Medical Emergencies II Flashcards
1. List the common medical emergencies in dentistry 2. Recognise the clinical signs and symptoms of common medical emergencies in dentistry 3. Understand the specific management of each common medical emergencies in dentistry 4. Recognise the essential drugs and equipment used to manage medical emergencies in dentistry 5. Understand the specific use of each essential drug and equipment used to manage medical emergencies in dentistry
List common medical emergencies in dentistry
Asthma, anaphylaxis, angina, adrenal insufficiency, aspiration and chocking, epileptic seizures, hypoglycaemia, myocardial infarction, syncope
What can trigger asthma in the dental surgery
Stress, anxiety, infection and allergen exposure
- attack can be severe and progress to be life threatening
What are the clinical signs of acute severe asthma
- inability to complete sentences in one breath
- respiratory rate >25/min
- tachycardia HR >110/min
What are the clinical signs of life threatening asthma
Cyanosis
Respiratory rate <8/min
Bradycardia HR <50/min
Exhaustion, confusion, decreased consciousness level
How is asthma managed
- Stop treatment and remove instruments from mouth
- Reassure patient and sit them in comfortable position
- Administer salbutamol (10 activations/min) with spacer
- Administer oxygen at rate of 15L/min
- Monitor vital signs
What are the different inhalers used to treat asthma
- Brown beclomethasone inhaler is a steroid preventer which the patient will take daily - this is not used in a medical emergency
- Salbutamol inhaler is a B2 agonist-reliever used in acute asthmatic attacks
Why is a spacer device used
Ensured the patient takes everything in and so delivery of the B-agonist into the lungs
What should be done if there is no rapid response features in a patient presenting with severe asthma
- Call 999
- Repeat salbutamol every 10 mins
- Monitor vital signs
- If unresponsive check B+C, if one or both are absent, start CPR
What is anaphylaxis
Severe, life-threatening, generalised or systemic hypersensitivity reaction (type I causing breathing and abdominal issues)
Can be hard to diagnose because it has inconsistent symptoms with a wide range of presentations
Using ABCDE is vital to diagnosis of anaphylaxis
What are the common triggers of anaphylaxis
Drugs (penicillin)
Latex
Additives in medicine
What are the sings and symptoms of anaphylaxis
Uticaria, erythema, rhinitis, conjunctivitis
Abdominal pain, vomiting, diarrhoea, sense of impending doom
Stridor, wheeze, hoarse voice (due to laryngeal oedema and bronchospasm), rapid breathing, fatigue, cyanosis, confusion
Respiratory arrest leading to cardiac arrest
How can anaphylaxis lead to cardiac arrest
Vasodilation occurs causing hypovolaemia and so low BP
This causes the patient to appear pale and clammy, and they will become drowsy and faint due to low oxygen perfusion in the brain
They will collapse and go into cardiac arrest
How is anaphylaxis managed
- Call 999 as soon as anaphylaxis is suspected
- Administer Adrenaline 500ug IM (0.5ml of 1:1000)
- Lay patient flat and raise their legs to restore BP
- Administer oxygen at rate of 15L/min
- Reassure patient and monitor vital signs
- If patient becomes unresponsive, check B + C and if one is absent start CPR
- All patients treated for anaphylaxis must be sent to hospital in an ambulance
How is adrenaline administered during anaphylaxis
Adrenaline injection IM into anteriolateral fat (midway between hip and knee)
EpiPen auto injection IM - clothing can remain, this doesn’t contain the normal dose for anaphylaxis
Emirade pen has the full adult dosage and can be repeated after 5 mins
What are the signs and symptoms of angina
- Acute chest pain of cardiac origin, crushing in nature
- Can radiate to the jaw, neck, shoulder and back
- Shortness of breath and increased respiratory rate
- Fast and slow heart rates, low BP, poor peripheral perfusion
- Altered mental state
- Feeling faint
How is angina managed in a medical emergency
Calm and reassure patient
Sit them up in a comfortable position
Administer 2 sprays of GTN spray sublingually (800ug)
Administer oxygen at 15L/min and monitor vital signs
Repeat GTN spray after 5 mins if no response
No improvement after repeated dose GTN - suspected MI
How does GTN spray relieve angina
It is a vasodilator which reduces preload and after load by dilating coronary artery
What are the signs and symptoms of MI
- Includes all those for angina
- Shortness of breath, nausea, vomitting
- Pale clammy skin and can be cyanosed
- Pulse is weak, irregular and BP may fall
- Rapid loss of consciousness
How can myocardial infarctions be managed
- Call 999
- Sit up in a comfortable position
- Give aspirin 300mg in single oral dose (crush/chew)
- Administer oxygen 15L/min and monitor vital signs
- If unresponsive check B + C, if one or both absent then start CPR
All patients treated for MI must be sent to hospital in an ambulance and inform the crew they have been given aspirin (because it is a blood thinner)
What are the drugs given in cardiac emergencies
GTN spray and aspirin
What can trigger an epileptic seizure
Stress, anxiety, dehydration/starvation, temperature extremities, bright/flashing lights
What are the signs and symptoms of epileptic seizures
- Brief warning/aura prior to fit
- Tonic phase
- Clonic phase
- Lasts few minutes and then patient regains consciousness
- May be confused (post-ictal confussion)
What happens in the tonic phase of epileptic seizures
sudden loss of consciousness, become rigid, falls, may give a cry, can become cyanosed
What happens in the clonic phase of epileptic seizures
Jerking movements of the limbs, toungue may be bitten, frothing, incontinence
How are epileptic seizures managed
- Stop all work and ensure surroundings are cleared
- Do not restrain convulsive movement
- Fitting may be a sign of hypoglycaemia - check blood glucose and if low give oral glucose/glucagon
- Place in recovery position after convulsion, clear airway and give oxygen 15L/min
- Most are self-limiting and only require protection from injury
- Medication is given in status epilepticus
- Send to hospital if there are any serious injuries
How is status epilepticus managed
Call 999 and administer midazolam 10mg bucally
Patient must be sent to hospital after recovery
What are the signs and symptoms of hypoglycaemia
Shaking, tremor
Irritated, aggressive, hard to concentrate, confused, disorientated
Thirsty, clammy, blurred vision, slurred speech
Headache, increased pulse rate
Fitting, seizure, loss of consciousness
How is early stage hypoglycaemia managed
When the patient is conscious and has a gag reflex
- give oral glucose (liquid, gel, powder, tablet)
- can repeat after 10-15mins
How is late stage hypoglycaemia managed
When the patient is uncooperative and unable to swallow
- give glucose gel by squeezing into buccal sulcus
What do you do if a diabetic patient fails to respond to glucose during hypoglycaemia
When there is signs of life
- measure blood glucose using automated blood glucose device (hypo = <3.0mmol/L)
- give glucagon IM 1mglml
- monitor vital signs (can take 10 mins for glucagon to work)
- after regaining consciousness give oral glucose
- re-measure blood glucose and check it has risen to >5.0mmol/L
When there is no signs of life
- Call 999
- CPR immediately
Why might glucagon be inefficient in a patient who is having a hypoglycaemic episode
Their glucose stores may be inadequate e.g. in
- long distance runners
- anorexics
- chronic alcoholics
Why is it important that patients given glucagon take glucose when they are alert and able to swallow
Because they need to replenish the blood glucose as all the glycogen stores have been depleted by glucagon
What is syncope and what are the common triggers
Temporary loss of consciousness due to cerebral hypoperfusion (vasovagal attack, simple faint)
Triggers include
- stress, anxiety, fear, pain, sight of blood/injection
- extremes of temperature, dehydration, starvation
- IV injection of LA
- postural hypotension
- drug effects (antihypertensives ACEi, ARBs) and interactions
What are the signs and symptoms of syncope
Feeling weak, faint, dizzy, light headed Pallor and sweating Nausea and vomiting Slow pulse rate Low BP Confusion Loss of consciousness
How is syncope (vasovagal attack, simple faint) managed
- Lay flat and raise legs to improve venous return and brain perfusion
- Loosen tight clothing around neck
- Administer oxygen at 15L/min
- Monitor vital signs
- Recovery is usually rapid but if not call 999 and reconsider diagnosis
- If patent becomes unresponsive, check B + C and if one or both absent, start CPR
What are the signs and symptoms of choking and aspiration
- cough/splutter
- difficulty breathing
- noisy breathing with wheeze = aspiration, stridor = obstruction
- may develop paradoxical chest and abdominal movements
- may become cyanosed and lose consciousness
How is choking and aspiration managed
If cough is active, encourage continuous cough
If cough is inactive
- 5 sharp back blows between shoulder blades
- 5 abdominal thrusts
- repeat until object is out or dislodged
If patient collapses, becomes unresponsive/unconscious
- call 999
- check vital signs of life B + C if one or more absent, start CPR
Why might adrenal insufficiency occur
Long term use of oral corticosteroids which can persist for years after stopping (because suppresses body’s normal production of corticosteroids)
Can be due to stress, trauma, iatrogenic (surgery/drug induced), infection or sepsis
Signs and symptoms of adrenal insufficiency
- Patient may become hypotensive under physiological stress
- Irregular, weak and rapid pulse
- Shock-like features
- Confusion
- Rapidly falling BP
- Rapid loss of consciousness
How is adrenal insufficiency managed
Call ambulance 999
Lay patient flat and raise legs
Administer oxygen 15L/min
Maintain airways and monitor viral signs
Measure blood glucose to rule out hypoglycaemia
If patient is unresponsive, check B + C, if absent start CPR
