How To Manage Flashcards
What are the signs of symptoms of adrenal crisis
- Collapse; pallor, cold & clammy skin
- Hypotension & dizziness
- Vomiting & diarrhoea
Management of adrenal crisis
- Airway Breathing Circulation Disability Exposure
- Call 999, state “Addisonian crisis”, SBAR
- Lie flat; administer oxygen 15 litres/min
- Patient’s hydrocortisone emergency IM kit at hand: hydrocortisone 100mg IM.
Anaphylaxis signs and symptoms
Signs & symptoms can include:
- Sudden onset
- Urticaria (hives) &/or angioedema (swelling); flushing & pallor
- Respiratory distress; stridor (high pitched sound from throat), wheeze &/or hoarseness
- Hypotension & tachycardia
Anaphylaxis likely:
- Sudden onset & rapid progression of symptoms
- Life-threatening A &/or B &/or C
- Skin &/or mucosal changes
Anaphylaxis management
- Airway Breathing Circulation Disability Exposure
- Call 999, state “Anaphylaxis”, SBAR
- Lie flat, elevate legs (if breathing not impaired); administer oxygen 15 litres/min
- Administer adrenaline 500 micrograms IM (0.5ml of 1:1000)
- Repeat adrenaline at 5 minute intervals until an adequate response
Paediatric doses of adrenaline:
- < 6 yrs = 150 micrograms (0.15ml of 1:1000);
- 6-12 yrs = 300 micrograms (0.3ml of
1:1000); > 12 yrs - 500 micrograms (0.5ml of 1:1000)
Asthma signs & symptoms
- Breathlessness & expiratory wheeze
Severe: inability to complete sentences in one breath, RR>25/min (resp rate) pulse >110/min
- Life threatening: cyanosis or RR<8/min, pulse < 50/min, exhaustion, confusion, decreased level of consciousness
Asthma management
- Airway Breathing Circulation Disability Exposure
- Sit upright; if available, follow patient’s personalised asthma action plan (PAAP)
- 2 puffs (100 micrograms/puff) B2 bronchodilator inhaler e.g. salbutamol; repeat doses may be necessary (early use of spacer device)
- Unsatisfactory/no response or if severe/ life threatening; Call 999, SBAR
- While awaiting ambulance: oxygen 15 litres/min; B2 bronchodilator via spacer given one puff at a time, inhaled separately using tidal breathing; according to response, give another puff every 60 seconds up to a maximum of 10 puffs
Cardiac emergencies - signs & symptoms
- Symptoms can vary but commonly:
- Chest pain or discomfort that suddenly occurs and doesn’t go away. It may feel like pressure, squeezing or heaviness in your chest
- Pain that may spread to your left or right arm or may spread to your neck, jaw, back or stomach
- Feeling sick, sweaty, light-headed or short of breath
NB: Heart attacks in women commonly missed
Cardiac emergencies: management
- Airway Breathing Circulation Disability Exposure
- Call 999, state “heart attack”, SBAR
- Comfortable position (usually sitting up)
- GTN spray 400-800mcg (typically1-2 activations) sub lingual
- Dispersible aspirin 300 mg to chew (unless there is clear evidence of allergy to it)
NB Known angina: sit down, rest, GTN; no relief after a few minutes repeat GT. Still no relief after a few minutes→heart attack protocol: call 999, SBAR & aspirin (see above) (SBAR = Situation • Background • Assessment • Recommendation.)
Epileptic seizures: signs & symptoms
- Sudden collapse & loss of consciousness
- Rigidity & cyanosis
- Jerking movements of limbs
- Noisy breathing
- Tongue may be bitten
- Frothing at mouth
- Incontinence may occur
Epileptic seizures: management
- Airway Breathing Circulation Disability Exposure
- Safe environment: prevent injury, do not put anything into mouth, do not restrain Administer oxygen 15 litres/min; note timings of seizure
- Once jerking movements cease: recovery position
- If available, follow Patient’s Treatment Plan; Call 999 if necessary, SBAR
- Prolonged convulsive seizures (5 minutes or more) or repeated rapidly:
Midazolam oromucosal solution can be given via the buccal route in adults as a single dose of 10mg (unlicensed in adults) (BNF, 2020)
Paediatric doses of midazolam oromucosal solution:
- 1-4 years- 5mg; 5-9 years-7.5mg; 10-18 years - 10mg
Hypoglycaemia: signs & symptoms
- Shaking/trembling
- Slurred speech & vagueness
- Sweating & pallor; blurred vision
- Tiredness/Lethargy
- Confusion/aggression
- Stroppy/moody
- Unconsciousness
Hypoglycaemia: management
- Airway Breathing Circulation Disability Exposure
- Offer 15-20g quick acting carbohydrate e.g. 4-5 Glucotabs® or 1.5 - 2 tubes of
Glucogel - Impaired consciousness/unable to swallow safely or unconscious:
Call 999, SBAR, recovery position, glucagon 1mg IM Once consciousness returns, offer oral carbohydrate - If able, measure blood sugar to help confirm correct diagnosis
Paediatric dose of glucagon: < 8 years of age or < 25kg: 0.5mg IM
Red flag sepsis: signs & symptoms
- In the context of presumed infection, if patient looks very unwell, family or carer is very concerned, there is ongoing deterioration or if physiology abnormal for this patient (check HR, SpO2 & BP): is ONE red flag present:
- New deterioration in GCS/ AVPU
Systolic B.P ≤90 mmHg (or ≥40 mmHg < normal) - Heart rate ≥ 130 per minute (60-100 is normal)
- Respiratory rate ≥ 25 per minute (normal is 12-18)
- Needs oxygen to keep SpO2 92% (88% in COPD)
- Non-blanching rash or mottled/ ashen/ cyanotic
- Not passed urine in last 18 hours
- Recent chemotherapy (within last 6 weeks)
NB Refer to age-appropriate GDP Sepsis Decision Tool for guidance in children ≤ 12 years of age
Red flag sepsis: management
- Airway Breathing Circulation Disability Exposure
- Refer to GDP Sepsis Decision Support Tool For Primary Dental Care (≥ 12 years of age)
- Call 999, state ‘Red Flag Sepsis!, SBAR
- Oxygen 15 litres/min
- Ensure paramedics pre-alert as ‘Red Flag Sepsis
NB Refer to age-appropriate GDP Sepsis Decision Tool for guidance in children ≤ 12 years of age
Stroke: signs & symptoms
Facial weakness
Arm weakness
Speech problems
Time to call 999
Stroke: management
- Airway Breathing Circulation Disability Exposure
- Act FAST & call 999; SBAR
- Administer oxygen 15 litres/min
- Nil by mouth; appropriate position
Syncope: signs & symptoms
Feels faint/dizzy/light headed
Collapse & loss of consciousness
Pallor, sweating, slow pulse, low BP
Nausea/vomiting
Syncope: management
- Airway Breathing Circulation Disability Exposure
- Lie flat, elevate legs & loosen tight clothing; consider oxygen? (not usually necessary)
- Once consciousness returns, offer glucose in water or sweet tea
- Slow recovery: consider alternative diagnosis; unresponsive: check signs of life
General advice and management of hypoxia (normal vs COPD)
Ensure a patent airway
Treat life threatening hypoxia with high flow oxygen
Titrate subsequent oxygen therapy with pulse oximetry:
- SpO2 for asthma 94-98%, high flow O2 given if O2 goes below 94%
- COPD: 88-92% is the aim, so below 88% consider O2
