Medical emergencies

Question 1

Medical emergency: A?

Answer 1

Airway - wheezing (may be partial blockage), no noise (complete blockage)

Question 2

Medical emergency: B —> Respiratory rate ?

Answer 2

respiratory rate (12-20 breaths per min is normal, 25> dangerous)

Question 3

Medical emergencies: B —> blood oxygen level?

Answer 3

SPO2 (blood oxygen level) 96% and above is good (less than is dangerous).

Question 4

Medical emergency: B —> visual check

Answer 4

Is the chest equally expansive on both sides. Again consider sound of breathing (wheezing etc)

Question 5

Medical emergency: C —> pulse?

Answer 5

Pulse (rate and strength) 60-100bpm is good, over 100bpm is dangerous.

Question 6

Medical emergency: C —> Blood pressure?

Answer 6

Blood pressure (120/70 roughly)

Question 7

Medical emergency: D?

Answer 7

Disability

Question 8

Medical emergency: D —> score?

Answer 8

Record ACVPU score: Alert, Confusion, verbal, pain, unconscious.

Question 9

Medical emergency: D —> what shouldn’t you forget?

Answer 9

NFG —> Never forget glucose !

Record blood glucose <4mmols indicates hypoglycaemia (low level of sugar in blood).

Question 10

Medical emergency: E?

Answer 10

Exposure/everything else; expose the patient while maintaining their dignity to check for swelling, rash, blood loss or any abnormality. Take patients temperature to see If they are pyrexial (abnormally high temp) as this could indicate SEPSIS.

Question 11

Four main reasons why patients faint at the dentist

Answer 11

1. Anxiety
2. Pain
3. Low blood sugar (pain may mean patient isn’t eating properly)
4. Standing for too long

Question 12

Vasovagal syncope

Answer 12

1. The vagus nerve is the longest cranial nerve in the body - reports on lungs, heart, liver, stomach, intestines.
2. Overstimulation of this nerve (i.e anxiety, pain) can trigger the person to faint/collapse.

Question 13

ABCDE approach vasovagal syncope: A?

Answer 13

Airway is patent (i.e not obstruction) could tell this as they would be talking with you.

Question 14

ABCDE approach vasovagal syncope: B?

Answer 14

Respiratory rate increases (panic, anxiety)

Due to fast, shallow breathing —> not getting enough oxygen.

SpO2 (oxygen saturation of blood) decreases

Question 15

ABCDE approach vasovagal syncope: C?

Answer 15

Heart rate slows down - vasovagal reflex.

Hypotension (low blood pressure) due to vasodilation —> pallor (pale face).

Question 16

ABCDE approach vasovagal syncope: D?

Answer 16

ACVPU: Alert but anxious

Blood glucose: potentially low due to lack of food (tooth ache)

Question 17

ABCDE approach vasovagal syncope: E?

Answer 17

Patient will look distressed, flustered, brief loss of consciousness (go back to ACVPU - no longer alert)

Question 18

Management of vasovagal syncope: before loss of consciousness

Answer 18

1. Reassure patient (manage anxiety etc)
2. Dextrose (tablet/gel form) to increase blood sugar - even if blood sugar isn’t low (placebo/boost).
3. Open window to circulate fresh air
4. Get patient in supine position to address hypotension

Question 19

Management of vasovagal syncope: after loss of consciousness

Answer 19

1. ABCDE approach
2. patent airway?
3. assess breathing to rule out more sinister cause
4. loosen tight clothing around neck to help with breathing
5. O2 at 15 litres/min until consciousness regained through non re-breather mask then titrate down to 6 litres/min
6. Recovery position if necessary to maintain patent airway
7. Plenty of reassurance on awakening

Question 20

O2 cylinder: how would you turn on the oxygen flow?

Answer 20

With the key and lock

Question 21

O2 cylinder: once the cylinder is attached to tubing and ready how do you adjust litres per minute?

Answer 21