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3rd Year > MEDICAL EMERGENCIES > Flashcards

MEDICAL EMERGENCIES Flashcards

1
Q

Discuss the pattern seen when a patient becomes unwell.

A

When unwell, the patient’s oxygen requirement increases.

HR and respiratory rate increase to achieve this.

But eventually the high HR and RR cannot be sustained & the patient becomes very unwell.

A bell curve is seen.

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2
Q

When do we give a patient oxygen and how much oxygen do we give?

A

If they are sick or you are using the emergency box of drugs for them.

15l of oxygen via a rebreathing mask.

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3
Q

What is a disadvantage of the rebreathing mask for oxygen delivery?

A

It only provides 90% oxygenation as it does not provide the perfect seal.

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4
Q

What does the ABCDE approach stand for?

A

Airways

Breathing

Circulation

Disability

Exposure.

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5
Q

When checking the patient’s airway:

What are we looking for?

A

Any airway obstructions.

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6
Q

What can cause airway obstructions?

A

Infection.

Inflammation

Swelling (the result of inflammation)

Loss of conciousness.

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7
Q

How can we tell if the airway is obstructed?

A

Breathing will be noisy.

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8
Q

How do we fix an obstructed airway?

A

head tilt and chin lift.

Jaw thrust

Oropharyngeal airway

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9
Q

Name.

Function.

Different sizes & selection criteria.

A

Oropharygeal airway.

Provides a passage for air into the lungs.

size 2(green) for women. Size 3 (orange) for men.

To select- Size along with jaw- upper incisors should be aligned with the bite block.

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10
Q

How do we check the patient’s breathing.

A

Listen

Colour- skin colour/ nailbeds.

Check breathing rate.

Feel them breathing

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11
Q

How do you count a patient’s respiratory rate?

A

Ask them can you feel their pulse and put your hand on their shoulder to count.

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12
Q

How do we treat a problem with patient breathing?

A

Oxygen.

Bronchodilators.

Improve patient posture.

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13
Q

What can cause a problem with circulation?

A

Arrythmia

Acute coronary syndrome

Heart failure

Loss of fluid.

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14
Q

How do we check the patient’s circulation.

A

Pulse check(HR) & BP

Capillary refill-Press down on nailbed for 5s and time how long it takes for colour to return. (should return in 2s)

Limb temperature- does the patient feel warm

BP

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15
Q

How do we treat problems with patient circulation.

A
  • Treat the cause.
  • Elevation of patients legs
  • Apply pressure.
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16
Q

Where can you check a patient’s pulse and what is the estimated pulse you feel in these areas?

A

Wrist- You can feel 80 systolic BP.

Inside of elbow- you can feel 60 systolic BP

Neck- you can feel systolic50BP

physiologically normal for an ill patient- 120bpm

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17
Q

How do we describe patient consciousness?

A

A-Alert

C-New confusion- it should always be assumed that the confusion is new.

V-voice and verbal response.

P- apply pressure to the trapezium- normal response should be to try and knock the hand away.

U-are they unconcious?

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18
Q

What checks can we complete to check patient conciousness?

A

Direct dental light in their eyes:

Pupils should both get smaller

Pupils should get smaller at the same time.

Check motor responses.

Ask patient to squeeze your hands.

Ask patient to raise their feet.

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19
Q

Discuss the relevance of exposure in a dental setting.

A

Look at all of the showing parts of the patient.

Are there any engorged neck veins?

Swollen- face/ eyes/ hands/ ankles

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20
Q

What is anaphylaxis?

A

This is a severe systemic reaction where we get massive vasodilation causing the collapse of blood pressure and the loss of fluid.

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21
Q

What is the ABCDE expected for anaphylaxis?

A

A-

Swelling of the lip/tongue

Osophageal swelling (may become hoarse/stridor)

B-

Increased breathing rate then wheeze.

Gas exchange cannot occur (No perfusion)

Pt goes into anaphylactic shock- the inability to perfuse organs and tissue.

C-

Increased rate and hypotension- causing loss of conciousness.

Swelling- due to leaky vessels after vasodilation.

D- use ACVPU.

E- Hives/rashes on body/swelling/ redness (due to vasodilation). Patient can be blue when they turn hypoxic.

22
Q

How do we identify anaphylaxis as life threatening

A

A- any swelling/funny noises/hoarseness.

B- if pt is blue/cyanotic

C-You can’t feel a pulse.

23
Q

name this position and the function

A

Trendleberg position.

This raises legs above the rest of the body send blood back to the central system.

24
Q

How do we treat anaphylaxis .

A

Give IM adrenaline (0.5mg 1:1000)

Inject it then remove the needle halfway- this moves the patients skin allowing you to remove the needle the rest of the way without the adrenaline being pushed back out.

If the pt is not getting better- give another adrenaline dose every 5 minutes (rotating the site)

25
Q

How does adrenaline work?

A

It constricts your blood vessels.

It is a peripheral vasoconstrictor (increased blood flow through the body) and a central vasodilator to the brain- this acts to break bronchopasm by relaxing the smooth muscle.

26
Q

Why should you never stand an anaphylaxis patient up if they are breathless?

A

It can provoke cardiac arrest.

27
Q

Compare the IM adrenaline found in a medical box and an epipen.

A

The Adrenaline found in the medical box is 0.5.

The adrenaline found in an epipen is 0.3.

28
Q

Compare the different types of asthma:

A

Mild asthma- Normal RR. Normal HR.Chest tightness

Severe asthma- RR >25. Increased HR (>120). There is an audible wheeze without a stethoscope.

Life threatening asthma. RR <8. HR <40.

29
Q

Describe ABCDE for asthma

A

A- get pt to talk- an obstructed airway makes it difficult for patient to complete a sentence.

B- increased breathing- can have wheeze due to bronchoconstriction and excess mucous production.

C- increased circulation

D- Alert

E-Get patient in the tripod position.

30
Q

What is our treatment for asthma.

A

If patient cannot talk- Call ambulance.

Mild/moderate Provide with salbutamol inhaler- 2 puffs (100micrograms per actuation) & use spacer device for 20s)

Severe- use higher dose

Life threatening- call an ambulance.

31
Q

Why do we use a spacer device?

A

To prevent respiratory acidosis- patient rebreathing their own CO2.

32
Q

Describe the ABCDE for cardiac arrest.

A

A- Cover airways when doing chest compressions.

B- Not breathing

C-No circulation (heart is no longer beating)

D- unresponsive

E-can look dead

33
Q

Why is the ability of a patient to cough an important observation?

A

If a patient can cough air can still get in.

34
Q

Discuss the ABCDE of hypoglycaemia.

A

A- Follows the path of the bells curve. INITIALLY TALKING

B- Increased Breathing INITIALLY. then breathing stops.

C- Increased circulation Initially.

D- Initially alert.

E- Irritable. Confused. pale/

35
Q

What is the normal blood sugar of a patient & at what level of blood sugar is a patient at risk of losing conciousness.

A

Normal blood sugar is between 5 and 6.

Under 3= risk of losing conciousness.

36
Q

How do we treat a patient with hypoglycaemia?

A

give them sugar (e.g. sugar gel)

If they are unconcious- use glucagon- frees up all the stored glucose to revive the patient.

37
Q

What do you need to give a patient after giving them glucagon and why?

A

You need to give the patient more sugar to back it up- as glucagon depletes their sugar stores.

38
Q

What is temporary ischaemia and how do we treat it?

A

When the plaques are less than 1/3 diameter.

This pain is treated by sitting down.

39
Q

Discuss the ABCDE of a patient with angina.

A

A- not typically affected. Pt talking.

B- increased breathing.

C- Blood flow stopped to the area causing ischameia. (increased circulation)

D- disability- alert

Exposure- Pale. Clutching their chest. Right side radiation. Radiation into patient jaw.

40
Q

How do we treat a patient with angina.

A

GTN spray- 2 puffs sublingually under the tongue (400mg per dose)

If GTN spray doesn’t work- give 300mg aspirin crushed or chewed- to slow down platelet aggregation.

41
Q

After giving a patient crushed up aspirin why can the patient not drink water for 10 minutes?

A

Because we want the aspirin to dissolve inthe mucosa- drinking too much water would send the aspirin to the gut.

42
Q

Describe ABCDE for seizures.

A

A- compromised due to loss of airway tone. Commonly bites the tongue and releases more saliva .

B-Look for signs of adequate breathing (e.g. normal skin colour- they are well perfused)

C- can you see the veins on the back of the hand (thick veins- good circulation)

D- Unresponsive does not mean unconcious.

43
Q

How do we treat patient’s suffering from a seizure?

A

If seizures are recurrent or prolonged (over 5 minutes)

Use Midazolam 10mg via the buccal mucosa.

44
Q

Compare the two types of stroke?

A

Ischaemic stroke- Blockage prevents blood getting to an area

Haemorrhagic stroke- You get a rupture of the vessel and bleeding in the brain.

45
Q

Discuss ABCDE for strokes.

A

A- Patients have problems with the gag and swallow reflex.

Breathing- Affected by severity of the paralysis.

Circulation- affected by the severity of the paralysis

Disability- stroke affects the brain

Exposure- Look for lateralisation (droopy face/ pupils on one side). Anything that suggests one side is weaker than the other.

46
Q

What is syncope?

A

Fainting or passing out.

47
Q

Discuss ABCDE for syncope

A

A-compromised

B-reduced rate.

C- heart rate drops when you faint (causing the reduced blood pressure) But heart rate returns to normal straight away.

Disability- unresponsive. But pt. should respond immediately after the faint.

48
Q

Give the drug/delivery/action/complications for the emergency drug(s) used for anaphylaxis

A

Adrenaline

0.5mg 1:1000 IM by Z tract technique.

Peripheral vasoconstrictor (increasing blood flow in the body)

Central vasodilator (reducing bronchoconstriction)

Complications-Tachycardica/ Hypertension/Headache.

49
Q

Give the drug/delivery/action/complications for the emergency drug(s) used for chest pain

A

GTN- Glycerol Trinitrate. 400mg

2 puffs under the tongue

Vasodilator- to reduce blood flow & preload to the heart.

Complications- if pt blood pressure is low- it will reduce it even more causing fainting.

Aspirin 300mg

Chewed or crushed for absorption into oral mucosa.

Slows down platelet aggregation

Complications- nausea.

50
Q

Give the drug/delivery/action/complications for the emergency drug(s) used for Asthma

A

Salbutamol (100mg per puff)

2 puffs using an inhaler. If patient cannot hold breath for 10s use spacer device.

Action- beta 2 agonist- interaction with beta 2 receptors causing bronchodilation .

Complications- can cause a tremor and in rare events tachycardia.

51
Q

Give the drug/delivery/action/complications for the emergency drug(s) used for hypoglycaemic

A

Glucagon 1mg

IM using Z tract method

Releases all the sugar stored in the body.

Extra sugar needs to be given to back up glucagon or patient will crash. (15-20mg quick acting glucose)

52
Q

Give the drug/delivery/action/complications for the emergency drug(s) used for seizures

A

Midazolam 10mg

Via buccal mucosa. .

benzodiazepine- acts on GABA to prolong receptor repolarisation.

It is an unpredictable drug- could sedate/ hypertension.

3rd Year (63 decks)

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