Medical Emergencies I Flashcards
1. To carry out effective risk assessment in a dental setting 2. To recognise a sick patient 3. To recognise the essential emergency drugs and equipment required to manage medical emergencies in a dental practice 4. To understand the general principles of emergency management in a dental practice 5. To recognise the clinical signs and symptoms of common emergencies
What is observed in the physical examination of the patient
Posture Body movements Speech quality Feel and colour of patient's skin Odours on the breath Rate and pattern of respitation
What are the cardiovascular emergencies
- Myocardial infarction
- Angina
- Cardiac arrest
- Syncope (fainting)
- Postural hypotension
What are the respiratory emergencies
- Hyperventilation
- Respiratory arrest
- Acute respiratory obstruction (could be due to inhaled foreign body)
- Asthma
What are neurological emergencies
- CVA (stroke)
- Status epilepticus
- Loss of consciousness
What are metabolic emergenices
- Hypoglycaemia
- Hyperglycaemia
- Addisonian crisis
What are miscellaneous medical emergencies
Anaphylaxis
Drug overdose
Drug allergy
Drug interactions
What drugs are in the ME kit and when are they used
GTN spray
- sublingually for angina as it is a potent vasodilator
Salbutamol
- inhaled for asthma as it is a B2 agonist
Adrenaline
- IM for anaphylaxis as it is an a-receptor agonist, B1 + B2 agonist, stabalises mast cells and elevates glucose
Aspirin dispersable
- oral for MI as it is an antiplatelet drug
Glucagon
- IM for unconscious hypoglycaemia as it causes glycogenolysis
- same for glucose solution when the patient is concious during hypoglycaemia
Midazolam
- buccal for epilepsy (status epilepticus) as it is a muscle relaxant
Oxygen
- inhalation for syncope, MI, stroke, anaphylaxix, epilepsy and adrenal insufficiency
List medical emergency equiptment
- Portable oxygen cylinder
- Oxygen face mask with reservoir and tubing
- Pocket mask with oxygen port
- Basic set of oropharyngeal airways
- Self-inflating bag and mask apparatus
- Adult and child face masks for use with self-inflating bag
- Portable suction e.g. Yankauer sucker
- Single use sterile syringes, needles, PPE
- Spacer device for inhaled brochodilators
- Automated blood glucose measurement device
- Automated external defibrillatior (AED)
What are the general principles of management during a medial emergency
- Stay calm, use all members of team
- ABCDE
- Treat life-threatening problems as they are identified before moving onto the next part of the assessment
- Assess the effects of any treatment given (takes few mins)
- Continually re-assess starting with ABCs
- Recognise when extra help is needed and call 999 for an ambulance early
What are the sings of airway obstruction
- Paradoxical chest movements
- Use of accessory muscles of respiration
- Central cyanosis in late stage
- Partial obstruction: stridor, wheeze, gurgling, snoring
- Complete obstruction: no breath sound possible
What are the methods of airway clearance that can be used in obstruction
- Open airway by head tilt/ chin lift/ jaw trust
- Can use oropharyngeal airway adjuncts
- Give O2 at 15L/min flow rate
How are breathing problems identified
- Look, listen and feel for general signs of respiratory distress and count respiratory rate
- Assess breath depth, respiration pattern and whether chest expansion is normal and equal on both sides
- Listen to patients breath sounds short distance away form the face
What should be done when a breathing problem is identified in a patient
If depth or rate is inadequate/undetectable, give O2 and call immediately for n ambulance
Commonly = hyperventilation, panic attacks and both of these will resolve with simple reassurance
How can circulation be checked
Check colour of hands and fingers
Assess limb temperature by feeling patient’s hand
Measure the capillary refill time
Count the patients pulse rate
What is suggestive of poor circulation and how can this be managed
Weak pulses, decreased conscious level, slow capillary refill time = low BP
- lay patient down and raise their legs
- if no response, call ambulance
Simple faints/vaso-vagal episodes
- lay patient flat and raise their legs
- ABCDE approach
