MEDICAL EMERGENCIES Flashcards
THE ANXIETY THAT SOME PATIENTS EXPERIENCE HAVE THE FOLLOWING EFFECTS:
- lowers the pain threshold so that “discomfort” is experienced as “pain’’, producing an agitated or even uncooperative patient
- perception of being about to fell pain, so that stress levels and the anxiety state are raised - this can then put a huge strain on the patient’s body, especially the heart and circulatory system
- fear and anxiety at the prospect of dental treatment may worry patients enough to prevent them from eating beforehand, for fear of vomiting - they will then have a low blood sugar and be more prone to fainting; in diabetic patients, this low blood sugar is likely to precipitate a hypoglycemic attack
In addition, the following points also have to be considered by the dental team: - many dental treatments invlove the injection of local anaestethic, and these drugs may interact with some common patient medications
- any of the dental materials, antibiotics or local anaesthetics used in dentistry have the potential to cause an allergic reaction in the patient, the worst-case scenario being a full anaphylactic reaction
- many dental treatments are carried out with the patient lying SUPINE (flat) in the dental chair, and this leaves the airway potentially vunerable to foreign object innhalation, chocking and a full respiratory obstruction emergency
THE PATIENTS WHO POSE THE GREATEST CONCERN WITH REGARD TO MEDICAL EMERGENCIES ARE THOSE DIAGNOSED RISK FACTORS SUCH AS:
- HEART CONDITIONS - any abnormality or disorder of the heart may potentially allow unexpected problems to arise during stressful episodes, such as when undergoing dental treatment
- HYPERTENSION - anxiety often raises the systolic blood pressure, which can then put a considerable strain on an already malfunctioning heart
- LIVER OR KIDNEYDISORDERS - both these organs are responsible for eliminating waste products and toxins from the body, and any amount of malfunction due to disease could result in drugs not being detoxified and removed adequately
- DIABETES - uncontrolled diabetes or failure to take medications accuratley may result in an hypoglycaemic attack, in addition, diabetics tend to heal poorly and be more prone to infections, including those involving the oral cavity
- ALLERGIES - these patients are often sensitive, or even allergic to more than one allergen, so great care must be taken in order to avoid the use of known potential allergens in the dental workplace, such as latex and penicillin-based antibiotics
- certain medications known to react with some local anaesthetics - these are drugs that can be potentiated by adrenaline-containing local anaesthetics, and include medications such as some types of anti-depressants, thyroxine, and any medcation that may cause hypertension, such as some contraceptives and hormone replacement therapy
- previous history of complications during dental treatment - depending on the complication and its cause, it is possible for some to be a regular occurance with the same patient
long-term steroid treatment - this treatment tends to override the body’s own production of the hormones required to react to and survive stressful events, resulting in shock and a potentially fatal crash in the patient’s blood pressure when sstressful events do occur
SIGNS AND SYMPTOMS OF AN EMERGENCY:
the signs are what the rescuer can see with regard to the casualty, such as:
- SKIN COLOUR - is it pink, grey, red, pale?
- BREATHLESSNESS - are they gasping, breathing quickly, struggling to inhale or exhale
- SUDDENNESS OF ANY COLLAPSE - did the casualty fall straight to the ground, or did they slowly slump down?
- actions before collapse, such as clutching the chest
- CONDITION OF THE PULSE - is it fast, slow, weak, absent
at the same time, the casualty will feel symptoms, which may be asked about if they are not unconscious, such as:
- ANY PAIN - is it sharp, dull throbbing, made worse by anything?
- LOCATION OF PAIN - where is it felt exactly?
- NAUSEA - does the person feel sick or have they vomitted?
- DROWSINESS - do they feel sleepy (are they struggling to respond to verbal commands)?
- DIFFICULTY BREATHING - are they struggling to breathe in or out, or both?
- DIZZINESS - do they feel like they will fall over; is the room spinning
CAUSES OF COLLAPSE:
the following medical emergenices are all potentially life-threatening events:
- asthma attack
- anaphylaxis
- epileptic seizure
- diabetic hypoglycaemia or coma
- angina attack that may lead to myocardial infarcation
- choking that may lead to respiratory arrest
DRUG AND DOSE AND ROUTE GIVEN FOR (EMERGENCY) ASTHMA ATTACK:
- salbutamol metered dose 0.1 mg - inhaler
- oxygen - face mask
DRUG AND DOSE AND ROUTE GIVEN FOR (EMERGENCY) ANAPHYLAXSIS:
- adrenaline 1:1000 - IM injection
- oxygen - face mask
- hydrocortisone 100 mg - IM injection
- chlorphenamine 10mg/mL - IM injection
DRUG AND DOSE AND ROUTE GIVEN FOR (EMERGENCY) EPILEPTIC FIT:
- oxygen if possible - face mask
- midazolam buccal gel if fits is prolonged - oral
DRUG AND DOSE AND ROUTE GIVEN FOR (EMERGENCY) HYPOGLYCAEMIA:
- conscious = glucogel - oral
- unconscious = glucagon 1 mg - IM injection
DRUG AND DOSE AND ROUTE GIVEN FOR (EMERGENCY) ANGINA:
GTN metered dose 0.4 mg - sublingual
oxygen - face mask
DRUG AND DOSE AND ROUTE GIVEN FOR (EMERGENCY) MYOCARDIAL INFARCATION:
aspirin 300 mg - oral
oxygen - facemask
SIGNS, SYMPTOMS AND TREATMENT FOR FAINT:
This is a brief loss of consciousness due to a temporary reduction in oxygenated blood to the brain (HYPOXIA), and is the likeliest medical emergency to be ecountered in the dental surgery.
SIGNS - pale and clammy skin, weak and thready pulse, loss of conciousness
SYMPTOMS - dizziness, tunnel vision, nausea
TREATMENT:
- if UNCONSCIOUS - lie casualty flat with the legs raised above the head to restore blood flow to the brain
- maintain airway and loosen tight clothing
- provide fresh air flow or oxygen
- if CONSCIOUS - sit casualty with the head down, loosen tight clothing, provide fresh air
- give glucogel or dextrose tablet when consciousness returns to restore the blood sugar levels
SIGNS, SYMPTOMS AND TREATMENT FOR ASHTHMA ATTACK:
asthma is a pre-diagnosed hypersensitivity condition affecting the repiratory airways. they narrow in response to exposure to inhaled particles, so that exhaled air has to be forced out of the respiratory system and the casualty has difficult breathing. the same response can occur in stressful or fearful situations, or with excercise, especially if the casualty has a respiratory tract infection.
SIGNS - breathless with wheezing on expiration, cyanosis (blueness of lips), restlessness
SYMPTOMS - difficulty in breathing, sensation of suffocating or drowning
TREATMENT:
- administer SALBUTAMOL INHALER from emergency drug box
- give OXYGEN
- calm and reassure the casualty
- call 999 if the casualty does not make a rapid recovery
SIGNS, SYMPTOMS AND TREATMENT OF ANAPHYLAXSIS:
this is a severe allergic reaction by the casualty’s immune system to an allergen, such as with an allergy to penicillin, latex or food products such as nuts. the immune system overreacts to the allergen, causing sever swelling to the head and neck in particular, and a sudden fall in blood pressure (HYPOTENSION), causing collapse
SIGNS - rapid facial swelling, formation of a rash, gasping, collapse
SYMPTOMS - sudden onset of breathing difficulties, becoming severe, tingling of extremities
TREATMENT:
- call 999 urgently
- trained rescuer to administer ADRENALINE from the emergency drug box
- also STEROID and ANTIHISTAMINE if necessary
- maintain airway and give OXYGEN
- perform BASIC LIFE SUPPORT (BLS)
SIGNS, SYMPTOMS AND TREATMENT FOR EPILEPTIC FIT:
this is a pre-diagnosed condition, where there is a bried disruption of the normal electrical activity within the brain, causing a fit. the fits can occur mildy (PETIT MAL) and the casualty may appear to be daydreaming, or they may occur in a major form (GRAND MAL)
SIGNS - sudden loss of consiousness, followed by “TONIC-CLONIC” seizure, possible incontinence. tonic phase - casualty becomes rigid; clonic phase - casualty convulses
SYMPTOMS - casualty may experience an altered mood (aura) just before the fit begins, dazed on recovery, with no memory of the fit
TREATMENT:
- protect the casualty from injury, but mae no attempt to move them
- remove onlookers from the area and maintain the casualty’s dignity
- allow their recovery, then ensure they are escorted home
- if no recovery within 7 minutes, call 999
- trained rescuer to administer MIDAZOLAM buccal gel from emergency drug box
SIGNS, SYMPTOMS AND TREATMENT FOR HYPOGLYCAEMIA AND DIABETIC COMA:
these two condition may occur in pre-diagnosed diabetics who either have not followed their insulin regime correctly or have not eaten at the correct times. the resulting drop in blood glucose levels can be catastrophic and cause collapse. the timing of dental appointments involving local anaesthesia is crucial for tese patients, as they will be unable to eat without traumatizing their oral soft tissues until the anaesthetic has worn off. the dental team must therefore ensure that appointment times fit around the diabetic patient’s normal insulin and meal regimes
SIGNS - trembling, cold and clammy skin, becoming irritable to the point of being aggressive, drowsy, slurred speech, may mistakenly appear to be drunk
SYMPTOMS - confusion, disorientated, blurred or double vision
TREATMENT:
- if conscious, give GLUCOGEL TUBE orally from emergency drug box
- if unconscious, trained rescuer to administer GLUCAGON from emergency drug box
- maintain airway and give OXYGEN
- call 999 if no recovery
