Emergency Medicine

Question 1

What will you find in a dental emergency kit

Answer 1

Adrenaline
Aspirin
Glucagon 
Glyceryl triturate (GTN) 
Midazolam oromucosal solution 
Oral glucose
Oxygen cylinder 
Salbutamol Inhaler

Question 2

What does the adrenaline come as

Answer 2

Prefilled syringes

IM injection

Question 3

What does the aspirin come as

Answer 3

300 mg tablets

Question 4

What does glucagon come as

Answer 4

IM injection
1mg
In fridge

Question 5

What does GTN come as

Answer 5

400 mg per metered dose

Question 6

How is midazlolam oromucosal solution administered

Answer 6

5mg/ml

Question 7

What can be given as oral glucose

Answer 7

fizzy drinks e.g coke (NOT DIET)
glucose gel
powdered glucose
sugar lumps

Question 8

What does the salbutamol inhaler come as

Answer 8

100 mg per actuation

Question 9

What are the key signs of anaphylaxis

Answer 9

Upper airway oedema (stridor and wheezing)
Tachycardia (>110BPM)
Increased respiratory rate

Question 10

What are the key symptoms of anaphylaxis

Answer 10

Abdominal pain, vomiting, diarrhoea
Flushing
Symptoms of mild allergy

Question 11

What is the priority for a px with anaphylaxis

Answer 11

emergency transfer to hospital

Question 12

What is the management for anaphyalxis

Answer 12

ambulance
secure px airway and restore BP - lay px flat 
remove source of anaphylaxis if known 
oxygen
adrenalin 
if cardiac arrest after then BLS

Question 13

What are the key signs for allergies

Answer 13

○ Hives and rash, particularly on hands, chest & feet
○ Rhinitis, conjuctivitis
○ Mild bronchospasm without evidence of severe shortness of breath

Question 14

What is the management of mild allergies

Answer 14

cetirizine OR chlorphenamine OR loratadine

Question 15

If a px showing signs of mild allergy shows mild bronchospasm then what should be administered

Answer 15

a salbutamol inhaler (4 puffs, through a large volume spacer as needed)

Question 16

What should you do after the px has shown signs of mild allergies

Answer 16

refer to GP

Question 17

What are the key signs of LIFE THREATENING asthma

Answer 17

○ Cyanosis or respiratory rate <8 PM
○ Bradycardia <50 BPM
○ Exhaustion, confusion, decreased conscious level

Question 18

What are the key signs of ACUTE SEVERE asthma

Answer 18

○ Inability to complete sentences in one breath
○ Respiratory rate >25 PM
Tachycardia >110 BPM

Question 19

If a px is showing symptoms of life threatening asthma what is the priority

Answer 19

emergency hospital transfer

Question 20

What is the management of asthma

Answer 20

Sit px upright
oxgen
administer px own bronchodilator

Question 21

If during an asthma attack a px inhaler isn’t present what should be administered instead

Answer 21

salbutamol inhaler, 4 puffs through a large volume spacer, repeat as needed (1 puff for children)

Question 22

If a patient is suffering from a severe episode of asthma and does not respond to treatment with bronchodilators within 5 mins of administration then what is required

Answer 22

emergency hospital transfer

Question 23

What are the key signs of acute coronary syndromes

Answer 23

Progressive onset of severe crushing pain in centre and across the chest

Pain may radiate to the shoulders and down the arms (left more common) and into the neck and jaw or through the back

Question 24

What are the key symptoms of acute coronary syndromes

Answer 24

○ Shortness of breath
○ Increased respiratory rate
○ Skin becomes pale and clammy 
○ Nausea and vomiting are common
○ Pulse might be weak and BP may fall

Question 25

What is the management of ACS

Answer 25

``` sit px upright oxygen GTN if no response to GTN then MI - AMBULANCE ADMINISTER ASPIRIN ```

Question 26

What are the signs of cardiac arrest

Answer 26

○ Unconscious ○ Absence of normal breathing ○ Loss of pulse Dilation of pupils

Question 27

What is the management for cardiac arrest

Answer 27

Call for ambulance BLS using 100% oxygen or ventilation Early defibrillation

Question 28

What are the key signs of epilepsy

Answer 28

○ Sudden loss of consciousness, may become rigid, fall, might give a cry and becomes cyanosed ○ Jerking movements of the limbs and the tongue may be bitten

Question 29

What are the key symptoms of epilepsy

Answer 29

○ Brief warning or 'aura' | ○ Frothing from the mouth and urinary incontinence

Question 30

What is the management of epilepsy

Answer 30

Do not try to restrain convulsive movements Ensure the patient is not at risk from injury Secure the px airway Administer 100% oxygen - flow rate 15L/min

Question 31

If a fit is repeated or prolonged (>5min) what should be done

Answer 31

continue w/ oxygen administer midazolam after convulsive movements have subsided place the px in the recovery position and check the airway

Question 32

When should you give medication to someone having a seizure

Answer 32

Only give medication if convulsive seizures are prolonged or recur in quick succession

Question 33

When should you call an ambulance for epilepsy

Answer 33

If the convulsive seizures are prolonged (>5min) or recur in quick succession, first episode of epilepsy, convulsion was atypical, injury occurred or there is difficulty

Question 34

What are the key signs of someone who is faint

Answer 34

Patient feels faint, dizzy, light-headed Slow pulse rate Loss of consciousness

Question 35

What are the key symptoms of someone who is faint

Answer 35

Pallor and sweating | Nausea and vomiting

Question 36

What is the management of someone who is faint

Answer 36

○ Lay flat and raise feet, loosen tight clothing around the neck ○ Administer 100% oxygen until consciousness regained

Question 37

What are the key signs of hypoglycemia

Answer 37

○ Aggression and confusion ○ Sweating Tachycardia (>110BPM

Question 38

What are the key symptoms of hypoglycemia

Answer 38

``` ○ Shaking and trembling ○ Difficulty in concentration ○ Slurring of speech ○ Headache ○ Fitting Unconscious ```

Question 39

What is the management of hypoglycemia if the patient is conscious and cooperative

Answer 39

``` Oxygen Oral glucose (10-20g) and repeat if necessary ```

Question 40

What is the management of hypoglycemia if the patient is unconscious or uncooperative

Answer 40

glucagon - IM injection | oral glucose when patient regains consciousness

Question 41

When should an ambulance be called for a hypoglycemic

Answer 41

If px does not respond or difficulty is experienced

Question 42

What are the key signs of a stroke

Answer 42

○ Facial weakness/eye drooping ○ Arm weakness ○ Communication problems - slurred speech, unable to understand what is being said to them

Question 43

What is the priority for a stroke

Answer 43

EMERGENCY HOSPITAL TRANSFER

Question 44

What is the management of a stroke

Answer 44

Oxygen If px is unconscious and breathing then secure airway and put in recovery Ambulance

Question 45

What are the key signs of aspiration and choking

Answer 45

○ Px may cough and splutter ○ Px may complain of breathing difficulty ○ Breathing may become noisy on inspiration (stridor) ○ Px may develop paradoxical chest or abdominal movements ○ May become cyanosed and lose consciousness

Question 46

What is the management for aspiration

Answer 46

Encourage coughing Oxygen Salbutamol inhaler

Question 47

If you suspect that a large fragment has been inhaled or swallowed but there are no signs what do you do

Answer 47

refer to hospital for x-ray and removal of the fragment

Question 48

If a patient is asymptomatic following aspiration what should you do

Answer 48

emergency hospital transfer | ambulance

Question 49

What is the management of choking

Answer 49

○ Remove visible foreign bodies ○ Encourage coughing ○ If px is unable to cough but remains conscious then commence back blows followed by abdominal thrust ○ If becomes unconscious the BLS needs to be started Call an ambulance and transfer patient to hospital as an emergency