human disease / ME Flashcards
A patient has just walked into your surgery and collapsed.
Explain how you would manage this medical emergency.
- Check the area for danger.
- Assess the patient for a response and if this is not the case, commence ABC assessment.
Fainting presents with: dizziness, nausea, pallor, feeling cold/clammy and a slow pulse.
- place pt in a supine position and elevate legs.
- loosen clothing
- monitor pulse
- determine cause and remove
You are about to treat a patient and they complain of feeling unwell and start fitting.
Describe how you would proceed.
- Stop the procedure and remove all instruments from the pts mouth / surroundings.
- Establish symptoms (aura, familiar smell/sensation,
- Call for help.
- Start timing the seizure.
- Ensure the airway’s clear.
- Administer oxygen (100% O2 at 15 litres per min through a non-rebreathe mask).
You have just given a patient local anaesthetic and she suddenly becomes short of breath and develops swelling of the lips.
Describe how you would proceed.
- Stop the procedure and call for help.
- Ensure the pt is comfortable.
- Give O2 through a non-rebreathe mask at 15 litres per minute.
- Administer 500 micrograms of adrenaline IM.
- repeat after 5 mins unless the pt improves.
You are fitting a posterior crown and the crown slips and disappears. The patient coughs and becomes distressed.
What are the signs of an airway obstruction?
- Conscious pt with airway obstruction; pt will complain of difficulty breathing/be choking and distressed.
- Partial airway obstruction causes noisy breathing.
- Complete airway obstruction = no noise as there is no air movement.
If respiratory movements are present then they will involve the accessory muscles.
You are fitting a posterior crown and the crown slips and disappears. The patient coughs and becomes distressed.
What action would you take?
- Encourage coughing.
- 5 back blows.
- Carry out 5 abdominal thrusts.
- Repeat if unsuccessful or if the pt becomes unconscious.
At what BMI would a patient be categorised as being obese?
BMI over 30 would be classed as obese.
(calculated by doing weight / height ^2)
A patient with the following medical history attends for an extraction of a lower second molar:
- taking bisphosphinates
- taking warfarin for atrial fibrillation
- has diabetes mellitus
What further information would you need to obtain from this pt?
bisphosphinates:
- are they on oral or IV bisphosphinates and how long have they been taking them?
- do they have any other concurrent risk factors for BRONJ like diabetes/corticosteroid use/smoker?
warfarin:
- what is their usual value for INR and does this tend to fluctuate?
- ask if they are on any other medications that make them prone to bleeding (aspirin/clopidogrel).
diabetes:
- is it well controlled, type 1 or type 2?
A patient with the following medical history attends for an extraction of a lower second molar:
- taking bisphosphinates
- taking warfarin for atrial fibrillation
- has diabetes mellitus
Explain what the concerns are with regards to them having an extraction and what additional measures you would take.
Bisphosphinates: make the pt aware that they are more susceptible to BRONJ from impaired healing after the XLA.
- explain the XLA will be carried out as carefully as possible to reduce the risk.
Clotting Defect: explain the INR will have to be checked on the day of the procedure/the day before.
- measures will be taken to reduce bleeding (e.g: suturing socket, packing with haemostatic agent)
Diabetes: arrange the appointment for early morning or just after lunch to minimise hypo.
- advise pt to eat and take meds normally on the day - insulin might need to be adjusted depending on ability to eat after XLA.
What possible oral side effects does Nifedipine have?
Calcium Channel Blocker - mainly used as an antihypertensive.
- causes gingival hyperplasia.
- red and puffy papillae.
- tendency to bleed.
What possible oral side effects does Amitriptyline have?
Causes xerostomia.
What possible oral side effects does Amoxicillin have?
Broad Spectrum Antibiotics can cause candida infections, GI upset and antibiotic sore mouth.
What possible oral side effects does Penicillamine have?
Anti-Rheumatic Drug which can lead to lichenoid reactions.
What possible oral side effects does Phenytoin have?
Used in the treatment of epilepsy.
- can cause gingival hyperplasia/enlargement
- nifedipine and cyclosporine can also cause hyperplasia.
