MEDICAL EMERGENCIES Flashcards
When may adrenal insufficiency occur
following prolonged therapy with corticosteroids
what may a pt with adrenal insufficiency present as in the dental practice
hypotensive
management of a hypotensive pt with adrenal insufficiency
lay pt flat
give O2
transfer to hospital
when may anaphylaxis occur in the dental practice
contact with latex
anaphylaxis symptoms
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
anaphylaxis management stages
- call for ambulance
- remove trigger
- place pt in comfortable position
- administer IM adren/ epinephrine
- give high flow O2
- assess response
- repeat dose after 5 minutes if no improvement
how is IM adren injected
anterolateral aspect of middle third of thigh
signs of life threatening airway problem
hoarse voice
stridor
signs of life threatening breathing problems
increased work of breathing
wheeze
fatigue
cyanosis
sp02 below 94%
signs of life threatening circulation problems
low BP
signs of shock
confusion
reduced consciousness
concentration of IM adren
1mg/ml (1;1000)
dose of IM adren for adult and child >12 years
500ug IM (0.5ml)
dose of IM adren for child age 6-12
300ug IM (0.3ml)
dose of IM adren for child 6 months to 6 years
150ug IM (0.15ml)
dose of IM adren for child <6 months
100-150ug IM (0.1-0.15ml)
what is used for IV fluid challenge
crystalloid
dose of crystalloid for adults
500-1000ml
dose of crystalloid for children
10ml/kg
what position should you put a pt in with low blood pressure (circulation problem)
lying fat
leg elevation
pregnant pt position and why
lie on left side to prevent aortocaval compression
adrenaline action
reverses peripheral vasodilation and reduces tissue oedema
dilates bronchial airways
suppresses histamine and leukotriene release
how do you monitor the pts response to adrenaline
attach monitoring - pulse oximetry, BP, ECG
What needle is used for adrenaline administration
standard blue needle - 25mm and 23G
key indicator of adrenaline overdose
raised BP
what will most asthma attacks respond to
2 puffs of short acting beta2 agonist inhaler (salbutamol 100ug/puff)
what may be used for a pt who is unable to use their inhaler when having an asthma attack
further puffs given through a large vol spacer device
if asthmatic attack pt shows life threatening signs what must be done whilst awaiting the ambulance
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
what should be discussed for pts with severe chronic asthma/ whose asthma has deteriorated previously during dental procedure
may require an increase in prophylactic medication before dental procedure
may include increasing the dose of inhaled or oral corticosteroid
initial management of MI
- call ambulance
- pt in comfortable position
- administer sublingual glyceryl trinitrate
- give aspirin 300mg
- adminster high flow O2 15L/min if pt is cyanosed
- CPR if pt collpases
why avoid IM injection of drugs for someone with MI
absorption may be too slow (when cardiac output is reduced)
increases risk of local bleeding into muscle if pt given a thrombolytic drug
signs of epileptic shock
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
how long does a tonic clonic seizure usually last
3 minutes
epileptic seizure management
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
when is medication given for epileptic seizures
if convulsive seizures are prolonged - more than 5 mins - or repeated rapidly
what medication is given for a convulsive seizure and how
10mg midazolam oromucosal solution by buccal route
hypoglycaemia reading
<4mmol/l blood glucose
how do you treat hypoglycaemia
fast acting carb - oral glucose
repeat after 15 mins max 3 times
long acting carb once recovered
what should be given if hypoglycaemia is unresponsive or oral route cant be used
IM glucagon
larger portion of long acting carb
commonest cause of vasovagal syncope
emotional stress
signs of syncope
feel faint
low BP
pallor and sweating
nausea
dilated pupils
muscular twitching
syncope management
lay pt flat
raise legs (improve cerebral circulation)
loosen tight clothing around neck
once conscious give sugar in water
what predisposes postural hypotension
antihypertensive drugs
importance of awareness of AF
pt will be on anticoagulants
what other symptom will pts with cyanotic heart disease present with
pulmonary hypertension
significance of pts with hypertension in dental practice
they will be taking antihypertensive drugs
BP may fall dangerously low under GA
pts at risk of infective endocarditis
valve replacement
valvular heart disease
congenital heart disease
hypertrophic cardiomyopathy
previous IE
role of a pacemaker
prevent asystole or severe bradycardia
drugs which have serious interactions with anticoagulants
aspirin and NSAIDs
carbamazepine
miconazole
erythromycin, clarithromycin
metronidazole
acceptable resp rate?
12-20
what does sp02 measure?
level of oxygen enriched haemoglobin in the blood
acceptable sp02 level?
94% and above
88-92% in pts with COPD
what action would you take if sp02 is low?
high flow 02 15l/min through a non re-breather mask
what is measured when taking a manual pulse rate?
radial pulse (peripheral)
carotid pulse (central)
what does weak peripheral circulation and strong central circulation imply?
pt could be shutting down
what is a strong bounding pulse a symptom of?
sepsis
acceptable parameters for manual pulse?
60-100bpm
what 2 areas can be used to assess cap refill?
fingertip
sternum
what time is an acceptable cap refill?
2 seconds
what does high cap refill indicate?
circulatory issues
what colour may a pt present if they are cyanositc?
pallor
grey
clammy
what colour may a pt present if they are septic?
red and flushed
what scale is used to measure disability?
ACVPU
ACVPU
Alert
confusion
verbal
pain
unresponsive
what part of ACVPU could be a warning sign of sepsis?
confusion
what other 2 things must be assessed in D?
blood glucose
pupils
acceptable blood glucose level?
anything above 4mmols
what are you checking in a pts pupils?
equal in size and reactive to light
what do pinpricked pupils indicate?
pt has taken opiates such as morphine/ heroin
what do large saucer like pupils indicate?
drugs like amphetamine use
what does a difference in size of pupils indicate?
change in pressure on one part of the brain - symptom of stroke or bleed on the brain
what is assessed in E?
temperature
full body check
what temperature indicated pyrexia?
anything above 38 degrees
what are usual tx for high temp?
antipyretics - paracetamol and NSAIDs
what does SBAR stand for?
situation
background
assessment
recommendation
when do you call 999 in an asthma emergency?
if no improvement after administration of salbutamol after 5 minutes
what is salbutamol?
a bronchodilator
signs and symptoms of absence seizures
blank stare
zoning out
usually short lasting
ABCDE for tonic-clonic seizure?
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
management of tonic clonic seizure
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
what is the term for a seizure that lasts over 5 minutes
status epilepticus
midazolam effects for a seizure
anti-convulsant
muscle relaxant
midazolam dosages and concentration?
5mg/5ml
6-11 months: 2.5mg
1-4 years: 5mg
5-9 years: 7.5mg
10-17: 10mg
ABCDE for hypoglycaemia
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
management for hypoglycaemia
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
ABCDE angina/ MI
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
management of angina attack
02
2 puffs GTN (400ug) sunlingually - repeat 3 mins
management of MI
02
GTN sublingual - repeat after 3 mins
phone 999
aspirin 300mg chew
GTN action
vasodilator - increase blood flow
aspirin action
thins blood
ABCDE for life threatening asthma attack
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
ABCDE for acute severe asthma attack
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
