Medical emergencies Flashcards
Why might patients be susceptible to an upper airway obstruction?
Loss of pharyngeal reflex due to LA
Equipment in mouth for long time
Blood or other secretions in their mouth for a long time.
Foreign body aspiration and laryngospasm
What may alert you to an upper airway obstruction?
Sudden onset
Coughing and spluttering
Patient may complain of difficulty breathing
‘Paradoxical’ chest and abdominal movement (see-saw respiration)
Use of accessory muscles of respiration.
Central cyanosis is a late sign
What are some signs of partial obstruction>
Inspiratory stridor if obstruction at or above the larynx
Expiratory wheezing suggests lower airway obstruction
Gargling if semi solid material/liquid stuck in.
How can we manage an airway obstruction?
Removal of foreign body
Tilt head upwards or jaw thrust
High flow oxygen
How can we prevent airway obstruction?
Rubber dam
High speed suction.
Don’t lie patient absolutely flat.
What is hyperventilation?
Minute ventilation exceeds metabolic demands resulting in haemodynamic changes which may be acute or chronic and associated with panic disorder.
What are some symptoms of hyperventilation
Dizziness Paraesthesia (pins and needles) Dry mouth Chest pain Shortness of breath
How can we manage hyperventilation?
Stop treatment and try to reassure patient
Rebreathe CO2 via a bag and mask
Anxiety management before next appointment
Small dose of benzodiazepines e.g. lorazepam
What are risk factors for severe asthma
Previous near fatal asthma Previous respiratory acidosis Polypharmacy for asthma medication Heavy use of beta-2 agonists Repeated ED attendances
What are some things that can potentially precipitate an acute asthma attack?
Penicillin Sedatives + GA LA with vasoconstrictors Morphine NSAIDS Aspirin
What are the symptoms of severe asthma
Accessory muscles of breathing
Respiratory rate >25 per minute
Tachycardia >110 per minute
What are the symptoms of life threatening asthma?
Cyanosis
Respiratory rate <8 per min
Bradycardia <50 per minute
Exhaustion, confusion, decreased level of consciousness.
How can we manage a patient with Asthma?
Salbutamol via nebuliser 4-6 puffs via spacing device - repeat every 10 mins
High flow oxygen 10-15L/min
What are some clinical features of syncope?
light headedness Pale Clammy Sweaty Slow pulse rate Low blood pressure Loss of consciousness
How do we manage a patient who has fainted?
Reassure
Raise legs
Give oxygen 10L/min
Monitor breathing and circulation
How do we manage a patient with angina?
Reassure
Oxygen
GTN - nitrate
Call ambulance if episode is prolonged.
How do we manage a patient undergoing myocardial infarction?
Monitor patient Oxygen Nitrate Aspirin 300mg PO Summon Help MONASH
What is the first drug we give patients who have had an anaphylaxic reaction?
Epinepherine
What are some clinical signs / outcomes of anaphylaxis?
Face - Erythema - Conjunctivitis - Facial oedema - Runny nose Airway - bronchospasm - hoarse voise - tongue swelling - stridor Stomach - abdominal pain - vomiting - diarrhoea Total body - Rash - hypotension - pallor or cyanosis - impending doom - loss of consciousness
How can we manage anaphylaxis (ABC) ?
Airway - ensure open give oxygen
Breathing - salbutamol
Circulation - check pulse (60-100 )and blood pressure
Give epinephrine (IM dose 500mcg (0.5ml or 1:1000) or EpiPen dose of 0.3ml 1:1000 Repeat dose after 5 mins depending on vital signs
All patients which have suffered anaphylaxis must go to hospital
What are some of the signs of hypoglycaemia
Sweating Clamminess Trembling Slurred speech Confusion Tiredness Dizziness Hunger Anger Poor concentration Loss of consciousness
How can we measure blood glucose levels?
We can use an automated device called glucometer.
If patients blood glucose levels are <3mmol this is hypoglycaemia
How can we treat hypoglycaemia?
Glucose gel / tablet Glucagon IM - if child <8 or <25kg 0.5mg of glucagon - if child >8 or >25kg 1mg glucagon -Adults have 1mg glucagon Buccal glucose gel
How can we manage a patient with epilepsy?
ABCDE A- make sure airway open and protected B- make sure breathing ok C - circulation make sure no hypotension D- check blood glucose levels
MOVE M- monitor ABCDE O- oxygen V - verify help coming E - emergency action, away from sources of injury. ( place in recovery position
