Medical emergencies Flashcards
patient 67 collapses states that they feel dizzy after treatment
after standing up too quickly.
You suspect postural hypotension
- What is postural hypotension?
A form of low blood pressure that happens when an upright position is assumed after sitting or lying down.
Failure of auto-regulatory systems which normally maintain blood pressure when standing.
Put in the following order
1) venous pooling in legs
2) Poor venous return
3) Fall in stroke volume
4) Fall in cardiac output
5) Patient continues to lose consciousness
patient 67 collapses states that they feel dizzy after treatment after standing up too quickly.
What 3 things may have caused the patient to collapse?
Syncope
Hypoglycaemic
anaphylaxis
myocardial infarction
patient 67 collapses states that they feel dizzy after treatment
after standing up too quickly.
What would you do differently for this patient who has postural hypotension? (4)
Sit the chair upright slowly over the course of a few minutes (2)
Advising the patient to take deep breaths in through the nose and out through the mouth
schedule appointments 30-60 mins after eating meals/taking meds
providing oxygen
What is ABCDE and describe how are they assessed?
- AIRWAY
- can the patient speak to you?
- are the periooral tissues swollen
- is there cyanosis (blue tongue)
- is there an obstruction?
complete = no breathing sounds
partial = noisy breathing - BREATHING
* Assess the rate: look for chest rising and falling, listen for breathing sounds, feel for chest rising and falling – does the chest expand equally on both sides?
- Assess the rythym
- Assess depth
- ask to feel pulse and put hand on shoulder to feel for movement - CIRCULATION
- pulse check
Assess: rate, strength, speed of pulse
Count the pulse
- if you can feel a pulse on the wrist = minimum systolic blood pressure is 70mmHg
- if u can palpate the brachial pulse = minimum BP 60 mmHg
- if u can palpate the pulse in the neck = minimum BP 50 mmHg
Organ perfusion stops at 45 mmHg
capillary refill – press nail bed for 5 secs (reperfusion should occur in less than 2 secs)
if a px is reperfusion the nail bed = they will be reperfusing the other organs too
- caution: weather and age can alter capillary refill
limb temp (hands) & colour
- blue, pink, pale or mottled
- are the hands warm or cold?
- DISABILITY
ACVPU
A - alert
C - (new) Confusion
V- Verbal stimuli response
P- Painful pressure: is there a normal response when pressure is applied to the trapezius muscle?
- normal is try to move your hand away and abnormal is extension of arms
U – unresponsiveness to any/all stimulus
- assess pupils with a light = should response equally at same time and same size - EXPOSURE
Assess general appearance
What medications are in the dental medical emergency kit including uses and their doses? (7)
oxygen 15l/min
Adrenaline:
Use: anaphylaxis
Dose: 0.5mg in 0.5ml with 1:1000 ADR
- 2 doses in the kit (only use half = 0.25ml)
GTN spray:
Use: Angina
Dose:
2 puffs
400 micrograms per puff
Asprin:
Use: MI
DOSE: Chew 1 tablet or crush and place under tongue (edentulous px)
300mg loading dose
- NO WATER after = dilutes and washes drug into gut
Salbutamol:
Use: Asthma
Dose: 1 puff = 100 micrograms
- Asthma attack = 2 puffs initially
Glucose tablets, gel or glucagon
Use: Hypoglycaemia
Dose:
If conscious = provide 3x glucose tablets or use gel and place in mouth and gums asap
Can even use gel if px starting to lose cooperativeness however can still swallow
If patient unconscious:
provide glucagon - 1milligram (mg) syringe via IM injection
Midazolam (benzodiazepine)
Use: those having any type of prolonged seizure (>5 mins)
Dose: 10mg – squeezed into buccal sulcus/mucosa
Describe syncope?
What are the 3 main characteristics?
It is known as fainting, which is defined as a transient, self-limited loss of consciousness with an inability to maintain postural tone which is followed by spontaneous recovery.
It is generally characterised by a fast onset, short duration and spontaneous recovery.
patient can become hot but feel cold, sweaty, pale, LOC and vomit.
outline the physiological aspects of a faint.
It is a temporary malfunction in the automatic nervous system
= decrease in blood returning to the heart
= decreased blood pressure
= temporary reduction of oxygenated blood reaching the brain
= causing the patient to lose consciousness for short period of time.
How do you manage syncope in general practice (5)
Assess the patient
A: compromised
B: reduced rate
C: HR drops when you faint resulting in reduced BP. But HR returns back to normal straight away.
D: Unresponsive. After the faint the patient should respond immediately.
Lay the patient flat (and if they are not breathless) Raise the patient’s feet to increase blood flow back to the brain.
increase room ventilation
loosen clothing around the neck
give oxygen
List risk factors for postural hypotension in the elderly. (2)
age-related impairment in baroreflex compensatory reflexes to upright position
usually have one or more associated comorbid conditions and are under treatment with vasoactive drug/s
