Medical Emergencies Flashcards
What are the steps in patient assessment in a medical emergency?
- AIRWAY
- BREATHING
- CIRCULATION
- DISABILITY
- EXPOSURE
Is patient awake? Are they unwell? How do they feel?
What does it suggest if a patient can speak to you?
No airway problem
What are the signs of airway obstruction?
See-saw respirations
Central cyanosis- blue tongue
Complete obstruction- no breathing sounds
Partial- noisy breathing
What can be done if a patients airway is not patent?
Use an oro-pharyngeal airway
How is an OPA sized?
Measure from angle of jaw to vertical height of incisors
-> usually orange for males and green for females
What is the normal respiratory rate?
12-20 breaths per min
What are the common causes of breathlessness in patients?
Increased demand
Infection
Inflammation in airways
How is breathing assessed?
Assess breathing rate- look for chest rising/falling, listen for breathing sounds
-> check for equal expansion on both sides of chest
Assess rhythm
Assess depth
Why is it important not to tell the patient you are counting their respiratory rate?
They may alter it
-> ask to feel pulse and put hand on shoulder at same time to feel rate
What can be done to help patients who are struggling to breathe?
Place patient in tripod postion- allows opening of intercostal muscles
Give oxygen- 15l/min
Bronchodilators- salbutamol
What is the normal resting HR?
60-90 bpm
What are the causes of irregular pulse/circulation?
Arrhythmias- if you suspect this end to A&E
ACS- unstable angina, STEMI, NSTEMI
Heart failure
Loss of fluid/blood
What checks can help us recognise circulatory issues?
Check pulse- assess regularity, strength, speed
-> count it against clock
Capillary refill test- press nail bed for 5 sec
-> reperfusion should occur within 2 secs
Check limb temp and colour
-> are the hands blue, pink, pale, mottled
-> >37.8 is a fever
What are the different ways of checking pulse? What is the minimum BP required to detect each?
Pulse on wrist- minimum systolic of 70mmHg
Brachial pulse- minimum systolic of 60mmHG
Carotid- minimum systolic of 50mmhg
What is meant by disability in a medical emergency assessment?
Gross neurological function deficit
What are the causes of disability/unconsciousness?
Hypoxia
Hypercapnia
Drugs and alcohol
Brain injury- cerebral hypo perfusion
Hypoglycaemia
What are the steps in recognising disability? (ACVPU)
Alert- is patient responding
Confusion
Verbal stimuli response
Painful pressure- apply pressure to trapezius and see if they try to move your hand away
Unresponsiveness- to all/any stimuli
-> assess pupils with light- do they respond equally in terms of time and size
What is done at the exposure stage of patient?
Check colour of hands , check neck vessels, check continence (have they soiled themselves)
What are the emergency conditions that a dentist may have to deal with?
- ANAPHYLAXIS
- ANGINA/MI
- ASTHMA
- CARDIAC ARREST
- HYPOGLYCAEMIA
- SEIZURES
For what patients is oxygen given in an emergency situation in the dental setting?
For all emergencies (given in combination with any emergency drug)
*harm from over-oxygenation only occurs over long periods not seen in dental setting
How is oxygen administered to patients?
Use non-rebreathing mask which delivers 90% oxygen at a rate of 15 litres/min (one tank lasts 25 min)
Put finger in bag to allow it to inflate/place finger over green valve
Place over patients face and tighten straps
What is anaphylaxis?
Severe systemic hypersensitivity reaction
-> can result in shock- inability to perfuse organs/tissues