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medical emergencies Flashcards

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1
Q

what does adrenal insufficiency happen as a result of?

A

after prolonged therapy with steroids

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2
Q

what may patients with adrenal insufficiency become in the dental practice?

A

hypotensive under stress

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3
Q

what are some signs of adrenal insufficiency?

A 
anxious, stressed, irritable
mental confusion
nausea, vomitting
lowered BP
rapid weak pulse
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4
Q

what is the medical management of adrenal insufficiency?

A

lay patient flat
give oxygen
transport to hospital
dentist may give hydrocortisone

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5
Q

what O2 sats are you aiming for with an acutely ill patient?

a patient in resp failure?

A

94-98%

88-92%

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6
Q

what is anaphylaxis?

A

a severe allergic reaction

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7
Q

if anaphylaxis has a more rapid onset what does that usually mean?

A

the more profound a reaction

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8
Q

what are some signs/symptoms of anaphylaxis?

A 
wheezing, dysponea
urticaria, rash, itch
facial flushing
pallor/cyanosis
drowsy and confused
rapid weak pulse
loss of conscious and cardiac arrest
bronchospasm
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9
Q

what are 4 steps in anaphylaxis management?

A
  1. restore airway
  2. restore bp by lying pt flat
  3. severe anaphylaxis - administer 0.5mL adrenaline intramuscularly
  4. Hospital
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10
Q

adrenaline can be repeated how often?

and depending on what?

A

every 5 mins

depending on bp/pulse/resp rate

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11
Q

where is an IM injection best placed?

A

anterolateral aspect of middle 1/3 of thigh

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12
Q

what is the adrenaline dosage of a

A
  1. 15mL
  2. 3mL
  3. 5mL
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13
Q

what is asthma?

A

narrowing of airways
allergic reaction
can be the result of anxiety (dentist can precipitate)

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14
Q

what is moderate acute asthma?

A

pt able to speak

resp rate

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15
Q

what is the treatment of moderate acute asthma?

A

should respond to short acting beta agonist via large volume spacer
2-10 puffs repeated 10-20 mins

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16
Q

what is severe acute asthma?

A 
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
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17
Q

treatment of severe acute asthma?

A

high flow oxygen

same as for mod acute

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18
Q

what is life threatening acute asthma?

A 
silent chest, feeble resp effort, cyanosis
hypotension
bradycardia
exhaustion
loss of conscious
agitation - children
o2 sats
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19
Q

treatment of life threatning asthma?

A

same as before

hospital

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20
Q

what to ask a patient RE asthma?

A

how well controlled?

frequency of attacks, how often are meds needed to control.

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21
Q

why does an MI occur?

A

ischemia - lack of oxygen to the heart

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22
Q

what differs an MI to angina?

A

pain is more severe and lasts longer

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23
Q

signs of an MI?

A

severe crushing chest pain, spreading to neck/jaw/shoulder/arm
pale and clammy skin
weak pulse and fall in BP
breathless

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24
Q

stages of MI treatment?

A
  1. reassurance/ambulance
  2. Try GTN 1-2 sprays of 400mg
  3. O2
  4. 300mg aspirin crushed/chewed
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25
Q

if pt loses consciousness during MI do what?

A

CPR if necessary

26
Q

why is aspirin given in an MI?

A

for anti platelet effects

27
Q

what are some signs of an epileptic seizure?

A

tonic phase

clonic phase

28
Q

what is the treatment of a seizure?

A

assure no risk of injury
administer o2
dont restrain
post ictal confusion - reassure

29
Q

when would you seek medical attention with a seizure?

A

if first seizure
prolonged/atypical/recurrent
trauma

30
Q

when would you give midazolam with a fitting patient?

A

if seizure lasts over 5 mins

31
Q

hypolycaemic attack is when..?

A

blood glucose

32
Q

what are some signs of hypoglycaemia?

A 
shaking/sweating
pins and needles
hunger
palpitation
headache
concentration is off
slurred speach
confusion
convulsions
agitated
unconscious
33
Q

what is the management of a conscious hypoglycaemic patient?

A

10-20g glucose
coca cola/ribena/lucozade
2 tsp sugar
3 sugar cubes

34
Q

what is the management of an unconscious hypoglycaemic pt?

A

buccal glucose
glucagon IM 1mg
child

35
Q

when should the recovery position be used?

A

pt unconscious but breathing

36
Q

how is the recovery position achieved?

A 
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
37
Q

stages of BLS?

A 
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
38
Q

what makes CPR good CPR?

A 
30:2 compression :breath
centre of chest and heel of hand
shoulders directly above wrists
100-120bpm
5-6cm compression depth
allow recoil
39
Q

what is an effective cough?
ineffective?
which cough needs further help?

A

effective - pt breathing between cough - encourgae to keep going til obstruction removed
ineffective - pt unable to breathe - needs intervention

40
Q

how to help a choking pt?

A

back blows

abdo thrusts

41
Q

how to carry out a back blow?

A

lean pt forward
5 back blows with heel of hand between shoulder blade
check between each to see if they have worked

42
Q

how to carry out abdo thrusts?

A

clench fist above belly button

5 thrusts

43
Q

can only do back blows and abdo thrusts when pt is…?

A

conscious

unconscious = CPR

44
Q

how to manage a choking child?

A

small infants/babies can be help upside down/across knee on stomach
back blows/abdo thrusts/chest thrusts

45
Q

how can you tell an airway is partially obstructed other than by looking?

A

if breathing is noisy

46
Q

noisy inspiration suggests?

noisy expiration suggests?

A
  • layrngeal blockage

- lower airway blockage

47
Q

what else can be used to aid an obstructed airway other than head tilt/chin lift or jaw thrust?

A

oropharyngeal airways

48
Q

how are oropharyngeal airways used and what for?

A

to prevent backwards displacement of the tongue
measured from incisors to angle of mandible
entered upside down and flipped in mouth
sizes 1-4

49
Q

when using an AED where are the pads placed?

A

bare upper right chest

bare lower left chest

50
Q

resuming shock delivery from an AED continue CPR for how long?

A

2 mins

51
Q

AED is used to treat?

A

ventricular tachycardia

ventricular fibrillation

52
Q

what can pose as dangers when using an AED?

A

water, oxygen, metal

53
Q

what does ABCDE stand for?

A 
airways
breathing
circulation
disability
environment
54
Q

what is assessed in AIRWAY?

A 
look listen feel
high flow o2
open airway
adjuncts if necessary
call for help
55
Q

what is assessed in BREATHING?

A 
resp rate
chest inspection
palpitation
listen
02 sats
02 high flow
56
Q

what is assessed in CIRCULATION?

A

assess pulse/bp/CRT/peripheral colour

look for signs of shock

57
Q

what is assessed in DISABILITY?

A

assess CNS/AVPU

BM

58
Q

what is assessed in ENVIRONMENT?

A

rashes

temp

59
Q

what differs in pediatric life support from adult?

A

5 rescue breaths before compressions
compress chest to 1/3 of depth
infant under 1 = 2 fingers
infant over 1 = one hand

60
Q

how to inflate an oxygen mask?

A

hold finger over inner valve and let bag inflate

61
Q

always remember to do what when IM Injecting?

A

aspirate

62
Q

what does SBAR Stand for?

A

situation
background
assessment
recommendation

CMS OSCE (3 decks)

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