Medical Emergencies

Question 1

Postural Hypotension-
1. Give 2 risk factors in elderly for postural hypotension? (2)

Answer 1

• Rate of activity/movement
• Low blood pressure

• Low blood pressure
• Treatment with beta-blockers
• Rate of activity/movement
• Parkinson’s
• Diabetes

Question 2

2. What can you do differently in a patient with postural hypotension? (1)

Answer 2

• Seat them up slowly after treatment

Question 3

3. Give 3 other reasons the patient may have become unconscious? (3)

Answer 3

• Hypoglycaemia
• Stroke
• Hyperventilation
• TIA
• Seizure

Question 4

4. What to do B and C mean in ABCDE? (2)

Answer 4

• Breathing
• Circulation

Question 5

67-Year-Old patient states that they feel dizzy after treatment after standing up too quickly. You suspect postural hypotension.
1. What is postural hypotension/what is its physiology?

Answer 5

• Excessive fall in blood pressure when an upright position is assumed caused by a failure of the auto regulatory systems which normally maintain blood pressure on standing

Question 6

3. What things may cause a patient to collapse?

Answer 6

• Fainting/syncope (dehydration)
• Fear/anxiety/emotional trauma
• Heart attack- myocardial infarction
• Diabetic emergency- hypoglycaemic shock & ketoacidosis

Question 7

4. What would you do differently for this patient who has postural hypotension/how can you prevent it?

Answer 7

• After treatment sit the chair upright gradually over a couple of minutes and encourage the patient to take their time when standing and take slow dep breaths

Question 8

4. What would you do differently for this patient who has postural hypotension/how can you prevent it?

Answer 8

• After treatment sit the chair upright gradually over a couple of minutes and encourage the patient to take their time when standing and take slow dep breaths

Question 9

5. What is ABCDE & how do you assess them?

Answer 9

• Airway- assess if patient can speak if not then check mouth for finger obstruction, may perform 1x finger sweep, then can use jaw thrust to check for obstruction, if struggling to maintain patent airway may consider use of an oropharyngeal adjunct (measure the maxillary incisors to angle of the mandible)
• Breathing- ear to mouth to feel and listen for breathe while looking down chest for chest expansion, check for paradoxical movement, symmetry and work, regular RR 12-15/minute, listen for extra breathing sounds such as wheeze, stridor or snore
• Circulation- check carotid pulse and assess quality, rate, rhythm, patient colour and temperature
• Disability- use AVCPU
• Exposure- look for clinical signs of note on the body

Question 10

Medical Emergencies Kit-
1. What medications are in the dental medical emergency kit including quantities and uses?

Answer 10

• Adrenaline IM injection- 1:1000 1mg/ml vile, given 0.5mg via IM injection= anaphylactic shock
• Aspirin tablet- 300mg, given crushed in the buccal sulcus or chewed = suspected MI or unstable angina
• Glucagon IM injection- 1mg, given IM using Z-track technique = hypoglycaemic shock
• Glyceryl Trinitrate (GTN) spray- 400µg/actuation, given 2 sprays under the tongue = angina
• Glucose- normally powder or gel= hypoglycaemia
• Midazolam- 10mg solution, given orally into buccal sulcus= prolonged or recurrent seizure
• Salbutamol- 100µg/actuation, give 2 actuations = asthma attack
• Oxygen- 15L/min= any medical emergency

Question 11

1. What is a syncope?

Answer 11

• Known as fainting- 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

Question 12

1. What is a syncope?

Answer 12

• Known as fainting- 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

Question 13

2. Outline the physiology of a faint?

Answer 13

• Temporary malfunction in the autonomic nervous system due to a trigger
• Interference with ANS function results in reduced venous blood return to the heart, drop-in blood pressure, reduction in oxygen and interruption of blood flow to the brain causing the patient to lose consciousness for a short period of time
• The patient may feel hot but become cold, sweaty, pale, looses consciousness and may vomit