Medical Emergencies Revision

Question 1

List the contents of the emergency drug box:

Answer 1

• glyceryl trinitrate (GTN) spray (400mcg/dose)
• salbutamol aerosol inhaler (100mcg/actuation)
• adrenaline injection (1:1000, 1mg/ml)
• aspirin dispersible (300mg)
• glucagon injection (1mg)
• oral glucose solution/gel/tablets/powder
• midazolam (10mg/ml) - buccal or intranasal
• oxygen

Question 2

Hows best to prepare for medical emergencies?

Answer 2

• take full medical history
• once identified potential risk, ask more in-depth questions
• checking if pt has emergency medication with them, leave it close to their hand
• be familiar with location of emergency drug box and resus trolley
• modify or delay treatment if required

Question 3

What defines acute severe asthma?

How should this be treated?

Answer 3

Acute severe asthma: any one of -

• PEFR 33-50% of best or predicted
• respiratory ate >24
• HR > 110bpm
• inability to complete sentences in 1 breath

Treatment:

• salbutamol inhaler - 2-10 puffs per 10-20 mins then reassess
• use a spacer is possible
• oxygen
• 999

Question 4

Define life threatening asthma:

How is this treated?

Answer 4

Life threatening asthma: severe asthma as well as one of the following:

• PEF <33%
• SpO2 <92% –> hypoxic
• Normal PaCO2
• silent chest
• cyanosis
• poor respiratory effort
• arrhythmias
• exhaustion/ deteriorating GCS

Treatment: get pt to hospital immediately, in meantime treat as for acute severe asthma

Question 5

Symptoms of anaphylaxis:

Treatment:

Answer 5

Anaphylaxis: sudden onset and rapid progression

• life threatening problem to airway/breathing/circulation
• skin changes
• +/- exposure to known allergen

Treatment:

• 999
• oxygen
• IM adrenaline 500mcg, repeat every 5 mins if required

Question 6

Signs of epilepsy:

Treatment:

Answer 6

Epilepsy: sudden onset, may not get aura

• life threatening problem to airway and cerebral damage
• maintain ABCDE approach post ictal

Treatment:

• 999 if needed
• oxygen, airway control
• after 5 mins, administer midazolam 10mg/ml (buccal or intranasal)

Question 7

Signs of cardiac pain?

Treatment?

Answer 7

Cardiac pain:

• collapse often without any warning
• faintness, dizziness, nausea/vomiting
• breathlessness and blueness (cyanosis)
• have a sense of impending doom
• pale, cold and clammy skin
• a rapid, weak irregular pulse

Treatment:

• 999
• oxygen
• GTN spray - 2 puffs sublingually, repeat after 5 mins
• aspirin 300 mcg - chew and swirl around mouth (may be allergic!)
• reassure and keep calm
• sit in W position

Question 8

How to treat hypoglycaemia?

Answer 8

Hypoglycaemia - 4 = floor

• sugary drinks
• glucose gel - 2 tubes
• glucagon 1mg IM –> hospital
• seek medical advice

replenish sugar levels when blood glucose normalised

Question 9

List signs of syncope:

Treatment?

Answer 9

Syncope: inadequate cerebral perfusion results in loss of consciousness with low BP caused by vagal overactivity

• dizzy, faint, light-headed
• slow pulse rate
• low BP
• pallor and sweating
• nausea and vomiting
• loss of consciousness

Treatment:

• ABCDE
• lay pt flat as soon as possible and raise legs to improve venous return
• loosen any tight clothing, oxygen 15L/min, raise legs
• always check signs of life –> CPR if unresponsive

Question 10

What may cause adrenal insufficiency?

How should you treat this?

Answer 10

Adrenal insufficiency:

• may follow long term administration of oral corticosteroids and can persist for years after stopping therapy
• if a pt collapses during dental treatment other cuases should be explored and managed before diagnosis adrenal insufficiency

Treat as for shock!