Medical emergencies dentally relevant questions Flashcards
What ASA system would a dentist be expected to treat?
ASA 1 (healthy) to ASA 3 (severe systemic disease)
What are geudal airways used for?
Enable easier ventilation when doing ABCDE
How long do you listen to breathing when doing ABCDE?
10 seconds
What increase in blood volume does lying patient flat and raising legs when unconscious?
40% increase
If patient is struggling to breathe what position are they put in? and anaphylaxis exception?
Sat upright
Anaphylaxis - flat
What position should a pregnant woman be placed in a medical emergency and why?
Left lateral position
On right, inferior vena cava, therefore venous return will be worse
If flat, minimal venous return and will cause supine hypotension syndrome
In emergency anaphylaxis what should occur in dental practice?
How do the doses differ in children?
ABCDE
0.5ml 1:1000 sol. IM adrenaline in anterolateral thigh/ deltoid for 10 seconds
(<6months = 0.05ml, 6months-6yrs = 0.12ml, 6-12yrs = 0.25ml)
Repeat after 5 minutes if no change
Lie flat, maintain airway and give oxygen
How must carpal spasm and hyperventilation be managed?
Rebreathing exhaled air (more carbon dioxide) - using paperbag
What are the actions that need to be taken if an asthma attack were to occur in the dental chair?
ABCDE
B2-adrenoreceptor stimulant (salbutamol) inhaler via spacer
Struggling to breathe sit up
Repeat inhaler every 10 minutes
What is given in a suspected angina attack? and then MI?
GTN spray sublingual
300mg aspirin for MI - improves prognosis
What are the actions that need to be taken if an epileptic seizure were to occur in the dental chair?
How do the doses differ in children?
10mg midazolam in buccal sulcus or floor of nose
ABCDE
(<6months = 2.5mg max, 6months-1yr = 2.5mg, 1-5yrs = 5mg, 5-10yrs = 7.5mg)
What is the 1.conscious and 2.unconscious management of a hypoglycaemic attack?
- Oral glucose: glucogel/ 2-4tsp of sugar
1. IM/SC 1mg glucagon
What treatment is provided in an adrenal crisis?
Dentist: Put pt flat and legs up, clear airway, oxygen 15L/min
Paramedics: 200mg IV hydrocortisone, IV fluids
How is a MI treatment in a child carried out?
5 rescue breaths, 15 compressions, 2 ventilations
How is meningitis detected?
Roll tumbler and doesn’t fade
What are 1.shockable and 2.non shockable arrhythmia’s with an AED?
- VF, pulseless VT
2. Asystole, pulseless electrical activity
What is the normal amount of oxygen to give a patient in a medical emergency?
15L/min
What is impetigo and how is it treated?
Staphylococcus skin infection with gold encrusted highly infectious lesions
Fuscidic ointment or penicillin-based antibiotic if systemic
What are oral signs a patient has addisons disease?
Adrenal hypofunction
Pigmentation in buccal mucosa/ FOM
What is the treatment for oral lichen planus?
Low dose steroids
How is CN IX palsy tested for?
Patient says AHHH, uvula moves to RHS = LHS problem
What is the oral side effect of CCBs?
Gingival overgrowth
What is the steroid, brown inhaler called?
Beclomethasone
What homeostatic measures should be taken in a person with a bleeding disorder?
Local measures - sutures, oxidised cellulose
Anti-fibrinolytic agents - tranexamic acid
What drug is used in treatment of hypothyroidism?
Thyroxine
What drug is used in treatment of hyperthyroidism?
Carbimazole, radioiodine 131, surgery
Name 4 types of shock.
Hypovolaemic, distributive, obstructive, cardiogenic
What causes hypovolaemic shock and what treatment can be used?
Loss of intravascular vol. by haemorrhage, burns, GI loss
Treatment: ABCDE, identify and control bleeding, replace fluids/bloods
What causes distributive shock and what treatment can be used?
Failure of vasoregulation, caused by sepsis, anaphylaxis, neuro injury
Treatment: Sepsis 6, Anaphylaxis adrenaline tx
What causes cardiogenic shock and what treatment can be used?
Pump dysfunction, caused by MI, cardiomyopathy, dysrhythmia
Treatment: Revascularise if MI, correct arrhythmia
What causes obstructive shock?
Physical obstruction, caused by tension pneumothorax, cardiac tamponade, pulmonary embolism
What is the sepsis 6?
GIVE: oxygen, IV antibiotics, IV fluids
TEST: bloods, lactate, urine output
What type of interaction is caused between nystatin and miconazole?
Renal problems - horrendous interaction causing ICU condition
What is the positive interaction between LA and adrenaline?
Prolonged effect and vasoconstriction
What LA does not contain adrenaline?
Mepivacaine
What is the difference between a pharmacokinetic and pharmacodynamic interaction?
Pharmacokinetics - modification of drug X by drug Y, as Y alters the concentration of X reaching action site
Pharmacodynamics - Y alters X without altering concentration
How can pharmacokinetics affect distribution? Give example drugs.
If drugs are highly PPB, therefore competition and if not bound very active drug.
Examples: aspirin, warfarin, carbamezapine
Where is articaine metabolised?
Plamsa
Where is prilocaine metabolised ?
Partly metabolised in the lungs
What is the drug interaction of warfarin and azoles?
They both compete for drug metabolising enzymes in the liver (isosymes - e.g. cytochrome P450 family).
Therefore decreased clearance of warfarin and increased concentration in the blood.
Prolonged effect and increased dose dependent toxicity.
What drug interaction happens between SSRIs and triptan?
Serotonin syndrome
Why do propanolol and salbutamol interaction with each other?
Propanolol is a beta blocker and salbutamol is a beta agonist
What is the interaction between NSAIDs and corticosteroids?
Peptic ulceration
