Medical Emergencies 2 Flashcards
Name some common medical emergencies in dentistry
- Asthma
- Anaphylaxis
- Angina
- Myocardial Infarction
- Epileptic Seizures
- Hypoglycaemia
- Syncope
- Choking and Aspiration
- Adrenal insufficiency
What are some triggers for asthma attacks
- Stress
- Anxiety
- Infection
- Exposure to allergen
What are the clinical signs of acute severe asthma
- Inability to complete sentences in one breath
- Respiratory rate > 25/min
- Tachycardia - heart rate > 110/min
What are the clinical signs of life threatening asthma
- Cyanosis
- Respiratory rate < 8/min
- Bradycardia - heart rate < 50/min
- Exhaustion, confusion, decreased consciousness level
What are the management options for asthma
- 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
What is anaphylaxis
- Severe, life-threatening, generalised or systemic hypersensitivity reaction
What are some common triggers of anaphylaxis
Drugs e.g. penicillin
Latex
Additives in medicine
Why is anaphylaxis tricky to diagnose
- Often inconsistent clinical features
- Wide range of possible presentations
NB. must use ABCDE to diagnose
What are the signs and symptoms of anaphylaxis
- 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
What are the management options for anaphylaxis
- 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
What are the clinical features of angina
- 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
What are some management options for angina
- 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
What are the clinical features of myocardial infarction
- 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
What are the management options of myocardial infarction
- 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
What are some common triggers of epileptic seizure
Stress, anxiety, dehydration/ starvation, temperature extremes, bright/ flashing lights
What are the signs and symptoms of epileptic seizure
- 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)
What are the management options for epileptic seizures
- 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
What are the signs and symptoms of a hypoglycaemic attack
- Shaking, tremor
- Irritated/aggressive, difficulty concentrating, confusion, disorientation
- Thirsty, sweaty
- Blurry vision, slurry speech
- Headache, increased pulse rate
- Fitting/seizures, loss of consciousness
What does ABCDE stand for in an anaphylactic reaction
- Airway
- Breathing
- Circulation
- Disability
- Exposure
What dose of adrenaline are given in adult patients and children older than 12
500 micrograms
What dose of adrenaline are given in children 6-12 years old
300 micrograms
What dose of adrenaline are given in children less than 6 years old
150 micrograms
What are the management options for hypoglycaemia in early stages/mild cases
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
How do you administer glucose in late stage/severe hypoglycaemia
When patient is uncooperative or unable to swallow safely:
- give glucose gel by squeezing into the buccal sulcus
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”
- 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
What blood glucose measurement indicates hypoglycaemia
<3mmol/L
What blood glucose measurement do we want to see in the patient at least
5mmol/L
What are the management options in a hypoglycaemic patient that is unconscious and shows no “signs of life” (breathing and circulation)
- Call the ambulamb
- Start CPR immediately
Ay BaWS CAN I HABE DE NOTE PLZ
- 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
What is syncope
Temporary loss of consciousness due to cerebral hypoperfusion
What are some common triggers of syncope
- 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
What are the signs and symptoms of syncope
- Feeling weak and faint/dizzy/light headed
- Pallor and sweating
- Nausea and vomiting
- Slow pulse rate
- Low blood pressure
- Confusion
- Loss of consciousness
What are the management options for syncope
- 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
What are the signs and symptoms of choking/aspiration
- 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
What management options are there if cough becomes inactive while choking
- 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
What management options are there if a patient collapses/becomes unresponsive/unconscious when choking
- Call ambulamb
- Check for signs of life (breathing and circulation)
- If one or both absent start CPR
What might adrenal insufficiency follow on from
- Long term use of oral corticosteroids and can persist for years after stopping
- Patient with Adrenal insufficiency may become hypotensive under physiological stress
What may be the causes of adrenal insufficiency
- Stress or trauma
- Iatrogenic (surgery or drug induced)
- Infection or sepsis
What are the signs and symptoms of adrenal insufficiency
- Irregular, weak and rapid pulse
- Shock-like features
- Confusion
- Rapidly falling BP
- Rapid loss of consciousness
What are the management options for adrenal insufficiency
- 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
How do you administer Glyceryl Trinitrate spray
Sublingual - under tongue
What is Glyceryl trinitrate spray used for and why
Used for angina as its a potent vasodilator and should receive chest pain
What dose of Glyceryl trinitrate spray used
400ug/dose
What is salbutamol aerosol inhaler used for and why
Asthma
B2 agonist - bronchodilator
How many activations needed when administering salbutamol and what dose is there per activation
10/min
10ug/activation
How is adrenaline administered
IM
What conc and dose of adrenaline is administered
0.5mg - 0.5ml of 1:1000 solution
What is adrenaline administered for and what is its mechanism of action?
Anaphylaxis B1 agonist B2 agonist Alpha receptor agonist Mast cells stabilisation Glucose elevation
What dose of aspirin is given during an MI
300mg
How is aspirin administered in MI
Orally
What is the mechanism of action for aspirin
Antiplatelet
What is glucagon used for and how is it administered
IM
Unconscious hypoglycaemia
What is the mechanism of action of glucagon
glycogenolysis
What dose of glucagon is given in unconscious hypoglycaemia
1mg
What ME is glucose solution/tablet etc used for
conscious hypoglycaemia
How is midazolam administered
Buccally
What is midazolam administered for
Epilepsy - status epilepticus
What dose of midazolam is used for status epilepticus
10mg/ml
What is the mechanism of action for midazolam
Muscle relaxant
What MEs is Oxygen used for
- Syncope
- MI
- Anaphylaxis
- Epilepsy
- Adrenal insufficiency
- Stroke
