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Prevention/medical emergency > FINAL exam_powerpoints > Flashcards

FINAL exam_powerpoints Flashcards

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Royal College: Emergency Medicine flashcards USMLE® Step 1 flashcards
1
Q

What is the role of the rapid response team?

A

respond to medical emergencies in the school. They are ACLS/PALS providers

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2
Q

T/F after you fill out the med emergency evaluation, you should file in the patient’s chart?

A

false

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3
Q

What are common emergencies encountered in dental setting?

A
  • syncope
  • intravascular injection
  • Hypoglycemia
  • seizures
  • cardiac disease (chest pain)
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4
Q

What is the least common emergency in a private practice?

A

MI, cardiac arrest, and anaphylactic

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5
Q

Top 3 emergencies encoutnered in dental setting?

A

syncope, mild allergic, angina

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6
Q

what causes angina?

A

blockage of the coronary arteries

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7
Q

Describe unstable angina?

A
  • fatty deposits or atherosclerotic plaques build up on inside of blood vessels of the heart
  • blood clot forms and the blood vessel becomes clogged further
  • occlusion of artery reduced blood flow and O2 supply to heart muscle = CHEST PAIN
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8
Q

What are the first steps in the treatment of angina–> MI?

A

First give oxygen and nitroglycerin to open the artery to get blood flow. If this doesn’t work, then you want to give Morphine for pain and Aspirin to decrease platelets!

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9
Q

What is acute coronary syndrome?

A

Progressive occlusion of the coronary arteries leads to this–>total occlusion of the artery. This occlusion may ultimately result in MI

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10
Q

what is the role of morphine in MONA?

A

-provides pain relief, feeling of euphoria and vasodilation which diminishes volume of blood returning to the compromised heart.

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11
Q

what is the role of aspirin in MONA

A

prevents platelets from sticking to one another and cause further clotting

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12
Q

If angina pain persists for longer than 10 mins, what should you do?

A

Assume MI and give morphine sulfate + aspirin then transfer to the hospital

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13
Q

what are the potential causes of a seizure?

A
  • underlying seizure disorder

- high dose of local anesthetic and epi, alcohol withdrawal, high fevers, hypoglycemia

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14
Q

what should you do if patient is suffering a siezure?

A
  • protect patient from injury BUT DO NOT RESTRAIN

- place pillow beneath head and rolled towel between teeth if biting tongue

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15
Q

what do you do if a seizure is lasting longer than 5 minutes?

A

-give Valium (diazepam) or MIDAZOLAM (best) IZV or IM or Versed. Monitor the ABCS

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16
Q

what is the purpose of administering glucagon?

A

-stimulate glycogenolysis (breakdown of the storage form of glucose) in the liver and provide sugar through this route

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17
Q

Describe how you would treat a patient experiencing insulin shock?

A
  • if Conscious- give sugar by mouth
  • If stuperous patient- give glucagon IM and then monitor vital signs and airway
  • If unconscious, recline patient and support airway breathing. Start IV and administer DEXTROSE, if you can’t start IV give glucagon. Watch for seizures and treat PRN.
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18
Q

How is dextrose administered?

A

IV

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19
Q

how is glucagon administered?

A

IM

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20
Q

Describe symptoms of insulin shock/hypoglycemia?

A

-Mental clouding, lethargy followed by diaphoresis, coolness of skin, anxiety, hypersalivation, tachycardia. May lead to loss of consciousness and seizure.

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21
Q

What position should patient be in if experiencing insulin shock?

A

semi reclined unless unconscious- then recline the patient

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22
Q

if your patient has suspected anaphylaxis with hypotension, what should you do?

A

-epi 1:10,000 and titrate slowly, give benedryl and then decadron (glucocorticosteriod)

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23
Q

if an object is aspirated, where will it likely end up?

A

right stem bronchus

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24
Q

Describe treatment if patient has aspirited gastric contents into lungs?

A
  • trenderlenberg position and turn to the right
  • suction and finger sweeps
  • Patient INTUBATED (muscle relaxant first-succinylcholine) and suction perfored with a catheter placed through the endotracheal tube
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25
Q

what is succinylcholine?

A

muscle relaxant. used for rapid intubation

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26
Q

____ disease is cause of the majority of blood flow decreases?

A

atherosclerotic

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27
Q

what might precipitate an anginal attack?

A

physical or psychological stress (dental office visit)

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28
Q

What is a big difference between angina and unstable angina?

A

-unstable occurs at rest vs. angina usually after physical or psychological stress.

Unstable is the progression of atherosclerosis and a higher chance of MI

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29
Q

What is variant angina?

A
  • coronary artery spasm

- likely to occur at rest

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30
Q

describe the signs of angina?

A

-patient appears apprehensive, sweating, eleveated BP, tachycardia, Dyspnea

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31
Q

where does pain typically radiate in Angina?

A

left arm/shoulder

sometimes also right arm, jaw, and epigastrium

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32
Q

When might avoid giving nitroglycerin to a patient with angina?

A

if patient systolic pressure is

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33
Q

If patient has no history of chest pain, and has angina, what should you do?

A

-terminate the procedure and activate EMS right away. Position patient comfortably. Give O2 + nitroglycerin

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34
Q

Describe acute MI?

A
  • decrease in blood supply to myocardium which results in cellular death and necrosis
  • LONGER duration than angina
  • complications could be shock, cardiac arrest, heart failure
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35
Q

two types of MI?

A 
NSTEMI= incomplete occlusion
STEMI= complete occlusion
36
Q

If your patient previously had an MI more than 6 months ago with no residual complications, what is their ASA status, and what should you consider while treating?

A

They could be an ASA 2 or 3. Consider giving O2 during treatment and follow up phone call afterwards

37
Q

If patient had an MI more than 6 months ago but has angina, heart failure, or dsyrthmia present, what is their ASA status? What should you consider if you treat them?

A

3 or 4
Consider giving Nitroglycerin 5 mins before surgery if history of angina, O2 through nasal canula or nasal hood, and follow up phoen call

38
Q

If patient had one documented episode of MI more than 6 months ago with further cardiovascular complications, what’ their status?

A

3

Give O2 during treatment

39
Q

If Patient had an MI less than 6 months ago and has severe post MI complications, what is their ASA status?

A

4

40
Q

Name 6 possible causes of cardiac arrest

A
  • airway obstruction
  • MI
  • Sudden cardiac arrest
  • Drug OD
  • Anaphylaxis
  • Seizure
41
Q

if patient experiences cardiac arrest, what do you do?

A
  • Management with early activation of EMS
  • Early CPR
  • Early Defibrillation
  • Early ACLS
42
Q

List the critical “drugs” to include in your basic kit

A

Injectible- EPI and Diphenhydraime
NON injectible- Oxygen, sugar, aspirin, albuterol, nitroglycerin

Think of the basic 7

43
Q

Describe 6 essential items to include in your basic kit?

A

-Positive pressure and demand valve, AED, Syringes for drug admin, suction and suction tips, tourniquets, magill intubation forceps

44
Q

what is the purpose of Atropine?

A

anticholinergic — speed up heart rate

45
Q

What is esmolol?

A

antihypertensive

46
Q

what is the purpose of ephedrine?

A

vasopressor (cardiac arrest)

47
Q

If patient has bradycardia, what would you administer?

A

atropine

48
Q

If patient has an opioid OD, what can you give?

A

naloxine

49
Q

if patient has benzodiazepine OD, what is the antidote?

A

flumazenil

50
Q

what is the majority of adverse drug reactions caused by?

A

85% from drug OD

51
Q

what age group does local anesthetic OD usually affect?

A

Either end of spectrum! old and young

52
Q

What are factors that can affect local anesethic OD?

A
  • Age
  • Body weight
  • pathologic process- liver, cardiac (decreased blood flow or decreased hepatic flow), pulmonary disease
  • genetics- enzyme deficiencies
  • sex- decreased renal blood flow and drug excretion during pregnancy
53
Q

What is an adverse effect associated specifically with prilocaine, articaine and topical use of benzocaines if in high dose?

A

methmoglbineami- induces the formation of methemoglobin

Bluish coloring of the skin

54
Q

what is a risk assoicated with lidocaine?

A

sedation. caused by two metabolites- monoethylglycinexlidide and glycinexide can produce mild sedation

55
Q

Cyanosis condition in absence of cardiac or respiratory depression
Blood appears chocolate brown if severe

A

methemoglobinemia

56
Q

When do signs and symptos of methemoglobinemia typically occur?

A

3-4 hours after admin

57
Q

How do you treat methemoglobinemia?

A

treated with 1% methylene blue infusion of 1.5 mg/kg

58
Q

what is the purpose of intralipid during local anesthetic toxicity?

A

fat emulsion to bind to local anesthetic molecules

59
Q

if your patient experiences minimal local anesthic OD, what should you do?

A

reassure patient, BLS, oxygen, monitor vitals, Active EMS

60
Q

Describe a drug allergy?

A

hypersensitive response to a substance to which an individual has been previously exposed and has developed antibodies.

Exaggerated response of the body immune system

61
Q

noninflammatory edema involving the skin, subcutaneous tissue, GI, erspirtoary tract etc.

A

angioedema

62
Q

An antigen that can elicit allergic symptoms?

A

allergen

63
Q

pruitis?

A

itching

64
Q

Type I hypersenstivity

A

IgE

65
Q

type III hypersensitivity?

A

serum sickness and IgG

66
Q

uticaria vs. angioedema?

A

Uticaria= putitis, tingly and warmth, flushing hives. Diffuse erythema

Angioedema= NONPURITIC extremity, around the eyes and around the mouth swelling. Nonpitting edema and frequently ASYMMETRIC

67
Q

If patient has larygneal edema, what should you do?

A

BLS care, activate EMS

GIve Epi IM
Histamine blocker

68
Q

describe symptoms and signs of laryngeal edema?

A

dyspnea, hoarseness, tight throat.

Patient signs include laryngeal stridor, supgraglottic and glottic edema

69
Q

why might an allergic reaction lead to circulatory collapse?

A

-increased vascular permeability= loss of vasomotor tone and increased venuous capactiance

70
Q

what are signs of circulatory collapse related to allergic reaction?

A

lightheadness, generalized weakness, syncope, ischemic chest pain

-signs = tachycardia, hypotension and shock

71
Q

Depressed level of consciousness with inability to be fully aroused.

A

obtunded

72
Q

most common cause of altered consciousness!?

A

drugs!

73
Q

The most important inhibitory neurotransmitter in the central nervous system.

A

GABA A

74
Q

Potentiation of the GABA (inhibitory) receptors =?

A

increased chloride conductance.

Those that do this are barbiturate, propfol, and inhalation anesthetics

75
Q

Inhibition of NMDA (excitatory) receptors–

A

reduce sodium conductance

  • Ketamine
  • N2O
76
Q

Increased in alpha/ beta cell ratio = excess ____ secretion over insulin

A

glucAgon

77
Q

what are some of the macrovascular complications of diabetes?

A
  • coronary artery disease
  • Stroke
  • peripheral aterial disease
78
Q

what constitutes severe hypoglycemia?

A

If

79
Q

what is mild hypoglycemia?

A

blood sugar betwen 60-80 mg/dl

80
Q

what are the 3 Ps associated with diabetes?

A

Polydispia (thirst)
polyuria (urination)
Polyphagia (excessive hunger)

81
Q

clinical signs assoicated with diabetic ketoacidosis?

A

abdominal pain, nausae, vomitting, weakness

82
Q

What constitutes hyperglycemia blood glucose when fasting?

A

> 140 mg/dl on two occasions

83
Q

what glycosylated hemoglobin (hemoglobin A1c) is of a concern?

A

> 6.5%

84
Q

insulin that is ultra short acting

A

Lispro

Onset is 10 mins and lasts 2-4 hour

85
Q

insulin that is short acting/regular

A

humulin, novolin

30 min onset, 5-8 hour duration

86
Q

long acting insulin?

A

glargine, lantus

2 hours and lasts 20-24 hours

87
Q

if you have a diabetic patient with an infection, what should you do?

A

-if on oral agents, may need insulin, or increase insulin dose

Prevention/medical emergency (1 decks)

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