Medical Emergencies in Dentistry Flashcards
What should you pay attention to when observing the general physical condition of the patient
- Patient’s Posture
- Body movements
- Quality of speech
- Feel of the patient’s skin
- Colour of the patient’s skin
- Odours on the breath
- Rate and pattern of respiration
What basic ME skills should the dental team be trained to do (minimum requirements)
- BLS (basic life support)
- CPR
- Use of AED
- Use of self inflating bag and mask devices
What should be available to the dental team as part of preparation for MEs
- Easy and quick access to emergency drugs and equipment
- Plan to summon medical assistance
- Where possible drugs in solution should be in a pre-filled syringe
Give examples of how Medical Emergencies are classed systemically
- Cardiovascular emergencies
- Respiratory emergencies
- Neurological emergencies
- Metabolic emergencies
- Miscellaneous
Give examples of cardiovascular emergencies
- Myocardial Infarction
- Angina
- Cardiac Arrest
- Syncope (fainting)
- Postural Hypotension
Give examples of Respiratory emergencies
- Hyperventilation
- Respiratory Arrest
- Acute Respiratory Obstruction: Inhaled foreign body
- Asthma
Give examples of Neurological emergencies that you may encounter in the GD practice
- CVA (stroke)
- Status epilepticus
- Loss of consciousness
Give examples of metabolic emergencies you may encounter in the GD practice
- Hypoglycaemia
- Hyperglycaemia
- Addisonian crisis
Give some examples of the drug related (miscellaneous) emergencies
- Anaphylaxis
- Drug overdose
- Drug allergy
- Drug interactions
Describe the dose, route and mechanism of the drug you use for an Angina ME
Glyceryl Trinitrate Spray
Dose: 400 microgram/activation
Route: Sublingual
Mechanism: Potent vasodilator
Describe the dose, route and mechanism of the drug you use for an Asthma ME
Salbutamol Aerosol Inhaler
Dose: 100 microgram/activation
Route: Inhalation
Mechanism: B2 agonist
Describe the dose, route and mechanism of the drug you use for an Anaphylaxis ME
Adrenaline (1mg/ml)
Dose: 0.5 mg
Route: Intramuscular
Mechanism: Alpha receptor agonist, B1 agonist, B2 agonist, Mast cells stabilisation, Glucose elevation
Describe the dose, route and mechanism of the drug you use for a myocardial infarction ME
Aspirin Dispersable
Dose: 300mg
Route: Oral
Mechanism: Antiplatelet
Describe the dose, route and mechanism of the drug you use for an Unconscious hypoglycaemia ME
Glucagon
Dose: 1mg
Route: Intramuscular
Mechanism: Glycogenolysis
Describe the dose, route and mechanism of the drug you use for a conscious hypoglycaemia ME
Glucose solution/tablet/gel/powder
Dose: -
Route: Oral
Mechanism: -
Describe the dose, route and mechanism of the drug you use for an epilepsy (status epilepticus) ME
Midazolam
Dose: 10mg/ml
Route: Buccal
Mechanism: Muscle relaxant
Describe the dose, route and mechanism of the drug you use for a syncope, MI, Stroke, anaphylaxis, epilepsy and adrenal insufficiency MEs
Oxygen
Dose: 15L/min
Route: Inhalation
Name some medical emergency equipment that needs to be available in a GD practice
- 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 and protective equipment (gloves, aprons, eye protection)
- Spacer device for inhaled bronchodilators
- Automated blood glucose measurement device
- Automated external defibrillator (AED)
What does ABCDE stand for when trying to assess and treat a patient in an ME
Airway Breathing Circulation Disability Exposure
Name a few of the general principles of managing MEs
- Treat life-threatening problems as they are identified before moving to the next part of the assessment
- Assess the effects of any treatment given (can take a few mins to work)
- Continually re-assess starting with airway if there is further deterioration
Name a few of the signs for airway obstruction
- Paradoxial chest and abdominal movements
- Use of accessory muscles of respiration
- Central cyanosis in late stage
- In partial obstruction - stridor, wheeze, gurgling or snoring may be noticed
- In complete obstruction - no breath sound possible
What needs to be done in the case of airway obstruction
- Only simple methods of airway clearance needed in most cases
- Open airway - head tilt/chin lift or jaw trust
- Can use oropharyngeal airway adjuncts
- In some cases give O2 at 15L/min flow rate
What are the most common breathing problems in the GD practice
Hyperventilation and panic attacks - both tend to resolve with simple reassurance
How do you measure/observe the circulation of the patient
- Check the colour of the hands and fingers
- Assess limb temperature by the patient’s hand - cool of warm?
- Measure the capillary refill time
- Count the patient’s pulse rate
- Weak pulses + decreased conscious level + slow capillary refill time suggests low BP
What simple measures can be taken to control/fix circulation issues in patients in the GD practice
- Laying patient down and raising their legs
- If no response to simple measure, call ambulance
What are the most likely causes of circulation problems in the GD practice
Simple faint/ vaso-vagal episodes
What should be examined to measure any disability of the patient with an ME
- Review and treat the ABCs: exclude hypoxia and Low BP
- Check the patient’s drug record for reversible drug induced causes of depressed consciousness
- Examine pupils: size, equality, reaction to light
- Rapid initial assessment of patient’s consciousness level using AVPU method
- Measure blood glucose to exclude hypoglycaemia, using a glucose meter
- Nurse unconscious patients in the recovery position if their airway is not protected
What procedures might need to be done in the exposure stage of ABCDE and what purpose do they serve
- Loosen/remove some of patient’s clothes may be need to assess and treat properly - can see any rashes or perform procedures
- Importnat to respect patient’s dignity and minimise heat loss when doing this
