Medical Emergencies Flashcards
what are the principles of emergency management ?
check responsiveness, airway and oxygen, breathing, circulation, disability, exposure
why are dental patients at risk of upper airways obstruction ?
blood or saliva in the mouth for long periods of time,
LA may diminish normal protective pharyngeal reflexes,
dental equipment in mouth for long periods
what are the commonest problems for dental patients regarding compromised airways ?
foreign body aspiration and laryngospasm
what are the signs of an upper airway obstruction ?
paradoxical chest and abdominal movements,
use of accessory muscles of respiration,
central cyanosis - late sign
what are the signs of partial airway obstruction ?
inspiratory stridor - obstruction at or above the larynx,
expiratory wheeze - lower airway obstruction,
gurgling,
snoring
what is the management for airway obstruction ?
head tilt, chin lift, jaw thrust
remove visible foreign body
airway adjuncts
high flow oxygen
what medical conditions present with breathing problems ?
hyperventilation, asthma, angina, heart failure
what are the signs of respiratory distress ?
sweating, central cyanosis, use of accessory muscles of respiration, abdominal breathing
what is the normal respiratory rate for adults ?
12-20 breaths per min
what is the normal respiratory rate for children ?
20-30 breaths per minute
what is the management for inadequate breathing ?
bag and mask/pocket mask,
ambulance
what is hyperventilation ?
minute ventilation exceeds metabolic demands resulting in haemodynamic changes
what are the symptoms of hyperventilation ?
shortness of breath/wheeze, chest pain/palpitations, belching, dry mouth, dizziness, paraesthesia/circumoral numbness
what is the management for hyperventilation ?
encourage re-breathing of CO2 through paper bag
small dose of benzodiazepines e.g. lorazepam
what is asthma ?
more than one of wheeze, breathlessness, chest tightness, cough
when is asthma worse ?
at night/early hours
exercise
allergens
what are the risk factors for severe asthma ?
previous hospitalisation, repeated ED attendances, require more than 3 medications, heavy use of beta 2 agonist, brittle asthma
what are the potential precipitants of acute asthma in the dental setting ?
sulphites in vasoconstrictors may case bronchospasm,
sedatives and general anaesthetics,
penicillin allergy
what drugs may precipitate and asthma attack ?
NSAIDs, aspirin, barbiturates, beta blockers, cyanoacrylates, mefanamic acid, morphine, pancuronium, suxamethonium
what are the symptoms of severe asthma ?
inability to complete sentences in one breath,
RR > 25 per min
tachycardia > 110
use of accessory muscles
what are the symptoms of life threatening asthma ?
cyanosis,
RR
what is the management for an asthma attack ?
ABCDE assessment,
high flow oxygen 10-15L/min,
Salbutamol through spacer or nebuliser every 10 mins,
ambulance
what emergencies affecting the cardiovascular system might occur in dental surgery ?
syncope, angina, MI, anaphylaxis
what are the features of a cardiovascular examination ?
colour of hands - blue, pink, pale, mottled
temperature of peripheries,
capillary refill time should be less than 2 seconds
pulse - weak and thread indicates hypotension
what are the signs and symptoms of syncope ?
light headedness, pale, clammy, sweaty, slow pulse rate, low blood pressure, loss of consciousness
how do you manage a faint ?
reassure, raise legs, 10L/min oxygen, looses tight clothing, monitor breathing and circulation
what are the symptoms of acute chest pain ?
central crushing chest pain,
pain radiates to left arm, neck, through back or into epigastrium,
associated with nausea, sweating, vomiting or difficulty breathing
what is a sign of an inferior heart attack ?
slow pulse
how do you manage angina ?
reassure, give oxygen, GTN, ambulance of episode is prolonged
how do you manage MI ?
monitor, give oxygen, nitrate, aspirin 300mg PO, summon help
what is anaphylaxis ?
an acute, life threatening IgE antibody-antigen-mediated hypersensitivity reaction
characterized by rapidly developing airway, breathing and circulation problems associated with skin and mucosal changes
what are the common precipitants to anaphylaxis ?
drugs - penicillin, muscle relaxants, NSAID’s, opiates
foods - shellfish, nuts, milk, eggs, nitrates, nitrites
latex,
radiographic contrast media,
additives in medicines and topical drugs
what symptoms of anaphylaxis are associated with the face ?
urticaria, erythema, rhinitis, conjunctivitis, facial oedema, facial flushing
what symptoms of anaphylaxis are associated with the airway ?
tongue swelling, hoarse voice, bronchospasm leading to wheeze, upper airways oedema leading to stridor
what symptoms of anaphylaxis are associated with the stomach ?
nausea, abdominal pain, vomiting, diarrhea
what symptoms of anaphylaxis are associated with the entire body ?
rash, hypotension, pallor or cyanosis, feeling of impending doom, loss of consciousness
how do you manage anaphylaxis ?
ensure airway is patent, give oxygen, assess respiratory rate, salbutamol through spacer, lay patient flat, check pulse and blood pressure, give adrenaline IM 500 mcg (0.5mL of 1:1000) or epipen 0.3mL of 1:1000, repeat after 5 mins, hospital
what are the signs of hypoglycemia ?
sweating, clamminess, trembling, poor concentration, slurred speech, aggression, fitting, loss of consciousness
how do you confirm a diagnosis of hypoglycaemia ?
automated blood glucose measurement device, blood glucose
how do you manage hypoglycaemia ?
if patient conscious and able to swallow, give oral glucose, if patient unconscious give buccal glucose gel or IM glucagon
what is the recovery time for hypoglycaemia if glucagon is given ?
10 mins
what is the glucagon dose for adults ?
1mg
what is the glucagon dose for children over 8 or above 25kg ?
1mg
what is the glucagon dose for children under 8 or 25Kg ?
0.5 mg
what is epilepsy ?
chronic neurological disorder,
characterized by recurrent siezures due to abnormal neuronal activity in the brain
what are the types of seizure ?
simple partial seizure
complex partial seizure
tonic clonic seizure
what is a simple partial seizure ?
hallucinating, confused, disorientated
what is a complex partial seizure ?
patient may become unconscious
what is a tonic clonic seizure ?
patient is unconscious and convulses
what are the signs and symptoms of a tonic clonic seizure ?
pre seizure aura,
tonic phase - brief cry precedes loss of consciousness with ridged extended body,
clonic phase - widespread jerking movements,
tongue biting, incontinence, cyanosis,
slow recovery
how do you manage a seizure ?
ensure airway open and protected, breathing, beware of hypotension, check glucose, high flow oxygen, recovery position, buccal or intranasal midazolam, ambulance
what is the dosage of midazolam ?
1-5 years 5mg,
5-10 years 7.5mg,
>10 years 10mg
