Medical emergencies

Question 1

Why might patients be susceptible to an upper airway obstruction?

Answer 1

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

Question 2

What may alert you to an upper airway obstruction?

Answer 2

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

Question 3

What are some signs of partial obstruction>

Answer 3

Inspiratory stridor if obstruction at or above the larynx

Expiratory wheezing suggests lower airway obstruction

Gargling if semi solid material/liquid stuck in.

Question 4

How can we manage an airway obstruction?

Answer 4

Removal of foreign body
Tilt head upwards or jaw thrust
High flow oxygen

Question 5

How can we prevent airway obstruction?

Answer 5

Rubber dam
High speed suction.
Don’t lie patient absolutely flat.

Question 6

What is hyperventilation?

Answer 6

Minute ventilation exceeds metabolic demands resulting in haemodynamic changes which may be acute or chronic and associated with panic disorder.

Question 7

What are some symptoms of hyperventilation

Answer 7

Dizziness
Paraesthesia (pins and needles)
Dry mouth
Chest pain
Shortness of breath

Question 8

How can we manage hyperventilation?

Answer 8

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

Question 9

What are risk factors for severe asthma

Answer 9

Previous near fatal asthma
Previous respiratory acidosis
Polypharmacy for asthma medication
Heavy use of beta-2 agonists
Repeated ED attendances

Question 10

What are some things that can potentially precipitate an acute asthma attack?

Answer 10

Penicillin
Sedatives + GA
LA with vasoconstrictors
Morphine
NSAIDS
Aspirin

Question 11

What are the symptoms of severe asthma

Answer 11

Accessory muscles of breathing
Respiratory rate >25 per minute
Tachycardia >110 per minute

Question 12

What are the symptoms of life threatening asthma?

Answer 12

Cyanosis
Respiratory rate <8 per min
Bradycardia <50 per minute
Exhaustion, confusion, decreased level of consciousness.

Question 13

How can we manage a patient with Asthma?

Answer 13

Salbutamol via nebuliser 4-6 puffs via spacing device - repeat every 10 mins
High flow oxygen 10-15L/min

Question 14

What are some clinical features of syncope?

Answer 14

light headedness
Pale
Clammy
Sweaty
Slow pulse rate
Low blood pressure
Loss of consciousness

Question 15

How do we manage a patient who has fainted?

Answer 15

Reassure
Raise legs
Give oxygen 10L/min
Monitor breathing and circulation

Question 16

How do we manage a patient with angina?

Answer 16

Reassure
Oxygen
GTN - nitrate
Call ambulance if episode is prolonged.

Question 17

How do we manage a patient undergoing myocardial infarction?

Answer 17

Monitor patient
Oxygen
Nitrate
Aspirin 300mg PO
Summon Help
MONASH

Question 18

What is the first drug we give patients who have had an anaphylaxic reaction?

Answer 18

Epinepherine

Question 19

What are some clinical signs / outcomes of anaphylaxis?

Answer 19

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

Question 20

How can we manage anaphylaxis (ABC) ?

Answer 20

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

Question 21

What are some of the signs of hypoglycaemia

Answer 21

Sweating 
Clamminess
Trembling 
Slurred speech
Confusion
Tiredness
Dizziness
Hunger
Anger
Poor concentration
Loss of consciousness

Question 22

How can we measure blood glucose levels?

Answer 22

We can use an automated device called glucometer.

If patients blood glucose levels are <3mmol this is hypoglycaemia

Question 23

How can we treat hypoglycaemia?

Answer 23

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

Question 24

How can we manage a patient with epilepsy?

Answer 24

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

Question 25

What drug can we give to a patient who is having a prolonged seizure?

Answer 25

Midazolam
Dosage 1-5 years = 5mg
5-10 years = 7.5 mg
>10 years = 10mg.

Question 26

What are some signs of upper airway obstruction?

Answer 26

Paradoxical chest and abdominal movements

Use of accessory muscles

Central cyanosis

Question 26

What are some signs of upper airway obstruction?

Answer 26

Paradoxical chest and abdominal movements

Use of accessory muscles

Central cyanosis