Medical Emergencies 1

Question 1

5 conditions that increase chance of adverse event occurring in dental surgery

Answer 1

• ischaemic heart disease
• diabetes
• asthma
• allergies
• polypharmacy

Question 2

principles of emergency management ABCDE

Answer 2

Airways
breathing
circulation
disability
exposure

Question 3

3 reasons dental pts at inc risk of upper airway obstruction

Answer 3

• 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

Question 4

symptoms of upper airway obtsruction 3

Answer 4

• sudden onset
• coughing/ spluttering
• difficulty breathing

Question 5

signs of upper airay obstruction 3

Answer 5

• paradoxical chest and abdominal movement (see saw respiration)
• use of accessory muscles of respiration
• central cyanosis is a late sign

Question 6

signs of partial airway obstruction :

• inspirationay stridor =
• expiratory wheeze
• gurgling=
• snoring

Answer 6

• 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

Question 7

management of upper airway obstruction 4

Answer 7

• simple manoevres: head tilt/ chin lift/ jaw thrust
• remove visible foreign body
• airway adjuncts
• high flow oxygen

Question 8

4 conditions presenting with breathing problems

Answer 8

• hyperventilation
• asthma
• angina
• heart failure

Question 9

explain look, listen, feel for breathing problems

Answer 9

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

Question 10

normal respiratory rate (breaths) in

a. adults
b. children

Answer 10

a. adults: 12-20 breaths/min

b. children: 20-30 breaths/min

Question 11

what does inc/ dec resp rate suggest

Answer 11

inc: in trouble

big decrease: very bad

Question 12

what to do to manage breathing 2

Answer 12

• call ambulance

- use bag and mask/ pocket mask

Question 13

define hyperventilation

Answer 13

minute ventilation exceeds metabolic demands resulting in haemodynamic changes
associated with panic disorder, may be acute or chronic

Question 14

5 symptoms of hyperventilation

Answer 14

• shortness of breath/ wheeze
• chest pain/ palpitations
• belching/ dry mouth
• dizziness
• paresthesia/ circumoral numbness

Question 15

management of hyperventilation 4

Answer 15

• 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

Question 16

how to diagnose asthma 4

Answer 16

• 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

Question 17

risk factors for severe asthma 7

BE AWARE OF PSYCHOSOCIAL ISSUES WITH ASTHMA

Answer 17

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

Question 18

common causes of asthma attack in dental setting 5

Answer 18

• 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

Question 19

4 symptoms of mild asthma

Answer 19

• increasing wheeze
• complaints of chest tightness
• inc resp rate
• tachycardia

Question 20

symptom of moderate asthma

Answer 20

increasing symptoms of mild asthma

Question 21

symptoms of severe asthma 4

Answer 21

• inability to complete sentences in 1 breath
• resp rate >25 /min
• tachycardia >110 /min
• use of accessory muscles

Question 22

symptoms of life threatening asthma 4

Answer 22

• cyanosis

- resp rate

Question 23

how to manage asthma attack in dental setting 2

Answer 23

• ABCDE
• high flow oxygen 10-15l/min
• salbutamol 4-6 puffs every 10 mins using spacing device/ nebuliser in severe attack