MEDICAL EMERGENCIES Flashcards
Discuss the pattern seen when a patient becomes unwell.
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.
When do we give a patient oxygen and how much oxygen do we give?
If they are sick or you are using the emergency box of drugs for them.
15l of oxygen via a rebreathing mask.
What is a disadvantage of the rebreathing mask for oxygen delivery?
It only provides 90% oxygenation as it does not provide the perfect seal.
What does the ABCDE approach stand for?
Airways
Breathing
Circulation
Disability
Exposure.
When checking the patient’s airway:
What are we looking for?
Any airway obstructions.
What can cause airway obstructions?
Infection.
Inflammation
Swelling (the result of inflammation)
Loss of conciousness.
How can we tell if the airway is obstructed?
Breathing will be noisy.
How do we fix an obstructed airway?
head tilt and chin lift.
Jaw thrust
Oropharyngeal airway
Name.
Function.
Different sizes & selection criteria.
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.
How do we check the patient’s breathing.
Listen
Colour- skin colour/ nailbeds.
Check breathing rate.
Feel them breathing
How do you count a patient’s respiratory rate?
Ask them can you feel their pulse and put your hand on their shoulder to count.
How do we treat a problem with patient breathing?
Oxygen.
Bronchodilators.
Improve patient posture.
What can cause a problem with circulation?
Arrythmia
Acute coronary syndrome
Heart failure
Loss of fluid.
How do we check the patient’s circulation.
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
How do we treat problems with patient circulation.
- Treat the cause.
- Elevation of patients legs
- Apply pressure.
Where can you check a patient’s pulse and what is the estimated pulse you feel in these areas?
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
How do we describe patient consciousness?
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?
What checks can we complete to check patient conciousness?
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.
Discuss the relevance of exposure in a dental setting.
Look at all of the showing parts of the patient.
Are there any engorged neck veins?
Swollen- face/ eyes/ hands/ ankles
What is anaphylaxis?
This is a severe systemic reaction where we get massive vasodilation causing the collapse of blood pressure and the loss of fluid.
What is the ABCDE expected for anaphylaxis?
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.
How do we identify anaphylaxis as life threatening
A- any swelling/funny noises/hoarseness.
B- if pt is blue/cyanotic
C-You can’t feel a pulse.
name this position and the function
Trendleberg position.
This raises legs above the rest of the body send blood back to the central system.
How do we treat anaphylaxis .
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)
How does adrenaline work?
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.
Why should you never stand an anaphylaxis patient up if they are breathless?
It can provoke cardiac arrest.
Compare the IM adrenaline found in a medical box and an epipen.
The Adrenaline found in the medical box is 0.5.
The adrenaline found in an epipen is 0.3.
Compare the different types of asthma:
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.
Describe ABCDE for asthma
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.
What is our treatment for asthma.
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.
Why do we use a spacer device?
To prevent respiratory acidosis- patient rebreathing their own CO2.
Describe the ABCDE for cardiac arrest.
A- Cover airways when doing chest compressions.
B- Not breathing
C-No circulation (heart is no longer beating)
D- unresponsive
E-can look dead
Why is the ability of a patient to cough an important observation?
If a patient can cough air can still get in.
Discuss the ABCDE of hypoglycaemia.
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/
What is the normal blood sugar of a patient & at what level of blood sugar is a patient at risk of losing conciousness.
Normal blood sugar is between 5 and 6.
Under 3= risk of losing conciousness.
How do we treat a patient with hypoglycaemia?
give them sugar (e.g. sugar gel)
If they are unconcious- use glucagon- frees up all the stored glucose to revive the patient.
What do you need to give a patient after giving them glucagon and why?
You need to give the patient more sugar to back it up- as glucagon depletes their sugar stores.
What is temporary ischaemia and how do we treat it?
When the plaques are less than 1/3 diameter.
This pain is treated by sitting down.
Discuss the ABCDE of a patient with angina.
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.
How do we treat a patient with angina.
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.
After giving a patient crushed up aspirin why can the patient not drink water for 10 minutes?
Because we want the aspirin to dissolve inthe mucosa- drinking too much water would send the aspirin to the gut.
Describe ABCDE for seizures.
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.
How do we treat patient’s suffering from a seizure?
If seizures are recurrent or prolonged (over 5 minutes)
Use Midazolam 10mg via the buccal mucosa.
Compare the two types of stroke?
Ischaemic stroke- Blockage prevents blood getting to an area
Haemorrhagic stroke- You get a rupture of the vessel and bleeding in the brain.
Discuss ABCDE for strokes.
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.
What is syncope?
Fainting or passing out.
Discuss ABCDE for syncope
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.
Give the drug/delivery/action/complications for the emergency drug(s) used for anaphylaxis
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.
Give the drug/delivery/action/complications for the emergency drug(s) used for chest pain
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.
Give the drug/delivery/action/complications for the emergency drug(s) used for Asthma
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.
Give the drug/delivery/action/complications for the emergency drug(s) used for hypoglycaemic
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)
Give the drug/delivery/action/complications for the emergency drug(s) used for seizures
Midazolam 10mg
Via buccal mucosa. .
benzodiazepine- acts on GABA to prolong receptor repolarisation.
It is an unpredictable drug- could sedate/ hypertension.
