Medical Emergencies / BLS / Other Flashcards
BLS for baby
SSSABCR
S - safety - assess surroundings for danger
S - stimulate - shake shoulders or use voice stimulant
S - shout - for help
A - airway head tilt, chin lift or jaw thrust
B - breathing - stop here & do 5 rescue breaths then move onto checking pulse
C - circulation - brachial arm pulse absent or <60bpm = start CPR
R - reassess - most important; call 999 if no improvement
CPR for baby
initial 5 rescue breaths with mouth over mouth & nose
15 compressions to 2 rescue breaths
compressions =
- 1/3 depth of child 100-120/min & 2/sec
- trace along ribs to find xiphisternum, place thumb & fingers above this & squeeze down with thumbs & place rest of fingers around the back - encircling technique
hold mandible with c shape grip & not on the neck
for choking baby
hold child on forearm & place hand around mandible in c shape, lay on knee for stability and angle downwards
heal of hand on top of back for 5
support head on occupy - flip onto other arm & do sharp finger thrusts for 5
if child becomes unconscious start CPR & phone 999
for choking small child
ask if they are choking & encourage them to cough
go down on knees, arm on front of shoulders & heal of hand back slaps for 5
stand them up, use dominant hand find half way between belly button & xiphisternum & do 5 thrusts
if unconscious start CPR & phone 999
how to radiographic report an OPT
systematic manner
type of xray, age date etc
quality
grade 1 = diagnostically excellent no positioning errors
grade 2 = diagnostically acceptable with error in positioning / elsewhere
grade 3 = diagnostically unacceptable
dentition
teeth = erupted / unerupted / permanent / primary / mixed / missing / supernumerary / impacted / ectopic
restorations = heavily / moderate / mild / overhangs / # / poor margins
trauma
disease
caries = primary / secondary / supra or sub gingival / PA pathology
perio = bone levels / localised / generalised / supra or sub gingival calculus
endo = well or poorly compacted / material / how many mm from or to apex / separated instruments etc
TMJ
other = cysts
SIRS - criteria & mx
SIRS = systemic inflammatory response syndrome
4 criteria from NEWS assessment ( national early warning score )
1. temp <36 or >38
2. white cell count <4 or >11 thousand per mm/3
3. tachycardia pulse >90bpm
4. tachypnoea resp rate >20bpm
2/4 of these required for definition of sepsis syndrome & requires URGENT referral
when to urgently refer
- spread of infection to pharyngeal or submandibular space
- systemic manifestations & immunocompromised
- trouble swallowing / breathing
- rapidly progressing infection
antibiotics for dental abscess if systemic manifestations or immunocompromised
always try local measures 1st - drain by XLA / through canal or via soft tissue incision
amoxicillin - 500mg x3 for x5 days
metronidazole 400mg x3 for x5 days
LA common formulation & doses, assembly, side effects & check
lidocaine 2%HCl 1:80k adrenaline max 7mg/kg
articaine 4% HCl 1:100kadrenaline max 6mg/kg
prilocaine 3% w/ felypressin max 8mg/kg
assembly - check batch & exp, check bung is on right way around
side effects - allergic reaction (rash, tingling, breathing problems), seizure, cardiac arrest, nausea, vomiting, dizziness, headache, blurred vision, twitching muscles, nerve damage, continuing numbness, haematoma, tachycardia
check - ask pt do they feel tingling sensation / rubbery, check via percussion to tooth, probe to gingivae / palate
cleaning unit
wear appropriate PPE
dispose of all sharps, clinical waste then domestic waste
wipe down bay in prep for next pt
start from top - dental light, control surfaces, full length of all cables
change wipes for chair & spittoon
change wipes for bench top surfaces, computer keyboard & mouse
choking adult
ABCDE
are you choking
can you cough
5 back slaps between shoulder blades
5 abdominal thrusts between belly button & sternum
continually checked for object dislodging
re evaluate ABCDE
BLS if still not resolved
call 999
difference between type N & type B sterilisers, type of water used, tests for sterilisers, if instruments on top of steriliser how do you know if sterilised & what do you do
type N - non vacuum, passive air removal, unwrapped solid products, non hollow, non lumened
type B - vacuum, active air removal, packaged instruments, lumened, hollow cannulated or porous
cycle -
stages - air removal sterilising drying cooling
134-137 degrees, 2-2.3 bar pressure for minimum holding time of 3mins
water used = reverse osmosis / distilled / sterilised / deionised
tests
- daily = wipe clean, change water, ACT, steam penetration test (bowie dick or helix)
- weekly = vacuum leak test, automatic air detector function test
- quarterly = validation report (taking loads of data for effectiveness of steriliser)
- yearly = annual report (by insurance company for safety e.g. check pressure release valves)
for instruments on top of steriliser
- should be set out non overlapping with hinged instruments open
- check for recent print out from steriliser
- check if colour change of packaged instruments; brown to pink & helix / bowie dick from yellow to blue
- if unsure take tray of instruments back to beginning cleaning in AWD or manual cleaning
explain asthma & anaphylaxis drugs to nurse, how to tx asthma attack, what to do if it turns to anaphylaxis, how to use adrenaline & what it is
asthma -
medication = salbutamol; SA beta 2 agonist relaxes smooth muscle in bronchi causing bronchodilation
assess ABCDE
signs = airway constriction, bronchoconstriction, fast breathing, wheezing, gasping, clutching chest, blushing, tachycardia
call ambulance
administer - salbutamol inhaler 100ug per actuation, shake, press, inhale, hold 10 sec, 4 actuations in large volume spacer 20secs inhalation and then put on O2 & repeat as required
reassess ABCDE & administer 100% O2 15L/min flow rate
anaphylaxis -
medication = adrenaline; powerful vasoconstrictor, bronchodilator & increases contractability of myocardium
assess ABCDE
signs = airway constriction / bronchoconstriction / fast irregular breathing / stridor / blushing / tachycardia / weak pulse / urticaria / angioedema
anaphylactic shock = inability to perfuse organs
secure airway
call ambulance
administration = adrenaline 1/2 of 1ml ampule 1:10000 = 500ug IM inj
aspirate as can generate arrhythmia
use Z track technique to inject into thigh / bicep - spread skin, advance needle in 90degrees, aspirate, inject 30s, pull out release tension
note that life threatening so no time to alcohol wipe skin & remove clothing
reassess ABCDE
administer 100% O2 15L/min flow
difference between the 2 = check MH or series of events leading to episode, asthma only has resp symptoms and those caused by hypoxia while anaphylaxis is systemic presenting with weaker pulse, urticaria (hives on skin) and angioedema (swollen face)
messy bracket table, how to rectify, waste streams, disposal of amalgam & sharps, cleaning up blood spillage
dangers:
bracket table = LA needle unsheathed, scalpel, tooth in forceps, endo files
surgery = sharp box on floor, gloves in sink, blood spillage
waste streams:
black - household waste i.e. packaging, hand towels
orange - low risk clinical waste i.e. swabs, dressings, non sharp clinical waste e.g. dam, microbrush
yellow - high risk clinical waste i.e. body parts
red - specialist, hazardous waste i.e. amalgam in white box with red lid that is spill / leak proof with mercury vapour suppressant in lid
blue - sharps inc vials with medication or pharmaceuticals in them
orange stream sharps box - 3As 2Ns
A - always dispose of sharps immediately after use
A - always keep out of reach of children & non authorised personnel
A - always close sharps box between use using temporary closing mechanism
N - never retrieve anything from sharps box
N - never fill more than 3/4 full; place at waist height on a flat surface
blood spillage -
- stop what you are doing
- apply appropriate PPE
- cover with disposable paper towels
- apply sodium dichloroisocyanurate liquid / powder / granules 10,000ppm
- leave for 3-5mins & use scoop to take gross contamination to orange waste
- clean with water & general purpose neutral detergent disinfectant wipes
explain hypoglycaemia & seizure / epilepsy to nurse & discuss drugs
hypoglycaemia -
medication = glucagon; increases concentration of glucose in the blood by promoting gluconeogenesis & glycogenolysis to convert glycogen into glucose
T1DM hypoglycaemic coma normal = 5-7mmolm unconscious <3mmol
assess ABCDE
signs - pale, sweaty, shaky, clammy, dizzy, hungry, confusion, blurred vision, loss of consciousness
*must mention LoC as it defines tx:
if conscious & cooperative -> administer oral glucose 10-20g or sugary drink
if unconscious / uncooperative -> 1mg IM glucagon inj & oral glucose when they regain consciousness (~15mins, 2nd dose if not)
IM inj - inject diluting solution in vial with glucagon powder, swirl to mix, don’t shake as will foam, use Z track technique to inject into thigh/bicep
reassess ABCDE
epilepsy -
medication = midazolam; short acting benzodiazepine that enhances the effect of neurotransmitter GABA on the GABA receptors resulting in neural inhibition
signs - LoC / uncontrollable muscle spasms / drooling / tonic (falls rigid) / clonic (sharp jerky movements) / hypotension / hypoxia / loss of airway tone
assess ABCDE
do not try to restrain convulsive movements but ensure pt not at risk from injury
secure airway
administer 100% O2 15L/min flow rate
if fit repeated or prolonged (>5min) given midazolam 2ml oromucosal solution, 5mg/ml topically into buccal cavity (10mg) - repeat after 5mins if not worked
check exp date & form of midazolam is compatible with buccal admin & choose appropriate dosage
if subsided - recovery position & check airway
refer to hospital if: 1st seizure, seizure is atypical, injury was caused or difficult to monitor pt
handpiece safety
- back cap checked - gripped & turned anticlockwise
- bur security checked - suitable force applied to remove bur
- tension applied to handpiece when fitted to coupling; assess if handpiece is attached safely
- bur rotated laterally with fingers; attempts to spin bur, rolls along finger
- attempts to move bur laterally; pushes bur from side to side a few times
- handpiece sound tested; runs for 5secs or more & views bur movement
