emergency in dent Flashcards
equipment
Blood pressure monitor
Blood glucose monitor
Pulse oximeter
Automated external defibrillators
list some drugs in medical emergency
GTN
ventolin puffer
insulin?
corticosteroid
epipen
supplementary o2
causes of syncope
Vasovagal
Orthostatic (drugs or hypovolaemia)
Cardiac dysrhythmias
Cardiac disease
what to do in syncope
Stop treatment
Lie down, raise legs (recovery position)
Measure BP and pulse
if no recovery of consciousness, call 000 and perform BLS
what are 2 types of coronary ischemia
Angina and Acute MI
management of acute MI or angina
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
management of severe chest pain
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
cardiac arrest management
stop treatment
Call 000
BLS
what to do in asthma
medical hx is taken, and assess severity of asthma
manage asthma depending on severity
assessment of asthma
Mild - can speak full sentence
Severe
- need to use accessory muscle
- Abdominal breathing
- SaO2 - 90-94%
Life-threatening
- SaO2 below 90%
- Cyanosis
management of mild asthma
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
management of severe/life threatening asthma
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
prevention of inhalation of objects
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
management of inhaled object
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
signs of stroke
transient LOC
one-sided difficulty moving
difficulty in speech
management of stroke
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
seizure (not status epilepticus) management
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
management if status epilepticus
call 000
maintain airway
monitor till help comes
Management of facial paralysis
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
management of hypoglycemia
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
how to differentiate between stroke and adrenal crisis
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
management of adrenal crisis
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
management of mild urticaria
Stop treatment
Remove allergen whatever it maybe
Recommend oral antihistamine
Management urticaria/angiooedema with swellings
Stop treatment
Remove allergen whatever it maybe
Refer for medical attention. Corticosteroid maybe indicated
Management urticaria/angiooedema associated with hypotension and evidence of anaphylaxis
Stop treatment
Remove allergen whatever it maybe
Call 000
IM adrenaline
Management of anaphylaxis (severe)
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
