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CHHD > Medical Emergencies 2 > Flashcards

Medical Emergencies 2 Flashcards

1
Q

Name some common medical emergencies in dentistry

A
  • Asthma
  • Anaphylaxis
  • Angina
  • Myocardial Infarction
  • Epileptic Seizures
  • Hypoglycaemia
  • Syncope
  • Choking and Aspiration
  • Adrenal insufficiency
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2
Q

What are some triggers for asthma attacks

A
  • Stress
  • Anxiety
  • Infection
  • Exposure to allergen
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3
Q

What are the clinical signs of acute severe asthma

A
  • Inability to complete sentences in one breath
  • Respiratory rate > 25/min
  • Tachycardia - heart rate > 110/min
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4
Q

What are the clinical signs of life threatening asthma

A
  • Cyanosis
  • Respiratory rate < 8/min
  • Bradycardia - heart rate < 50/min
  • Exhaustion, confusion, decreased consciousness level
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5
Q

What are the management options for asthma

A
  • Stop treatment and remove all instruments from mouth
  • Reassure patient and sit them in a comfortable position
  • Administer salbutamol (10 activations/min) preferably via a spacer device
  • Administer oxygen at the rate of 15L/min
  • Monitor vital signs
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6
Q

What is anaphylaxis

A
  • Severe, life-threatening, generalised or systemic hypersensitivity reaction
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7
Q

What are some common triggers of anaphylaxis

A

Drugs e.g. penicillin
Latex
Additives in medicine

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8
Q

Why is anaphylaxis tricky to diagnose

A
  • Often inconsistent clinical features
  • Wide range of possible presentations
    NB. must use ABCDE to diagnose
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9
Q

What are the signs and symptoms of anaphylaxis

A
  • Urticaria, erythema, rhinitis, conjunctivitis
  • Abdominal pain, vomiting, diarrhoea and a sense of impending doom
  • Stridor, wheezing +/- hoarse voice (due to laryngeal oedema and bronchospasm) rapid breathing, fatigue, cyanosis, confusion
  • Respiratory arrest leading to cardiac arrest
  • Vasodilation = Hypovolaemia = low BP = pale/clammy = drowsy/faintness = collapse = cardiac arrest
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10
Q

What are the management options for anaphylaxis

A
  • Call ambulamb
  • Adrenaline 500ug. IM
  • Lay patient flat and raise legs to restore BP
  • Administer oxygen at rate of 15L/min
  • Reassure patient and monitor vital signs
  • If patient become unresponsive: check for ‘signs for life’, if one or both absent, start CPR
  • All patient treated for anaphylaxis must be sent to the hospital in an ambulamb
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11
Q

What are the clinical features of angina

A
  • Acute chest pain of cardiac origin, crushing in nature
  • Can radiate to the jaw, neck shoulder and back
  • Shortness of breath and increased respiratory rate
  • Fast and slow heart rates, low BP and poor peripheral perfusion
  • Altered mental state/feeling faint
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12
Q

What are some management options for angina

A
  • Calm and reassure patient
  • Sit them up in most comfortable position
  • Administer 2 sprays of GTN spray sublingually
  • Administer oxygen at 15L/min and monitor vital signs
  • Failure to respond, you can repeat the GTN spray after 5mins
  • No improvement after repeated doses of GTN, suspect MI
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13
Q

What are the clinical features of myocardial infarction

A
  • As per all features listed in angina but more severe
  • Shortness of breath, nausea and vomiting
  • Skin becomes pale and clammy and patient is cyanosed
  • Pulse is weak, irregular and BP may fail
  • Rapid loss of consciousness
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14
Q

What are the management options of myocardial infarction

A
  • Call ambulance immediately
  • Site up in most comfortable position
  • Give aspirin 300mg in single oral dose, crushed or chewed
  • Administer oxygen 15L/min and continued to monitor vital signs
  • If patient unresponsive: check for signs of life (breathing and circulation), if one or both is absent, start CPR
  • All patient treated for MI must be sent to the hospital in an ambulance, inform the ambulance crew that patient was given aspirin
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15
Q

What are some common triggers of epileptic seizure

A

Stress, anxiety, dehydration/ starvation, temperature extremes, bright/ flashing lights

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16
Q

What are the signs and symptoms of epileptic seizure

A
  • Brief warning/aura prior to fit, sometimes without warning
  • Tonic phase - sudden loss of consciousness, becomes rigid, falls, may give a cry, become cyanosed
  • Clonic phase - jerking movements of the limbs, tongue may be bitten
  • Other - frothing, incontinence
  • Typically lasts a few minutes, patient then regains consciousness but may still be confused (post ictal confusion)
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17
Q

What are the management options for epileptic seizures

A
  • Stop all work and ensure patient and ensure patients not at risk of injury by clearing surroundings, make no attempt to put anything in mouth
  • Don’t try to retrain convulsive movement
  • Fitting sometimes may be a sign of hypoglycaemia, check blood glucose to confirm if suspected
  • If blood glucose low, give oral glucose or glucagon
  • Place in recovery position after convulsion, clear the airway and give oxygen 15L/min
  • Most seizures are self limiting and requires and requires no intervention other than protection from injury
  • Give medication only in prolonged seizures
  • Call the ambulamb and administer midazolam 10mg bucally.
  • If status epilepticus, patient must be sent to hospital after recovery
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18
Q

What are the signs and symptoms of a hypoglycaemic attack

A
  • Shaking, tremor
  • Irritated/aggressive, difficulty concentrating, confusion, disorientation
  • Thirsty, sweaty
  • Blurry vision, slurry speech
  • Headache, increased pulse rate
  • Fitting/seizures, loss of consciousness
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19
Q

What does ABCDE stand for in an anaphylactic reaction

A
  • Airway
  • Breathing
  • Circulation
  • Disability
  • Exposure
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20
Q

What dose of adrenaline are given in adult patients and children older than 12

A

500 micrograms

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21
Q

What dose of adrenaline are given in children 6-12 years old

A

300 micrograms

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22
Q

What dose of adrenaline are given in children less than 6 years old

A

150 micrograms

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23
Q

What are the management options for hypoglycaemia in early stages/mild cases

A

Where patient is conscious and cooperative with a good gag reflex:

  • Stop all treatment and re-assure patient
  • Give oral glucose, can repeat 10-15 mins if needed
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24
Q

How do you administer glucose in late stage/severe hypoglycaemia

A

When patient is uncooperative or unable to swallow safely:

- give glucose gel by squeezing into the buccal sulcus

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25
Q

What management options are there in a hypoglycaemic patient who has failed to respond to initial treatment or is unconscious but has “signs of life”

A
  • Measure blood glucose using automated blood glucose measuring device
  • Give glucagon IM injection 1mg/ml in adults and children >8yrs old or >25kg otherwise give 0.5mg
  • Monitor vital signs, may take 5-10 mins for glucagon to work and for patient to regain consciousness
  • After regaining consciousness and able to swallow, give oral glucose
  • Measure blood glucose again to ensure to ensure it has risen to 5.0mmol/L or more
26
Q

What blood glucose measurement indicates hypoglycaemia

A

<3mmol/L

27
Q

What blood glucose measurement do we want to see in the patient at least

A

5mmol/L

28
Q

What are the management options in a hypoglycaemic patient that is unconscious and shows no “signs of life” (breathing and circulation)

A
  • Call the ambulamb

- Start CPR immediately

29
Q

Ay BaWS CAN I HABE DE NOTE PLZ

A
  • Patient needs to have adequate glycogen for glucagon to work, may be ineffective sometimes
  • May take 5-10 mins for glucagon to work
  • Important to give patients given glucagon once alert and able to swallow, any glucose containing drink or food high in carbohydrates
30
Q

What is syncope

A

Temporary loss of consciousness due to cerebral hypoperfusion

31
Q

What are some common triggers of syncope

A
  • Stress, anxiety, fear, pain, sight of blood/injection
  • Extremes of temperatures, dehydration and starvation
  • IV injection of LA
  • Postural hypotension
  • Drug effects and interactions
  • Some patients are more prone
32
Q

What are the signs and symptoms of syncope

A
  • Feeling weak and faint/dizzy/light headed
  • Pallor and sweating
  • Nausea and vomiting
  • Slow pulse rate
  • Low blood pressure
  • Confusion
  • Loss of consciousness
33
Q

What are the management options for syncope

A
  • Lay flat and raise legs to improve venous return
  • Loosen tight clothing, especially around neck
  • Administer oxygen at 15L/min
  • Monitor vital signs
  • Recovery is usually rapid but if not, call ambulamb and re-consider diagnosis
  • If patient becomes unresponsive: check for “signs of life”, if one or both is absent, start CPR
34
Q

What are the signs and symptoms of choking/aspiration

A
  • May cough or splutter
  • May have difficulty breathing
  • Breathing may be noisy with wheeze (aspiration) or stridor (obstruction)
  • May develop abnormal chest and abdominal movements
  • May become cyanosed and lose consciousness
35
Q

What management options are there if cough becomes inactive while choking

A
  • Give 5 sharp back blows between shoulder blades
  • Followed by 5 abdominal thrusts
  • Repeat steps above until object is out or dislodged and patient feels okay
36
Q

What management options are there if a patient collapses/becomes unresponsive/unconscious when choking

A
  • Call ambulamb
  • Check for signs of life (breathing and circulation)
  • If one or both absent start CPR
37
Q

What might adrenal insufficiency follow on from

A
  • Long term use of oral corticosteroids and can persist for years after stopping
  • Patient with Adrenal insufficiency may become hypotensive under physiological stress
38
Q

What may be the causes of adrenal insufficiency

A
  • Stress or trauma
  • Iatrogenic (surgery or drug induced)
  • Infection or sepsis
39
Q

What are the signs and symptoms of adrenal insufficiency

A
  • Irregular, weak and rapid pulse
  • Shock-like features
  • Confusion
  • Rapidly falling BP
  • Rapid loss of consciousness
40
Q

What are the management options for adrenal insufficiency

A
  • Call the ambulance immediately
  • Lay patient flat and raise the legs
  • Administer oxygen 15L/min
  • Maintain airway and monitor vital signs
  • Measure the blood glucose to rule out hypoglycaemia
  • If patient becomes unresponsive: check for signs of life and if one or both absent start CPR
41
Q

How do you administer Glyceryl Trinitrate spray

A

Sublingual - under tongue

42
Q

What is Glyceryl trinitrate spray used for and why

A

Used for angina as its a potent vasodilator and should receive chest pain

43
Q

What dose of Glyceryl trinitrate spray used

A

400ug/dose

44
Q

What is salbutamol aerosol inhaler used for and why

A

Asthma

B2 agonist - bronchodilator

45
Q

How many activations needed when administering salbutamol and what dose is there per activation

A

10/min

10ug/activation

46
Q

How is adrenaline administered

A

IM

47
Q

What conc and dose of adrenaline is administered

A

0.5mg - 0.5ml of 1:1000 solution

48
Q

What is adrenaline administered for and what is its mechanism of action?

A 
Anaphylaxis
B1 agonist
B2 agonist
Alpha receptor agonist
Mast cells stabilisation
Glucose elevation
49
Q

What dose of aspirin is given during an MI

A

300mg

50
Q

How is aspirin administered in MI

A

Orally

51
Q

What is the mechanism of action for aspirin

A

Antiplatelet

52
Q

What is glucagon used for and how is it administered

A

IM

Unconscious hypoglycaemia

53
Q

What is the mechanism of action of glucagon

A

glycogenolysis

54
Q

What dose of glucagon is given in unconscious hypoglycaemia

A

1mg

55
Q

What ME is glucose solution/tablet etc used for

A

conscious hypoglycaemia

56
Q

How is midazolam administered

A

Buccally

57
Q

What is midazolam administered for

A

Epilepsy - status epilepticus

58
Q

What dose of midazolam is used for status epilepticus

A

10mg/ml

59
Q

What is the mechanism of action for midazolam

A

Muscle relaxant

60
Q

What MEs is Oxygen used for

A
  • Syncope
  • MI
  • Anaphylaxis
  • Epilepsy
  • Adrenal insufficiency
  • Stroke

CHHD (27 decks)

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