Medical Emergencies Flashcards
You are a GDP. An adult patient walks into the practice and collapses.
Describe how you would proceed
6 mins
Stop what you are doing
DRS ABCDE
DRS - shout for help (help, O2, emergency drugs box and AED)
A - head tilt, chin lift - compromised/breathing
B - breathing/not
C - pulse (carotid)
If not breathing - cardiac arrest. Phone 999, start CPR (30:2), O2 15l/min via BVM, AED
If breathing - likely syncope
C - hypotension
D - unresponsive
E - assess - pale, clammy, unwell, faint
Lie flat, elevate legs, O2 (15l/min via non-rebreathing mask), glucose if required
You are a GDP. You are about to start treatment on a known epileptic when the C/O feeling unwell and start fitting.
Describe how you would proceed and when you would send the patient to hospital
6 mins
Stop what you are doing
DRS ABCDE
DRS - shout for help (help, O2, emergency drugs box and AED)
A - compromised B - rapid/normal C - normal/increased/decreased D - unresponsive E - seizure activity (convulsion, absent stare), incontinence
Ensure safe area (pillow for head, remove hard/sharp objects), O2 (15l/min via non-rebreathing mask ± OPA).
If >5 mins/repeated - buccal midazolam (2ml - 10mg) and call 999.
Reassess A-E
Send to hospital if >5 mins/repeated seizures without return to normal, first seizure, signs of injury, atypical seizure
You are a GDP. You have just given LA when suddenly the patient C/O shortness of breath and lip swelling.
Describe how you would proceed
6 mins
Stop what you are doing
DRS ABCDE
DRS - shout for help (help, O2, emergency drugs box and AED)
A - swelling, stridor, hoarse voice
B - increased RR, wheeze
C - increased HR, decreased BP. Increased cap refill
D - unresponsive
E - rash, swelling, flush/pallor, hives/urticaria
Call 999, lay pt flat with legs raised. O2 (15l/min via non-rebreathing mask ± OPA), adrenaline 0.5ml (0.5mg 1:1000) IM ALT (z-track technique - Draw up, pull skin tight, insert needle fully, aspirate, inject fully, remove halfway, release skin, remove fully. No IPC required as emergency) IM ALT.
Repeat evert 5 mins
Reassess A-E
BLS if stops breathing
You are a GDP. An adult patient in the waiting room suddenly starts to C/O chest pain/tightness and pain radiating down their left arm.
Describe how you would proceed
6 mins
Stop what you are doing
DRS ABCDE
DRS - shout for help (help, O2, emergency drugs box and AED)
A - talking
B - increased RR, SoB
C - increased HR, weak pulse, decreased BP
D - alert
E - pale, clammy, severe central crushing chest pain, may radiate to shoulders, left arm, neck, jaw, back
Sit in comfortable position, O2 (15l/min via non-rebreathing mask), 2x GTN SL puffs (400mcg/actuation). If no improvement after 3 mins, repeat
If no response to treatment, call 999 and give 300mg dispersible aspirin tablet (chew/dissolve in water)
Reassess A-E
BLS if stops breathing
You are a GDP. You are taking history from your patient, who is a known asthmatic, when they start to C/O shortness of breath and start wheezing.
Describe how you would proceed
6 mins
Stop what you are doing
DRS ABCDE
DRS - shout for help (help, O2, emergency drugs box and AED)
A - difficulty completing sentences B - increased RR, wheeze C - increased HR D - alert E - tripod
Make comfortable (sit upright). O2 (15l/min via non-rebreathing mask ± OPA), 2x puffs of own bronchodilator inhaler. If unavailable, salbutamol inhaler 4 puffs (100mcg/actuation) through large-volume spacer. Tidal breathing.
Repeat as needed (every 1-2mins). If no response within 5 mins, call 999.
Reassess A-E
BLS if stops breathing
You are a GDP. You have just finished an XLA on a patient with T1DM, when they start to appear confused and become irritate
Describe how you would proceed
6 mins
Stop what you are doing
DRS ABCDE
DRS - shout for help (help, O2, emergency drugs box and AED)
A - initially talking
B - increased RR (reduced if coma)
C - increased HR (reduced if coma)
D - initially alert (unresponsive if coma)
E - pale, irritable, confused, dizzy, shaky, clammy, coma
Comfortable position, O2 (15l/min via non-rebreathing mask ± OPA), glucose (10-20g if conscious, repeat after 10-15mins if required).
If unconscious, glucagon 1mg IM ALT (z-track technique - Draw up, pull skin tight, insert needle fully, aspirate, inject fully, remove halfway, release skin, remove fully. No IPC required as emergency) IM ALT.
If no response to treatment - call 999
If regains consciousness - administer oral glucose (10-20g)
Reassess A-E
BLS if stops breathing
You are a GDP. You are fitting a posterior crown when it slips from your fingers and disappears. The patient starts to cough and appears visibly distressed.
Describe how you would proceed
6 mins
Stop what you are doing
DRS ABCDE
DRS - shout for help (help, O2, emergency drugs box and AED)
A - obstructed/absent B - SoB, laboured C - often increased HR, cyanosis D - initially alert, eventually unresponsive E - frightened, clutch throat, coughing
Ask if choking
Remove any visible foreign bodies in mouth
Encourage to keep coughing
Stand up, lean forward, support weight (brace against wall/arm across chest)
5 back blows
5 abdominal thrusts
Repeat until dislodged (check after every one if dislodged)
Once dislodged, O2 (15l/min via non-rebreathing mask ± OPA)
Reassess A-E
BLS if stops breathing
List the emergency drugs that should be included in the emergency drugs box in a dental practice and how you would administer them
6 mins
O2 (15l/min via non-rebreathing mask or BVM ± OPA)
Adrenaline 1:1000 0.5ml (0.5mg) IM ALT every 5 mins for anaphylaxis
Salbutamol inhaler 100mcg/actuation. 4 puffs via large-volume spacer (repeat every 1-2mins) for asthma attack. Tidal breathing
GTN spray 400mcg/actuation. 2 puffs SL for angina/MI. Repeat after 3 mins
Aspirin 300mg dispersible tablet. Chew/dissolve in water for MI
Midazolam 2ml/10mg oromucosal solution. Buccal administration for seizure >5 mins or 2+ without return to normal
Glucose 10-20g quick acting CHO. Administer if conscious and hypoglycaemia
Glucagon 1mg IM ALT for hypoglycaemia if LoC (followed by glucose)
You are a GDP. A trainee dental nurse asks what to do if a patient has an asthma attack and how you identify and manage it.
She asks what is the difference between this and anaphylaxis and how you would use adrenaline
12 mins
Asthma - air passages in lungs narrow due to inflammation and muscle tightening
Asthma attack - airway swells, increased mucus production causing difficulty breathing.
Sz - airway constriction, fast breathing, wheeze, gasping, clutch chest, increased Hr, tripod, blushing
Mx - make comfortable (sit upright). O2 (15l/min via non-rebreathing mask ± OPA), 2x puffs of own bronchodilator inhaler. If unavailable, salbutamol inhaler 4 puffs (100mcg/actuation) through large-volume spacer. Tidal breathing.
Salbutamol - SABA - relaxes smooth muscle causing bronchodilation
Anaphylaxis - severe life-threatening allergic reaction. Antibodies recognise antigens on substance recently introduced (LA, nuts, penicillin, etc. - quick reaction) causing histamine release along with other chemical mediators. Causes smooth muscle constriction, BV dilation, increased vascular permeability
Sx - airway constriction, increased RR, hoarse, stridor, skin flush, increased HR, weak pulse, urticaria/hives, angiodema
Mx - call 999, lay pt flat with legs raised. O2 (15l/min via non-rebreathing mask ± OPA), adrenaline 0.5ml (0.5mg 1:1000) IM ALT (z-track technique - Draw up, pull skin tight, insert needle fully, aspirate, inject fully, remove halfway, release skin, remove fully. No IPC required as emergency) IM ALT. Repeat evert 5 mins
Adrenaline - stimulated adrenoceptors, increasing PVR (increase BP and perfusion, reducing peripheral vasodilation and angioedema) increase HR and myocardial contractility, bronchodilator and decrease in release of inflammatory mediators
Z-track technique - Draw up, pull skin tight, insert needle fully at 90 degrees, aspirate, inject fully, remove halfway, release skin, remove fully. Usually remove clothing, prep site (alcohol wipe) and change needle, but emergency so no IPC required
Differences - asthma usually post-exertion, MH, respiratory Sx
Anaphylaxis - sudden, system Sx, weak pulse, hives, angioedema, stridor
Does that all make sense? Do you have any questions?
You are a GDP. A trainee dental nurse asks what to do if a patient has an hypoglycaemic attack and how you identify and manage it.
She asks what is the difference between this and a seizure is what are the different drugs used for each situation
12 mins
Hypo - low blood glucose. When level of sugar in blood drops too low.
Sx - pale, shaky, clammy, sweaty, dizzy, confused, irritable, blurred vision, tingling lips, hungry, LoC.
Mx - comfortable position, O2 (15l/min via non-rebreathing mask ± OPA), glucose (10-20g if conscious, repeat after 10-15mins if required).
If unconscious, glucagon 1mg IM ALT (z-track technique - Draw up, pull skin tight, insert needle fully, aspirate, inject fully, remove halfway, release skin, remove fully. No IPC required as emergency) IM ALT.
If no response to treatment - call 999. If regains consciousness - administer oral glucose (10-20g)
Glucagon increases concentration of glucose in blood by promoting gluconeogenesis and glycogenolysis to convert glycogen to glucose.
Normal BG - 4-7mmol/l.
IM injection and technique - inject diluting solution in vial with glucagon powder, swirl to mix - don’t shake (will foam up), syringe solution back into syringe
Z-track technique - Draw up, pull skin tight, insert needle fully at 90 degrees, aspirate, inject fully, remove halfway, release skin, remove fully. Usually remove clothing, prep site (alcohol wipe) and change needle, but emergency so no IPC required
Reassess A-E
Epilepsy = condition affecting the brain causing seizures. Sx - LoC, uncontrolled muscle spasms, drooling, jerking, reduced BP, hypoxia, lip smacking, vacant stare, loss of airway tone
Mx - Ensure safe area - don’t restrain (pillow for head, remove hard/sharp objects), O2 (15l/min via non-rebreathing mask ± OPA). If >5 mins/repeated - buccal midazolam (2ml - 10mg) and call 999. Can repeat midazolam after 5 mins. Reassess A-E
Midazolam - short-acting benzodiazepine - enhances effect of GABA (neurotransmitter) on receptors, resulting in reduced neuronal activity
Check exp date and form of midazolam is compatible with buccal administration - appropriate dose by age (2.5mg <1yo; 5 between 1-4; 7.5 between 5-9; 10mg >10)
Once stopped, recovery position and check airway until recovery
O2 for both - pt struggle to oxygenate blood and perfuse organs, so need help
