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BDS3 BAMS Patient Safety > Medical Emergencies > Flashcards

Medical Emergencies Flashcards

1
Q

Pneumonic used for medical emergency assessment and what does it stand for.

A

ABCDE
Airway, breathing, circulation, disability, exposure.

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2
Q

What are three causes of airway obstruction ?

A

Choking.
Loss of consciousness.
Infection, inflammation or swelling.

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3
Q

Patient has lost patent airway. What is the first thing you should do to assess airway if appropriate ?

A

Triple manoeuvre - head tilt, jaw thrust, chin lift - will relieve airway blockage.
Can place oro-pharyngeal airway (measure from lips to angle of mandible) to maintain patent airway.

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4
Q

Patient has choked and has airway obstruction. What do you do ?

A

5 back slaps, Heimlich manoeuvre and repeat.
If patient is lying down, start chest compressions.

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5
Q

What is normal respiratory rate and oxygen saturation ?

A

12-15 breaths per minute and >94%.

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6
Q

At between 60-84% oxygen saturation, how will the patient appear ?

A

Lips and finger begin to go blue.

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7
Q

With oxygen saturation <60% oxygen saturation, patient will ?

A

Begin to centrally cyanose and tongue will begin to go blue.

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8
Q

What can be the cause of reduced respiratory rate ?

A

Trauma, neurological deficit, demand, infection, inflammation.

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9
Q

Why will a patient struggling to breath naturally go into tripod position ?

A

Optimal position to open intercostal muscles and accessory muscles and ease breathing.

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10
Q

What is the best way to assess patient breathing ?

A

Listen - should be silent, any noise is problem.
Rate - hand on chest and shoulder, normal is 12-15 breaths per minute.

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11
Q

What is the best way to assess patient circulation ?

A

Take brachial pulse, normal is between 60-100bpm, changes can be normal.

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12
Q

At what heart rate does perfusion of organs stop ?

A

<45bpm.

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13
Q

What position should the patient be in if circulatory problem has been diagnosed ?

A

Lie back and elevate legs.

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14
Q

What can cause neurological disability ?

A

Drugs, brain injury, hypoglycaemia, seizure.

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15
Q

What scoring scale is used to assess patient disability ?

A

ACVPU/GCS.
Alert, new confusion, verbal, pressure (in trapezius), unconciousness.

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16
Q

How many litres of oxygen should be selected for every medical emergency in dental setting ?

A

15l.

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17
Q

A patient is in anaphylaxis. What will be seen to do with their airway ?

A

Swelling and stridor due to bronchoconstriction.

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18
Q

A patient is in anaphylaxis. What will be seen to do with their breathing ?

A

Increased rate and wheeze.

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19
Q

A patient is in anaphylaxis. What will be seen to do with their circulation ?

A

Increased HR and decreased BP.

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20
Q

A patient is in anaphylaxis. What will be seen to do with their disability ?

A

Loss of consciousness.

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21
Q

A patient is in anaphylaxis. What will be seen to do with their exposure ?

A

Rash and swelling.

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22
Q

What treatment is given for anaphylaxis ?

A

Adrenaline 1:1000 0.5mg for single dose IM emergency injection.
Two doses will be found in medical emergency dental bag (1mg in 1ml).

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23
Q

What does adrenaline do for anaphylaxis ?

A

Bronchodilator.
Peripheral vasoconstrictor - helping BP.
Central vasodilator - more blood to brain and reduction of swelling.
Improve myocardial function.

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24
Q

When should a second dose of adrenaline be given where there is no improvement in patient ?

A

After 5 mins.

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25
Q

What is the most appropriate position for a patient in anaphylaxis ?

A

Lie down, legs raised.

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26
Q

A patient is suffering angina/MI. What will be seen to do with their airway ?

A

Should be talking and no constriction/blockage.

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27
Q

A patient is suffering angina/MI. What will be seen to do with their breathing ?

A

Increased rate.

28
Q

A patient is suffering angina/MI. What will be seen to do with their circulation ?

A

Increased HR - usually more to do with anxiety (no significant physiological reason).

29
Q

A patient is suffering angina/MI. What will be seen to do with their disability ?

A

Should be alert.

30
Q

A patient is suffering angina/MI. What will be seen to do with their exposure ?

A

Pale, clammy, central crushing chest pain radiating down right arm and jaw or sometimes back pain (more common in women).

31
Q

What treatment options is there for angina/MI in dental emergency setting ?

A

GTN spray - 400micrograms per dose, 2x puffs.
Aspirin - 300mg crushed or chewed.

32
Q

How does GTN spray help angina/MI ?

A

Analgesic for symptomatic relief.
Vasodilator which relives heart (venous circulation dilation, reducing pressure).

33
Q

How does aspirin help angina/MI ?

A

Anti-platelet primary effect - slows platelet aggregation and slows thrombus formation.
Mild analgesic too.

34
Q

Patient has suffering central crushing chest pain. It has not relieved since treatment. When should you suspect MI ?

A

After 5 mins.

35
Q

A patient is suffering asthma attack. What will be seen to do with their airway ?

A

Difficult to complete sentences but still able to talk.

36
Q

A patient is suffering asthma attack. What will be seen to do with their breathing ?

A

Increased rate with wheeze due to bronchoconstriction.

37
Q

A patient is suffering asthma attack. What will be seen to do with their circulation ?

A

Increased HR.

38
Q

A patient is suffering asthma attack. What will be seen to do with their disability ?

A

Alert.

39
Q

A patient is suffering asthma attack. What will be seen to do with their exposure ?

A

Tripod position, anxious, cyanotic.

40
Q

What is the definition of a mild to moderate asthma attack ?

A

Chest tightness, normal HR and normal RR.

41
Q

What is the definition of severe asthma attack ?

A

Respiratory rate >25 breaths per minute.
Heart rate of >115bpm.
Audible wheeze with stethoscope.

42
Q

What is the definition of life threatening asthma attack ?

A

Heart rate of <40bpm.
Respiratory rate of <8 breaths per minute.

43
Q

What treatment should be given to patient suffering mild to moderate asthma attack ?

A

2x puffs of salbutamol inhaler 100 micrograms per actuation and ask patient to hold breath for 10 seconds, can be repeated as required.

44
Q

What treatment should be given to patient suffering severe or life-threatening asthma attack ?

A

10x puffs into spacer and breathe for no longer than 20 seconds, remove spacer and continue with oxygen. Can be repeated every 3-5mins. No improvement, medical emergency 999.
Patient has now lost ability to hold breath for 10 seconds.

45
Q

How does a salbutamol inhaler help an asthma attack ?

A

Bronchodilator - improves gas exchange.

46
Q

What patient is most likely to suffer hypoglycaemic attack ?

A

Type 1 diabetes - as they are insulin dependent.
If not, inflammatory or infective reason to cause i.e. sepsis.

47
Q

A patient is suffering hypoglycaemic attack. What will be seen to do with their airway ?

A

Should be initially talking if still conscious.

48
Q

A patient is suffering hypoglycaemic attack. What will be seen to do with their breathing ?

A

Increased RR initially if still conscious.

49
Q

A patient is suffering hypoglycaemic attack. What will be seen to do with their circulation ?

A

Increased HR initially if still conscious.

50
Q

A patient is suffering hypoglycaemic attack. What will be seen to do with their disability ?

A

Initially alert and loss of consciousness as blood sugar begins to drop further.

51
Q

A patient is suffering hypoglycaemic attack. What will be seen to do with their exposure ?

A

Irritable, confused, pale.

52
Q

What treatment can be given to patient suffering hypoglycaemic attack ?

A

Glucose gel or tablets.
Glucagon (1milligram IM injection) - comes as fluid and powder and needs mixed.

53
Q

Following glucagon injection, what should always be given to patient ?

A

Glucose gel or tablet - to regain normal blood sugar level.

54
Q

A patient is suffering seizure. What will be seen to do with their airway ?

A

Compromised.

55
Q

A patient is suffering seizure. What will be seen to do with their breathing ?

A

Can be various different presentations and very difficult to assess.

56
Q

A patient is suffering seizure. What will be seen to do with their circulation ?

A

Can be various different presentations and very difficult to assess.

57
Q

A patient is suffering seizure. What will be seen to do with their disability ?

A

Unresponsive - not always unconscious.

58
Q

A patient is suffering seizure. What will be seen to do with their exposure ?

A

Convulsions, seizure activity, incontinence.

59
Q

What treatment is available in dental setting if patient is suffering seizure ?

A

Midazolam (benzodiazepine) 100mg via buccal mucosa.

60
Q

When should treatment be initiated in patient having seizure ?

A

If seizure lasting longer than 5 mins or repeated seizures.

61
Q

A patient is suffering syncope. What will be seen to do with their airway ?

A

Compromised.

62
Q

A patient is suffering syncope. What will be seen to do with their breathing ?

A

Reduced rate.

63
Q

A patient is suffering syncope. What will be seen to do with their circulation ?

A

Reduced rate and pressure.

64
Q

A patient is suffering syncope. What will be seen to do with their disability ?

A

Unresponsive.

65
Q

A patient is suffering syncope. What will be seen to do with their exposure ?

A

Pale and clammy.

BDS3 BAMS Patient Safety (4 decks)

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