Emergency scenarios in the dental setting Flashcards
1
Q
What to do if patient faints:
A
- lie with feet up, head down
- Check ABCDE
- Check vital signs
- Wait for them to come too
- Provide palliative care (cool towel, reassurance)
- Consider oxygen
- Slowly raise to sitting position
- Document and future prevention. Refer if required.
2
Q
What are the vital signs we can check in surgery: (4)
A
- Body temp
- Pulse rate or HR
- Respiration rate
- Blood pressure
3
Q
What is normal body temp:
A
36.5 to 37.5
4
Q
What is normal pulse rate/heart rate for adults, children and infants?
A
Adults 60-100
Children 70-100
Infant 90-150
5
Q
What is a normal respiration rate for adults, children and infants?
A
Adults - 12-16
Children 18-34
Infant 30-60
6
Q
What are the symptoms of angina attack?
A
- Substernal crushing pain, radiating through to back
- Radiates to left arm, neck and jaw
- Shortness of breath
7
Q
3 precipitants of angina:
A
- Exertion
- Cold weather
- Stress
8
Q
Management of Angina:
A
- Stop procedure, administer GTN, and repeat twice
- If no improvement after 2 repeats, consider as MI and call for help.
- It patient has not had pain before - assume MI.
9
Q
What to do for an assumed MI for a conscious patient:
A
- Call III
- Check vital signs
- Give oxygen
- Reassure.
- Record how many doses of GTN have been given.
10
Q
What are the three key features of MI that angina attacks don’t have:
A
- Nausea
- Sweating
- Pallor
11
Q
Aspirin is the only medication which have been shown to increase MI survivability. Would require at least a dose of:
A
300-600mg
12
Q
Management of pt in cardio-respiratory arrest
A
- Call 111
- Consider cause, review medical history
- Render patient safe
- DRS ABCs
- CPR until help arrives
13
Q
What does DRS ABCD stand for?
A
- Dangers
- Responsive?
- Send for help
- Airway
- Breathing
- CPR
- Defib
14
Q
Adrenaline should be given to an arrested patient whether they are in a shockable rhythm or not
True or false
A
True
15
Q
How much adrenaline should be given to patients?
A
1mg
16
Q
What level of CPR training for GDPs need:
A
NZRC CORE immediate
(CORE advanced if doing sedation)
17
Q
How often does NZRC CORE immediate require recertification?
A
2-4 yearly
18
Q
Triggers of asthma in the dental setting:
A
Stress/Anxiety
19
Q
Signs of Asthma attack:
A
- Patient breathes in but not out
- Wheeze
- Shortness of breath
- Tightening of chest
20
Q
Management of asthma patient:
A
- Stop procedure
- Sit upright or tilt forward slightly
- Administer salbutamol 2 puffs every 5 minutes up to three times
- Provide oxygen 8-10L/min via mask
- Call 111
21
Q
What alternate scenarios need to be considered in asthma attack?
A
Airway obstruction
Anaphylaxis
22
Q
What is Salbutamol?
A
Beta 2 agonist (bronchodilator)
23
Q
How should severity of an asthma attack be assessed?
A
Accordint to how many words they can speak - full sentences, 3-5 words, unable to speak
24
Q
How to manage hyperventilation:
A
- Sit pt upright
- Reassure
- Paper bag over nose and mouth
25
Management of seizure:
1. Remove everything from patients mouth
2. Clear safe zone
3. Check ABCDES
4. Call for help
5. Once over, reassure
26
How to prevent seizure in clinic:
1. Find out history
2. Find out current medication levels
3. Find out when last event was
4. Find out triggers
5. Reduce light
6. Agree on signal for tool down
27
Sign/Symptoms of hypoglycaemic patient:
* Sweaty
* Pale
* Rapid pulse
* Tremors/shaking
* Dizziness
* Confusion
* Slurred speech
* Unresponsive
28
Patients who are presenting with symptoms of hypoglycaemia - what should be ruled out?
MI/Stroke
29
Management of conscious hypoglycaemic patient:
1. Stop procedure
2. Sugary drink
3. Call for help
4. Find out history
30
Management of unconscious diabetic patient:
IM or IV glucagon
31
What is the dose of glucagon for unconscious diabetic patient:
1mg IM (takes under 5 mins to act)
Continue to check blood sugar levels and vital signs
32
In a type I hypersensitivity reaction, there is a massive release of _._
histamine
33
Signs and symptoms of Anaphylaxis:
1. Feeling of impending doom
2. Cold clammy unwell
3. Swelling or oedema
4. Airway compromise
5. Loss of consciousness
6. Hypotension
7. Peripheral shutdown
34
Managment of anaphylaxis:
1. Lie patient flat
2. ABCDEs
3. Call 111
4. Maintain airway - consider adjuncts
5. Oxygen via full face mask
6. Immediately administ 1mg/ml adrenaline 1:1000 IM
35
What does of adrenaline should be given to adults and children over 12 having anaphylactic reaction?
0.5ml (1mg/ml solution)
36
What vital signs might indicated shock?
* Hypotension
* Confusion
* Tachycardia
37
Management of adrenal insuffificny
1. ABCDE
2. Call for help
3. Check blood sugar and use hypoglycemia protocol
38
Precipitating factors of addisonian crisis:
* Infection
* Trauma
* Asthma
* MI
* Steroid withdrawal
* Alcohol
39
Rule of 2's
* Greater than 20mg prednisone
* For longer than 2 weeks
* In the past 2 years
40
What is the normal range of blood sugar levels in a non-diabetic
4-8 mmol/L
41
Anything above is acceptable for blood saturation on a pulse oximeter.
95
42
Why does breathing into a paper bag help with hyperventilation
They're breathed off too much CO2 so this way they breathe it back in.
43
Signs and symptoms of syncope:
* Dizzy, nauseous, agitated
* Pale, sweaty, slow pulse, low BP
44
Tx of syncope:
* Lie flat and raise legs. If they don't come right immediately, get O2
* If they don't recover quickly, ABC then hospital.
* Once recovered offer a drink and time to feel better
45
Symptoms of hypoglcaemia (5)
* Sweaty
* Tremor
* Agitation
* Drowsiness
* Confusion
* Coma
46
What to do for hypoglycaemic collapse;
IM Glucagon 1mg, then ABC and hospital
47
3 signs/symptoms of hyperglycaemia
* dehydration
* altered consciousnes
* ketotic smell
48
Management for seizure:
* Gently lower onto ground, try get them onto their side
* Do not restrain
Afterwards - recovery position, O2, monitor airway. Could be secondary to hypoglycaemia
49
When should pt go to hospital for seizure:
* First seizure event
* More than 5 minutes
* Complicated recovery
50
Symptoms of asthma attacK
* Short of breath
* Audible wheeze
* Cough
Severe - wheeze ++, unable to speak a full sentence, air hunger, unable to lie flat
51
Tx for severe asthma attack:
* O2
* 10 puffs of salbutamol into a spacer, then get patient to take 6 deep breaths from it if possible
* Alternate the salbutamol and oxygen
* If no improvement - oral prednisone 30-60mg (if airway is safe to)
* Call 111 if needed
52
How can intra-vascular LA trigger angina attack?
Induces tachycardia which increases likelihood of ischaemia
53
What dose of aspirin hsould you give for a suspected MI?
300mg - improves circulation
54
Tx for severe angina/suspected MI (conscious patient) whilst waiting for ambulance:
* GTN ever 5 minutes
* Aspirin 300mg
* High flow O2
* Position patient comfortably
55
Signs of airway obstruction:
* Distress
* Noisy breathing
* Coughing
* Something missing eg swab, tooth
56
Tx for partial airway obstruction:
Encourage patient to cough
57
Tx for full respiratory obstruction:
5 brutally sharp blows between the shoulder blades
If collapse - 111 and ABC
58
Symptoms patient might feel which indicate anaphylaxis:
* Unwell
* Dizzy
* Nauseous
59
Severe anaphylaxis signs:
* Hives (urticaria)
* swelling (angioedema)
* Hypotension
* Tachycardia
* Bronchospasm
60
Tx for anaphylaxi:
* Remove cause
* Call 111
* Patient supine, raise legs if faint
* If can talk - high flow O2
* Check BP and pulse
* Adrenaline 0.5mg IM if severe
* Repeat every 5 minutes if required
61
What does DR ABC stand for?
* Danger
* Response (Call for help here)
* Airway
* Breathing
* Circulation
62
Describe the recover position
* Chin well up to keep airway open
* Mouth facing down to enable drainage
* Arms and legs locked for stability
63
What BP should you not be undertaking routine dental tx without liaising with dr:
160 systolic or 100 diastolic
64
how long should you wait after MI before doing dental tx:
6 monts
65
5 things you can do to help with anxiety at dental appts
* Bring a support person
* Create a calm environment
* Have a calm collected attitude
* Instruments out of sight
* Good anesthesia/sedation
66
INR target for pts on warfarin is:
2-3.5
67
In addition to warfarin what are two anticoagulant drugs you might want to consult dr about potential delaying before exo
* Dabigatran
* Rabinaxtrin
68
Target HbA1C for diabetics is:
50-55%
69
What is a normal HbA1C?
40% or below
70
What HbA1C is considered pre-diabetic?
40-50%
71
A blood sugar reading below ?? level is cause for concern re hypoglycemia event
3.9mmol/L or below
