medical emergencies Flashcards by Grace Dillett

what does adrenal insufficiency happen as a result of?

after prolonged therapy with steroids

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

hypotensive under stress

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what are some signs of adrenal insufficiency?

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

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what is the medical management of adrenal insufficiency?

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

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

a patient in resp failure?

94-98%

88-92%

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what is anaphylaxis?

a severe allergic reaction

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

the more profound a reaction

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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

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what are 4 steps in anaphylaxis management?

restore airway
restore bp by lying pt flat
severe anaphylaxis - administer 0.5mL adrenaline intramuscularly
Hospital

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adrenaline can be repeated how often?

and depending on what?

every 5 mins

depending on bp/pulse/resp rate

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where is an IM injection best placed?

anterolateral aspect of middle 1/3 of thigh

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what is the adrenaline dosage of a

15mL
3mL
5mL

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what is asthma?

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

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what is moderate acute asthma?

pt able to speak

resp rate

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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

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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

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treatment of severe acute asthma?

high flow oxygen

same as for mod acute

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what is life threatening acute asthma?

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

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treatment of life threatning asthma?

same as before

hospital

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what to ask a patient RE asthma?

how well controlled?

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

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why does an MI occur?

ischemia - lack of oxygen to the heart

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what differs an MI to angina?

pain is more severe and lasts longer

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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

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stages of MI treatment?

reassurance/ambulance
Try GTN 1-2 sprays of 400mg
O2
300mg aspirin crushed/chewed

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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