medical emergencies Flashcards
what must be regularly done in practice?
stock and regularly check drugs and equipment
CPD
GDC recommends 10hrs per cycle (2hrs pa)
what does the BNF recommend as an emergency drug for the management of status epilepticus in GDP?
buccal midazolam
adrenline
1ml ampoules or prefilled syringes of 0.5ml of 1:1000 solution IM
aspirin
300mg dispersible tablets
glucagon
1mg IM
GTN spray
400mcg per metered dose
midazolam
oromucosal solution 5mg/ml
topical buccal administration
not licensed <3m/>18yrs
glucose
oral
O2 cylinder
2 size D/CD or 1 size E
salbutamol
inhaler
100mcg per acutation
optional drugs
cetirizine 10mg
chlorphenamine 4mg
loratidine 10mg
signs of anaphylaxis
upper airway oedema and bronchospasm
stridor and wheezing
tachycardia >110bpm, increased resp rate
symptoms of anaphylaxis
abdo pain, vomiting, diarrhoea, sense of impending doom
flushing (/pallor)
symptoms of mild allergy
managment of anaphylaxis
assess ABCDE
999
secure airway, help restore bp by laying flat and raising feet - DON’T stand
remove source if known
100% O2 15l/min
adrenaline 0.5ml (1:1000) IM, repeat after mins if needed
- children 6m-5yrs 0.15ml
- 6-11yrs 0.3ml
if cardiac arrest - BLS and early defibrillation
tx if signs of mild bronchospasm
salbutamol inhaler 4 puffs (100mcg per actuation) large vol spacer, repeat as needed
refer to GP
key signs of milder allergy
urticaria and rash (chest, hands, feet)
rhinitis, conjunctivitis
mild bronchospasm without evidence of severe SOB
signs of life-threatening asthma
cyanosis or resp rate <8 per min
bradycardia <50
exhaustion, confusion, reduced consciousness level
signs of acute severe asthma
unable to complete sentences in 1 breath
resp rate >25 per min
tachycardia (>110)
tx of life-threatening asthma
999
assess pt
sit upright
100% O2 15l/min
2 puffs of pt own bronchodilator or salbutamol 4 puffs (100mcg per actuation) through large vol spacer, repeat as needed
- children 1 puff spacer every 15s (max 10), repeat at 10-20min intervals
tx of acute severe asthma
assess pt
sit upright
100% O2 15l/min
2 puffs of pt own bronchodilator or salbutamol 4 puffs (100mcg per actuation) through large vol spacer, repeat as needed
- children 1 puff spacer every 15s (max 10), repeat at 10-20min intervals
if severe episode doesn’t respond to tx with bronchodilators within 5mins - hospital emergency
ACS presentation
progressive onset of severe crushing pain in centre and across front of chest, may radiate to shoulders and down arms (usually left), neck, jaw, back
symptoms of ACS
SOB increased resp rate pale and clammy skin nausea and vomiting common may have weak pulse/bp may fall
tx of ACS
assess
100% O2 15l/min
GTN 2 puffs (400mcg per metered dose) sublingually, repeat 3mins if pain remains
if pt doesn’t respond to GTN
- 999
- aspirin 300mg dispersible tablet (chew/in water) - send note with pt
- if needed BLS
signs of cardiac arrest
LOC
absence of normal breathing
loss of pulse
dilation of pupils
tx of cardiac arrest
999
BLS, 100% O2 vent 15l/min
defib
signs of epilepsy
sudden LOC rigid fall might give a cry becomes cyanosed (tonic phase) jerking movement of limbs, might bite tongue (clonic phase)
symptoms of epilepsy
brief warning/aura
frothing from mouth and urinary incontinence
epilepsy tx
assess don't try to restrain convulsive movements ensure pt not at risk from injury secure airway 100% O2 15l/min
seizure will typically last a few mins, pt might then become floppy but remain unconscious
once pt regains consciousness they may remain confused
epilepsy tx if fit repeated/prolonged (5 or more mins)
continue O2 10mg midazolam - use 2ml oromucosal solution 5mg/nl - topically into buccal cavity - not licensed for use in adults in status epilepticus, but is recommended by BNF
after convulsive movements have subsided, place pt in recovery position and check airway. Don’t send pt home until recovered fully
epilepsy - when should you call 999?
prolonged more than 5mins repeated 1st episode for pt atypical convulsion injury occurred difficulty monitoring pt
signs of faint
feels faint dizzy lightheaded
slow pulse
LOC
symptoms of faint
pallor and sweating
nausea and vomiting
tx of faint
assess
lay flat and if not breathless raise feet
loosen any tight clothing around neck
100% O2 15l/min until consciousness regained
signs of hypoglycaemia
aggression and confusion
sweating
tachycardia >110
symptoms of hypoglycaemia
shaking and trembling difficulty in concentration/vagueness slurring of speech headache fitting unconsciousness
tx of hypoglycaemia if pt conscious and cooperative
assess pt
100% O2 15l/min
oral glucose 10-20g, repeat if necessary after 10-15mins
tx of hypoglycaemia if pt unconscious or uncooperative
assess pt
100% O2 15l/min
glucagon 1mg IM
oral glucose 10-20g when pt regains consciousness
hypoglycaemia - when should you call 999?
if pt does not respond or any difficulty is experienced
key signs of a stroke
facial weakness, one eye may droop or pt may only be able to move one side of mouth
arm weakness
communication problems - slurred speech, pt is unable to understand what is being said to them
tx of stroke
assess pt
100% O2 15l/min
if unconscious and breathing secure airway and place in recovery position
999
why are dental pts susceptible to aspiration and choking?
blood and secretions in mouth for prolonged periods
suppressed pharyngeal reflexes due to LA
imp material/dental equipment in mouths
S+S of aspiration and choking
cough and splutter complain of difficulty breathing stridor 'paradoxical' chest or abdo movements cyanosed/LOC
management of aspiration
encourage pt to cough vigorously
100% O2 15l/min
salbutamol inhaler 4 puffs (100mcg per actuation), through a large-vol spacer, repeat as needed
- children 1 puff every 15s (max 10) repeat at 10-20min intervals as needed
if you suspect a large fragment has been inhaled/swallowed but there are no S+S - refer to hospital for xray and removal of fragment if necessary
if pt symptomatic following aspiration refer to hospital as emergency
management of choking
remove any visible foreign bodies in mouth and pharynx
encourage pt to cough
if pt unable to cough but remains conscious - back blows followed by abdo thrusts
if LOC - BLS, may also help to dislodge foreign body
999
