-20kg: 150microgram Adr
* >20kg: 300 microgram adr Call 000
Supplement O2 and BLS
Repeat adrenaline every 5 minutes till help arrives
Follow up
- Record suspected allergen and pt response
- Request copy of medical report of allergic reaction