medical emergencies Flashcards
anaphylaxis
what is it?
key signs:
symptoms:
management:
A severe allergic reaction to a wide range of allergens
Key signs: Laryngeal oedema and bronchospasm causing wheezing, stridor and dyspnoea. Tachycardia and Tachypnea
Symptoms: Abdominal pain, diarrhoea, sense of impending doom, flushing or pallor and urticaria or the chest, hands and feet
Management
- Assess the patient and call an ambulance
- Lie the patient flat and raise their feet
- Remove the source of anaphylaxis (use suction is in mouth)
- Administer 100% oxygen at 15L/min
- Administer adrenaline
- 6 month – 5 years: 0.15ml (1:1000) IntraMuscular adrenaline
- 6 – 11 years: 0.3ml (1:1000) IM adrenaline
- 11 – 17 years: 0.5ml (1:1000) IM adrenaline
- Adults: 0.5ml (1:1000) IM adrenaline, repeat after 5 minutes if neede
- If cardiac arrest follows, initiate basic life support
mild allergic reaction
what is it?
key signs:
management:
A mild allergic reaction to a wide range of allergens
Key signs: Urticaria and rash, rhinitis, conjunctivitis alongside mild bronchospasm and shortness of breath
Management
- Either administer 1x 10mg Cetirizine tablet, 1x 4mg Chlorpheniramine tablet or 1x 10mg Loratadine tablet
- If bronchospasm present give 4 puffs of a salbutamol reliever inhaler through a large volume spacer, repeat every 3 minutes if needed
Common side effect with all of these medications is drowsiness, caution when driving
life threatening asthma
what is it?
key signs:
management:
An severe episode of asthma with the potential to cause mortality
Key signs: respiratory rate <8 breaths/min, bradycardia (<50bpm), cyanosis, exhaustion, confusion and loss of consciousness
It might appear like they are breathing when they are not
Management
- Assess the patient and call 999
- Sit the patient upright
- Administer 100% oxygen at 15L/min
- Administer salbutamol
- Adults: 2 puffs if their own inhaler and 4 puffs if not through a large volume spacer
- 2 – 17 years: 1 puff through a large volume spacer every 15 seconds (max 10), repeated every 10 minutes
acute severe asthma attack
what is it?
key signs:
management:
A serious asthma attack that is unlikely to cause morbidity
Key signs: Inability to complete sentences in one breath, tachypnoea (>25 breaths/min) and tachycardia ( >110BPM)
Management
- Assess the patient and call 999
- Sit the patient upright
- Administer 100% oxygen at 15L/min
- Administer salbutamol
- Adults: 2 puffs if their own inhaler and 4 puffs if not through a large volume spacer
- 2 – 17 years: 1 puff through a large volume spacer every 15 seconds (max 10), repeated every 10 minutes
angina and myocardial infarction
what is it?
key signs:
symptoms:
management
Chest pain caused by a reduction in blood flow to the heart
Key sign: Progressive onset of severe, crushing chest pain that radiates down the left arm, to the back and the jaw
Symptoms: Dyspnoea, tachypnoea, clammy skin, nausea and vomiting with a weak pulse
Management:
- Assess the patient and administer 100% oxygen at 15L/min
- Administer 2 puffs of GTN spray sublingually, repeat after 3 minutes if pain isn’t relieved
- If patient doesn’t respond to GTN it is likely that they are having an MI, if this is the case call 999
- Administer 300mg of crushed aspirin orally
- If cardiac arrest follows, initiate basic life support
cardiac arrest
what is it?
key signs:
management:
A sudden loss of blood flow resulting from the failure of the heart to pump
Key signs: loss of consciousness, absence of normal breathing, loss of pulse and dilation of pupils
Management:
- Assess the patient and call 999, if in hospital call 2222 for a crash team (they have a defibrillator)
- Initiate Basic Life Support administering 100% oxygen 15L/min
- If a defibrillator is available use it
what is basic life support for adults?
Call 999 and ask for an ambulance
30 chest compressions
2 rescue breaths
Continue CPR 30:2
When AED (defibrillator) arrives turn it on and follow instructions
what is basic life support for children?
Call 999 and ask for ambulance
5 rescue breaths
CPR 30:2 (Under 1 year old compress chest with two fingers and compress 4cm (1/3 of chest depth) and over 1 year old use one or two hands to compress to 5cm)
epileptic seizures
what is it?
key signs:
symptoms:
management:
Overstimulation of synapses in the brain lead to a seizure
Key signs: Sudden loss of consciousness, patient becomes rigid and falls, might become cyanosed, and jerking movement common
Symptoms: brief warning (aura), frothing from the mouth and urinary incontinence
Management
- Assess the patient; ensure they aren’t at risk of injury but don’t restrain them
- Remove anything from the mouth with suction and administer 100% oxygen at a rate of 15L/min
- If the seizure stops the patient will become floppy then regain consciousness. If it doesn’t it is likely a status epilepticus and is more dangerous
- If it continues: administer 10mg midazolam buccally, after 10 minutes there is no response give it again
- If there is no response in 30 minutes give their own antiepileptic medication
- After the patient has stopped convulsing place them in the recovery position, don’t send them home until they have fully recovered.
syncope
what is it?
key signs:
symptoms:
management:
Loss of consciousness due to a negative stimulus or cardiac problem
Key signs: Patient feels faint, tunnel vision, slow pulse and loss of consciousness
Symptoms: Pallor and sweating, nausea and vomiting
Management:
- Assess the patient
- Lie them flat, loosen any tight clothing, raise the patients feet and open a window
- Administer 100% oxygen at a rate of 15L/min
hypoglycaemia
what is it?
key signs:
symptoms:
management:
The patients blood sugar drops below 4mmol/L
Key signs: Aggression and confusion, sweating, tachycardia (>110bpm)
Symptoms: Shaking, slurring of speech, headache, fitting and loss of consciousness
Management:
- Assess the patient
- Administer 100% oxygen at a rate of 15L/min
- If conscious give 10-20g glucose drink, repeat after 10 minutes
- If unconscious give 1mg glucagon IM, and when they regain consciousness give 10-20g glucose drink
- If patient doesn’t regain consciousness call 999
stroke
what is it?
key signs:
management:
A loss of blood to the brain resulting in permanent neurological defects
Key signs: Facial weakness, arm weakness, slurred speech and inability to understand what they are being asked
Management:
- Assess the patient and call 999
- Administer 100% oxygen at a rate of 15L/min
- If the patient is unconscious secure their airway and place in the recovery position
aspiration
what is it?
signs and symptoms?
management:
This is likely in the dental practise because of small instruments, blood and saliva, loose impression material or local anaesthesia
Signs and symptoms: Patient MAY cough, splutter and complain of breathing difficulty, stridor, paradoxical chest movements (seems like they are breathing when no air is coming in. They may become cyanosed and lose consciousness.
There may be no signs, but if you believe they have swallowed something send the patient for chest x-ray
Management:
- Encourage the patient to cough vigorously and call 999
- Administer 100% oxygen 15L/min
- Administer 4 puffs of a salbutamol inhaler with a large volume spacer
choking
what is it?
signs and symptoms?
management:
This is likely in the dental practise because of small instruments, blood and saliva, loose impression material or local anaesthesia
Signs and symptoms: Patient may cough, splutter and complain of breathing difficulty, may develop paradoxical chest movements and may become cyanosed and lose consciousness
Management
- Remove any visible foreign bodies from the oral cavity and pharynx using suction
- Encourage the patient to cough
- If they cannot cough but remain conscious commence back blows, followed by abdominal thrusts
- If they become unconscious commence BLS and call 999
