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HUMAN DISEASE MOD 5 > MEDICAL EMERGENCIES > Flashcards

MEDICAL EMERGENCIES Flashcards

1
Q

When may adrenal insufficiency occur

A

following prolonged therapy with corticosteroids

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2
Q

what may a pt with adrenal insufficiency present as in the dental practice

A

hypotensive

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3
Q

management of a hypotensive pt with adrenal insufficiency

A

lay pt flat
give O2
transfer to hospital

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4
Q

when may anaphylaxis occur in the dental practice

A

contact with latex

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5
Q

anaphylaxis symptoms

A

paraesthesia, flushing and swelling of face
generalised itching, especially hands and feet
bronchospasm and laryngospasm (wheezing and difficulty breathing)
rapid weak pulse
fall in BP
pallor
lead to cardiac arrest

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6
Q

anaphylaxis management stages

A
  1. call for ambulance
  2. remove trigger
  3. place pt in comfortable position
  4. administer IM adren/ epinephrine
  5. give high flow O2
  6. assess response
  7. repeat dose after 5 minutes if no improvement
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7
Q

how is IM adren injected

A

anterolateral aspect of middle third of thigh

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8
Q

signs of life threatening airway problem

A

hoarse voice
stridor

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9
Q

signs of life threatening breathing problems

A

increased work of breathing
wheeze
fatigue
cyanosis
sp02 below 94%

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10
Q

signs of life threatening circulation problems

A

low BP
signs of shock
confusion
reduced consciousness

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11
Q

concentration of IM adren

A

1mg/ml (1;1000)

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12
Q

dose of IM adren for adult and child >12 years

A

500ug IM (0.5ml)

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13
Q

dose of IM adren for child age 6-12

A

300ug IM (0.3ml)

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14
Q

dose of IM adren for child 6 months to 6 years

A

150ug IM (0.15ml)

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15
Q

dose of IM adren for child <6 months

A

100-150ug IM (0.1-0.15ml)

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16
Q

what is used for IV fluid challenge

A

crystalloid

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17
Q

dose of crystalloid for adults

A

500-1000ml

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18
Q

dose of crystalloid for children

A

10ml/kg

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19
Q

what position should you put a pt in with low blood pressure (circulation problem)

A

lying fat
leg elevation

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20
Q

pregnant pt position and why

A

lie on left side to prevent aortocaval compression

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21
Q

adrenaline action

A

reverses peripheral vasodilation and reduces tissue oedema
dilates bronchial airways
suppresses histamine and leukotriene release

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22
Q

how do you monitor the pts response to adrenaline

A

attach monitoring - pulse oximetry, BP, ECG

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23
Q

What needle is used for adrenaline administration

A

standard blue needle - 25mm and 23G

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24
Q

key indicator of adrenaline overdose

A

raised BP

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25
Q

what will most asthma attacks respond to

A

2 puffs of short acting beta2 agonist inhaler (salbutamol 100ug/puff)

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26
Q

what may be used for a pt who is unable to use their inhaler when having an asthma attack

A

further puffs given through a large vol spacer device

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27
Q

if asthmatic attack pt shows life threatening signs what must be done whilst awaiting the ambulance

A

oxygen with salbutamol 5mg OR terbutaline sulfate 10mg by nebuliser

if nebuliser unavailable then:
2-10 puffs salbutamol 100ug/ metered inhalation by large volume spacer

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28
Q

what should be discussed for pts with severe chronic asthma/ whose asthma has deteriorated previously during dental procedure

A

may require an increase in prophylactic medication before dental procedure

may include increasing the dose of inhaled or oral corticosteroid

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29
Q

initial management of MI

A
  1. call ambulance
  2. pt in comfortable position
  3. administer sublingual glyceryl trinitrate
  4. give aspirin 300mg
  5. adminster high flow O2 15L/min if pt is cyanosed
  6. CPR if pt collpases
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30
Q

why avoid IM injection of drugs for someone with MI

A

absorption may be too slow (when cardiac output is reduced)
increases risk of local bleeding into muscle if pt given a thrombolytic drug

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31
Q

signs of epileptic shock

A

sudden loss of consciousness
pt becomes rigid, falls, may cry, cyanoses (tonic phase)
after 30 seconds, jerking movements of limbs and tongue biting (clonic phase)
frothing from mouth and urinary incontinence

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32
Q

how long does a tonic clonic seizure usually last

A

3 minutes

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33
Q

epileptic seizure management

A

make sure pt is not at risk from injury
give O2 to support if necessary
after convulsion, recovery position and check airway
transfer to hospital if this is first episode or atypical

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34
Q

when is medication given for epileptic seizures

A

if convulsive seizures are prolonged - more than 5 mins - or repeated rapidly

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35
Q

what medication is given for a convulsive seizure and how

A

10mg midazolam oromucosal solution by buccal route

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36
Q

hypoglycaemia reading

A

<4mmol/l blood glucose

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37
Q

how do you treat hypoglycaemia

A

fast acting carb - oral glucose
repeat after 15 mins max 3 times
long acting carb once recovered

38
Q

what should be given if hypoglycaemia is unresponsive or oral route cant be used

A

IM glucagon
larger portion of long acting carb

39
Q

commonest cause of vasovagal syncope

A

emotional stress

40
Q

signs of syncope

A

feel faint
low BP
pallor and sweating
nausea
dilated pupils
muscular twitching

41
Q

syncope management

A

lay pt flat
raise legs (improve cerebral circulation)
loosen tight clothing around neck
once conscious give sugar in water

42
Q

what predisposes postural hypotension

A

antihypertensive drugs

43
Q

importance of awareness of AF

A

pt will be on anticoagulants

44
Q

what other symptom will pts with cyanotic heart disease present with

A

pulmonary hypertension

45
Q

significance of pts with hypertension in dental practice

A

they will be taking antihypertensive drugs
BP may fall dangerously low under GA

46
Q

pts at risk of infective endocarditis

A

valve replacement
valvular heart disease
congenital heart disease
hypertrophic cardiomyopathy
previous IE

47
Q

role of a pacemaker

A

prevent asystole or severe bradycardia

48
Q

drugs which have serious interactions with anticoagulants

A

aspirin and NSAIDs
carbamazepine
miconazole
erythromycin, clarithromycin
metronidazole

49
Q

acceptable resp rate?

A

12-20

50
Q

what does sp02 measure?

A

level of oxygen enriched haemoglobin in the blood

51
Q

acceptable sp02 level?

A

94% and above
88-92% in pts with COPD

52
Q

what action would you take if sp02 is low?

A

high flow 02 15l/min through a non re-breather mask

53
Q

what is measured when taking a manual pulse rate?

A

radial pulse (peripheral)
carotid pulse (central)

54
Q

what does weak peripheral circulation and strong central circulation imply?

A

pt could be shutting down

55
Q

what is a strong bounding pulse a symptom of?

A

sepsis

56
Q

acceptable parameters for manual pulse?

A

60-100bpm

57
Q

what 2 areas can be used to assess cap refill?

A

fingertip
sternum

58
Q

what time is an acceptable cap refill?

A

2 seconds

59
Q

what does high cap refill indicate?

A

circulatory issues

60
Q

what colour may a pt present if they are cyanositc?

A

pallor
grey
clammy

61
Q

what colour may a pt present if they are septic?

A

red and flushed

62
Q

what scale is used to measure disability?

A

ACVPU

63
Q

ACVPU

A

Alert
confusion
verbal
pain
unresponsive

64
Q

what part of ACVPU could be a warning sign of sepsis?

A

confusion

65
Q

what other 2 things must be assessed in D?

A

blood glucose
pupils

66
Q

acceptable blood glucose level?

A

anything above 4mmols

67
Q

what are you checking in a pts pupils?

A

equal in size and reactive to light

68
Q

what do pinpricked pupils indicate?

A

pt has taken opiates such as morphine/ heroin

69
Q

what do large saucer like pupils indicate?

A

drugs like amphetamine use

70
Q

what does a difference in size of pupils indicate?

A

change in pressure on one part of the brain - symptom of stroke or bleed on the brain

71
Q

what is assessed in E?

A

temperature
full body check

72
Q

what temperature indicated pyrexia?

A

anything above 38 degrees

73
Q

what are usual tx for high temp?

A

antipyretics - paracetamol and NSAIDs

74
Q

what does SBAR stand for?

A

situation
background
assessment
recommendation

75
Q

when do you call 999 in an asthma emergency?

A

if no improvement after administration of salbutamol after 5 minutes

76
Q

what is salbutamol?

A

a bronchodilator

77
Q

signs and symptoms of absence seizures

A

blank stare
zoning out
usually short lasting

78
Q

ABCDE for tonic-clonic seizure?

A

A - difficult to assess but often patent
B - increased RR but hard to assess, decreased Sp02, paused in breathing (apnoea)
C - increased HR, hypertension
D - ACVPU: unresponsive
E - convulsions, flushed complexion, rigidity, urinary incontinence, frothing of mouth

79
Q

management of tonic clonic seizure

A

move objects thar may harm pt
do not attempt to restrain pt or put anything in their mouth
time the seizure - if over 5 mins then administer 10mg midazolam buccally and phone ambulance
administer 02
continuously monitor

80
Q

what is the term for a seizure that lasts over 5 minutes

A

status epilepticus

81
Q

midazolam effects for a seizure

A

anti-convulsant
muscle relaxant

82
Q

midazolam dosages and concentration?

A

5mg/5ml

6-11 months: 2.5mg
1-4 years: 5mg
5-9 years: 7.5mg
10-17: 10mg

83
Q

ABCDE for hypoglycaemia

A

A - patent
B - increased RR, decreased sp02
C - tachycardia, hypertension, pallor, clammy
D - ACVPU: confused blood glucose <4mmols
E - slurred speech, shaking, aggressive, appears drunk

84
Q

management for hypoglycaemia

A

02
if pt conscious - 10-20g oral glucose (repeat every 10-15 mins)
if pt unconscious - 1mg glucagon IM, call 999
when pt regains consciousness - more oral glucose

85
Q

ABCDE angina/ MI

A

crushing central chest pain radiating to left arm, neck and jaw
A - usually patent but potential for some sounds such as wheezing
B - increased RR, decreased sp02, rapid
C - HR increases or decreases, PB increases or decreases, CRT increases, pallor
D - ACVPU: A but anxious
E - clammy, grey in colour, sweaty, nausea, cyanosis

86
Q

management of angina attack

A

02
2 puffs GTN (400ug) sunlingually - repeat 3 mins

87
Q

management of MI

A

02
GTN sublingual - repeat after 3 mins
phone 999
aspirin 300mg chew

88
Q

GTN action

A

vasodilator - increase blood flow

89
Q

aspirin action

A

thins blood

90
Q

ABCDE for life threatening asthma attack

A

A - severe wheeze on expiration
B - decreased RR and effort, severely decreased Sp02, laboured breathing
C - decreased HR, cyanosis in lips/ nose
D - ACVPU: confused due to hypoxia
E - grey/ blue in colour, exhausted, sleepy

91
Q

ABCDE for acute severe asthma attack

A

A - wheezing on expiration
B - increased RR, decreased sp02, rapid shallow breaths
C - increased HR, hypertension, pallor
D - ACVPU: alert but anxious
E - pale, distressed, use of accessory muscles, inability to complete sentence in one breath

HUMAN DISEASE MOD 5 (54 decks)

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