Medical Emergencies 1 Flashcards
5 conditions that increase chance of adverse event occurring in dental surgery
- ischaemic heart disease
- diabetes
- asthma
- allergies
- polypharmacy
principles of emergency management ABCDE
Airways breathing circulation disability exposure
3 reasons dental pts at inc risk of upper airway obstruction
- blood/ saliva in mouths for prolonged periods of time
- LA prevents normal protective pharyngeal reflexes
- dental equipment in oral cavity for long time, possibility of aspiration
symptoms of upper airway obtsruction 3
- sudden onset
- coughing/ spluttering
- difficulty breathing
signs of upper airay obstruction 3
- paradoxical chest and abdominal movement (see saw respiration)
- use of accessory muscles of respiration
- central cyanosis is a late sign
signs of partial airway obstruction :
- inspirationay stridor =
- expiratory wheeze
- gurgling=
- snoring
- inspirationay stridor = obstruction at or above larynx
- expiratory wheeze = lower airway obstruction
- gurgling= liquid/ semi-solid foreign material in upper airway
- snoring= pharynx partially occluded by tongue or palate
management of upper airway obstruction 4
- simple manoevres: head tilt/ chin lift/ jaw thrust
- remove visible foreign body
- airway adjuncts
- high flow oxygen
4 conditions presenting with breathing problems
- hyperventilation
- asthma
- angina
- heart failure
explain look, listen, feel for breathing problems
look 4: sweating, central cyanosis (blue tongue), use of accessory muscles of mastication, abdominal breathing, count respiratory rate
listen 3: gurgling, stridor, wheeze
feel: movement of air on your cheek
normal respiratory rate (breaths) in
a. adults
b. children
a. adults: 12-20 breaths/min
b. children: 20-30 breaths/min
what does inc/ dec resp rate suggest
inc: in trouble
big decrease: very bad
what to do to manage breathing 2
- call ambulance
- use bag and mask/ pocket mask
define hyperventilation
minute ventilation exceeds metabolic demands resulting in haemodynamic changes
associated with panic disorder, may be acute or chronic
5 symptoms of hyperventilation
- shortness of breath/ wheeze
- chest pain/ palpitations
- belching/ dry mouth
- dizziness
- paresthesia/ circumoral numbness
management of hyperventilation 4
- stop tx, reassure pt
- encourage re-breathing of CO2 via paper bag or cupped hands
- [small dose of benzodiazepines eg lorazepam- may depress respiration BAD]
- consider anxiety management before next appointment
how to diagnose asthma 4
- more than one of: wheeze, breathlessness, chest tightness, cough
- symptoms worse at night and early morning
- occur in response to exercise, allergen exposure or drugs eg aspirin, beta blockers
- occur in association with atopy/ family history of asthma/ atopy
risk factors for severe asthma 7
BE AWARE OF PSYCHOSOCIAL ISSUES WITH ASTHMA
previous nr fatal asthma
- previous ventilation or resp acidosis
- prev hospitalisation esp in last year
- req 3+ classes of asthma meds
- heavy use of beta 2 agonist
- repeated ED attendances
- brittle asthma
common causes of asthma attack in dental setting 5
- LA with vasoconstrictors. sulphites –> bronchospasm
- sedative/ GA
- penecillin allergy more common in asthmatics
- NSAIDS
- other drugs eg aspirin, barbituates, beta blockers, cyanoacrylates, mefanamic acid, morphine, pancuronium, suxamethonium
4 symptoms of mild asthma
- increasing wheeze
- complaints of chest tightness
- inc resp rate
- tachycardia
symptom of moderate asthma
increasing symptoms of mild asthma
symptoms of severe asthma 4
- inability to complete sentences in 1 breath
- resp rate >25 /min
- tachycardia >110 /min
- use of accessory muscles
symptoms of life threatening asthma 4
- cyanosis
- resp rate
how to manage asthma attack in dental setting 2
- ABCDE
- high flow oxygen 10-15l/min
- salbutamol 4-6 puffs every 10 mins using spacing device/ nebuliser in severe attack
