medical emergencies Flashcards
what does adrenal insufficiency happen as a result of?
after prolonged therapy with steroids
what may patients with adrenal insufficiency become in the dental practice?
hypotensive under stress
what are some signs of adrenal insufficiency?
anxious, stressed, irritable mental confusion nausea, vomitting lowered BP rapid weak pulse
what is the medical management of adrenal insufficiency?
lay patient flat
give oxygen
transport to hospital
dentist may give hydrocortisone
what O2 sats are you aiming for with an acutely ill patient?
a patient in resp failure?
94-98%
88-92%
what is anaphylaxis?
a severe allergic reaction
if anaphylaxis has a more rapid onset what does that usually mean?
the more profound a reaction
what are some signs/symptoms of anaphylaxis?
wheezing, dysponea urticaria, rash, itch facial flushing pallor/cyanosis drowsy and confused rapid weak pulse loss of conscious and cardiac arrest bronchospasm
what are 4 steps in anaphylaxis management?
- restore airway
- restore bp by lying pt flat
- severe anaphylaxis - administer 0.5mL adrenaline intramuscularly
- Hospital
adrenaline can be repeated how often?
and depending on what?
every 5 mins
depending on bp/pulse/resp rate
where is an IM injection best placed?
anterolateral aspect of middle 1/3 of thigh
what is the adrenaline dosage of a
- 15mL
- 3mL
- 5mL
what is asthma?
narrowing of airways
allergic reaction
can be the result of anxiety (dentist can precipitate)
what is moderate acute asthma?
pt able to speak
resp rate
what is the treatment of moderate acute asthma?
should respond to short acting beta agonist via large volume spacer
2-10 puffs repeated 10-20 mins
what is severe acute asthma?
pt unable to complete sentence in one breath resp rate >25, >40, >30 pulse >110, >140, >125 arterial sats >92, under 92 for child peak flow 33-50% of expected best
treatment of severe acute asthma?
high flow oxygen
same as for mod acute
what is life threatening acute asthma?
silent chest, feeble resp effort, cyanosis hypotension bradycardia exhaustion loss of conscious agitation - children o2 sats
treatment of life threatning asthma?
same as before
hospital
what to ask a patient RE asthma?
how well controlled?
frequency of attacks, how often are meds needed to control.
why does an MI occur?
ischemia - lack of oxygen to the heart
what differs an MI to angina?
pain is more severe and lasts longer
signs of an MI?
severe crushing chest pain, spreading to neck/jaw/shoulder/arm
pale and clammy skin
weak pulse and fall in BP
breathless
stages of MI treatment?
- reassurance/ambulance
- Try GTN 1-2 sprays of 400mg
- O2
- 300mg aspirin crushed/chewed
if pt loses consciousness during MI do what?
CPR if necessary
why is aspirin given in an MI?
for anti platelet effects
what are some signs of an epileptic seizure?
tonic phase
clonic phase
what is the treatment of a seizure?
assure no risk of injury
administer o2
dont restrain
post ictal confusion - reassure
when would you seek medical attention with a seizure?
if first seizure
prolonged/atypical/recurrent
trauma
when would you give midazolam with a fitting patient?
if seizure lasts over 5 mins
hypolycaemic attack is when..?
blood glucose
what are some signs of hypoglycaemia?
shaking/sweating pins and needles hunger palpitation headache concentration is off slurred speach confusion convulsions agitated unconscious
what is the management of a conscious hypoglycaemic patient?
10-20g glucose
coca cola/ribena/lucozade
2 tsp sugar
3 sugar cubes
what is the management of an unconscious hypoglycaemic pt?
buccal glucose
glucagon IM 1mg
child
when should the recovery position be used?
pt unconscious but breathing
how is the recovery position achieved?
hand closest to you, lift up hand furthest away, place palm side to opp side of face lift up leg furthest away pull leg and arm towards you pull leg out slightly to stabilise maintain airway
stages of BLS?
safe to approach? shake/shout - check for response shout for help check airway for obstructions head tilt/chin lift look/listen/feel for 10 seconds check carotid pulse CPR
what makes CPR good CPR?
30:2 compression :breath centre of chest and heel of hand shoulders directly above wrists 100-120bpm 5-6cm compression depth allow recoil
what is an effective cough?
ineffective?
which cough needs further help?
effective - pt breathing between cough - encourgae to keep going til obstruction removed
ineffective - pt unable to breathe - needs intervention
how to help a choking pt?
back blows
abdo thrusts
how to carry out a back blow?
lean pt forward
5 back blows with heel of hand between shoulder blade
check between each to see if they have worked
how to carry out abdo thrusts?
clench fist above belly button
5 thrusts
can only do back blows and abdo thrusts when pt is…?
conscious
unconscious = CPR
how to manage a choking child?
small infants/babies can be help upside down/across knee on stomach
back blows/abdo thrusts/chest thrusts
how can you tell an airway is partially obstructed other than by looking?
if breathing is noisy
noisy inspiration suggests?
noisy expiration suggests?
- layrngeal blockage
- lower airway blockage
what else can be used to aid an obstructed airway other than head tilt/chin lift or jaw thrust?
oropharyngeal airways
how are oropharyngeal airways used and what for?
to prevent backwards displacement of the tongue
measured from incisors to angle of mandible
entered upside down and flipped in mouth
sizes 1-4
when using an AED where are the pads placed?
bare upper right chest
bare lower left chest
resuming shock delivery from an AED continue CPR for how long?
2 mins
AED is used to treat?
ventricular tachycardia
ventricular fibrillation
what can pose as dangers when using an AED?
water, oxygen, metal
what does ABCDE stand for?
airways breathing circulation disability environment
what is assessed in AIRWAY?
look listen feel high flow o2 open airway adjuncts if necessary call for help
what is assessed in BREATHING?
resp rate chest inspection palpitation listen 02 sats 02 high flow
what is assessed in CIRCULATION?
assess pulse/bp/CRT/peripheral colour
look for signs of shock
what is assessed in DISABILITY?
assess CNS/AVPU
BM
what is assessed in ENVIRONMENT?
rashes
temp
what differs in pediatric life support from adult?
5 rescue breaths before compressions
compress chest to 1/3 of depth
infant under 1 = 2 fingers
infant over 1 = one hand
how to inflate an oxygen mask?
hold finger over inner valve and let bag inflate
always remember to do what when IM Injecting?
aspirate
what does SBAR Stand for?
situation
background
assessment
recommendation
