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BDS3 BAMS Patient Safety > Medical Emergency > Flashcards

Medical Emergency Flashcards

1
Q

ABCDE

A

Airway

Breathing

Circulation

Disability

Exposure

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2
Q

ABCDE Startegy

A

assess each, perform to fix, then move on

complete and treat as you meet

continualy reassess

trends are key - see how pt is behaving and responding

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3
Q

Airway

A

cause of airway obstruction?

  • loss of consciousness
  • infection
  • inflammation
  • swelling
  • dental infection, cotton wool roll, sedation increases risk

Recognition

  • talking
  • sounds
  • look

Tx

  • head tilt
  • chin lift
  • jaw thrust
  • adjuncts
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4
Q

aid for triple maneuverer

A

head tilt with chin lift or jaw thrust

Involves you holding their head – hence oropharyngeal airways

  • Orange – size 3 – adult male
  • Green – size 2 – adult female

Size by end by angle of mandible and bite block under flange should be vertical height of upper incisors

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5
Q

breathing

A

causes

  • demand
  • infection
  • inflammation

recognition

  • rate
  • look
  • listen
  • feel

treatment

  • posture
  • oxygen
  • bronchodilators
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6
Q

breathing sensitivity

A

Changes immediately – sensitive indicator for physiology

  • Inc rate is physiological normal response to stress and demand

Respiratory rate – feel chest movement, tell them your doing something else

Look for chest expansion

  • see symmetrical hands on chest

Look at their colour

  • as o2 saturation fall, discolouration of fingers and lips 82%, tongue pale 60%

Tripod position – hanging over things, open up help breathe

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7
Q

circulation

A

causes

  • arrhythmia
  • ACS
  • HF
  • loss of fluids and bloods

recognition

  • pulse check
  • capillary refill
  • limb temp

treatment

  • treat cause
  • elevate legs
  • apply pressure
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8
Q

how to check circulation

A

Press on nail bed, reprofuse in under 2 secs is normal

Pulse – wrist (easy to access)

60 to 90 normal

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9
Q

bradycardia

A

less than 40 resting heart rate

normal physiological for athlete, rest sick (failing organs etc)

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10
Q

rhythm check

A

regularity of pulse, want normal sinus rhythm not arrhythmia

Fast arrhythmia – atrial fibrillation

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11
Q

normal rate but irregular rhythm

A

ectopic beats

if all well then ok

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12
Q

temperature range to know

A

Normally warm – highest is 37.8

If unwell – then 37.8 is lowest

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13
Q

how to take BP

A

By taking pulse – can palpate easily then lowest is 100 odd (100+ is adequate to perfuse all vital organs)

If unable to feel easily – BP dropped to 70mmHg or below then move up to brachial then if not below 60

Then neck then 50

Wrist is adequate BP

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14
Q

disability

A

causes

  • drugs
  • brain injury
  • hypoglycaemia

recognition

  • ACVPU/GCS
    • first section of Glasgow Coma Scale
      • alert
      • confused (new confusion unless otherwise known)
      • verbal response
      • pressure - press on trapezius and see if respond normally - knock away/move away but if abnormal (e.g. expand) alert
      • unresponsive
        • not the same as unconcious

treatment

  • optimise ABC
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15
Q

how to assess disability

A

Check pupillary response – light goes away see if they do, same at same time and equal

Check motor response – squeeze your hand, can they lift leg

Go through ACVPU

  • Alert
  • Confused (new confusion unless otherwise known)
  • Verbal response
  • Pressure – press on trapezius and see if respond normally – knock away or move away but if abnormal (e.g.expand) alert
  • Unresponsive
    • Not the same as unconscious
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16
Q

exposure

A

limited in dental setting

look for clinically relevant information

  • See eye – whites clear?
  • Colour of face
  • Neck – trachea in midline, congested veins
  • Swollen ankles
  • Spoiled themselves?

Then REASSESS

  • See if any changes and think why? Are they behaving as expected? Are they deteriorating?
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17
Q

important thing to do when doing ABCDE assessment

A

keep differentials open

think of what category problem falls in rather than dx

18
Q

emegency conditions

A
  • Anaphylaxis
  • Angina/MI
  • Asthma
  • Cardiac arrest
  • Choking
  • Hypoglycaemia
  • Seizure/fits
  • Syncope
19
Q

oxygen

A
  • 1.5l via a non rebreathing mask
    • Tight seal
    • Delivers 90% O2 – never 100% as never able to get a proper seal
  • GDC advice – give to anyone who is sick
  • 25mins worth of O2 from tank
20
Q

anaphylaxis ABCDE

A

A – swelling, stridor

  • Lips, tongue
  • Sound hoarse – lower down swelling, concern

B - increased rate, wheeze (due to bronchospasm)

  • Follow bell curve of unwell people

C – inc rate, hypotension

  • Heart rate inc as struggling to perfuse organs
  • Bronchoconstricted so gas exchange not happening so more inc rate
  • As vasodilated
  • Vasculature becomes leaky - swelling

D – LOC

E – rash, swelling

  • 80% swelling and rash, 20% don’t – typically young women
  • Gut disturbance – cramps, vomiting, diarrhoea, reactions to food
  • Clinically more likely reaction to drug
21
Q

anaphylaxis when to tx

A

ABCDE, happening right now -> adrenaline

See any airway involvement -> adrenaline (hoarse, tongue or lip swelling)

breathing - peripheral cyanosis -> adrenaline

Brachial pulse not there (circulation) -> adrenaline

Rather give one inappropriate dose of adrenaline rather than one non-inappropriate

22
Q

side effects of adrenaline

A

Tremor

Heart rate inc

Resp rate inc

No mortality

23
Q

key tx steps for anaphylaxis

A

Legs above their head – 350ml of blood to central cavity

  • Adrenaline peripheral constrictor so if more blood in central cavity works better

Preload reduce, ventricles don’t fill up so risk of cardiac arrest if stand up (postural change)

NEVER GET THEM TO STAND

If still unwell after 5 mins, give every 5 mins

But vary sites

24
Q

how to inject adrenaline

A

Z track technique

Tension on muscle pull skin, place needle, aspirate, no blood advance another mm, inject

Once deposited, withdraw half, release tension, then fully out

25
Q

adrenaline dose

A

Adult dose 0.5mg 1:1000

  • Epipens – only 0.3mg as non clinical person giving it

We have 2 doses – take half at a time

26
Q

key action points of adernaline

A

Peripheral vasoconstrictor

Central vasodilator – more blood to brain

Relive bronchospasm relax smooth muscle

Relive swelling

27
Q

ABCDE angina and MI

A

A -talking

B – increased

C – increased

D – alert

E – pale, clammy, central chest pain

28
Q

stable angina Vs unstable and acute coronary syndromes

A

Plaques in coronary artery blocks 1/3 or more than on exersion blood not able to flow freely enough, chest pain, Rest to alleviate – stable angina, not acute

Acute coronary syndrome 3 things

  • rupture so larger blockage
  • Inflammation causes artery to constrict
  • Thrombis formation

Rest doesn’t alleviate

29
Q

tx angina and MI

A

Time is muscle, need early decision and ambulance

GTN spray, 400micrograms per dose, 2 puffs under tongue (easy into circulation)

  • Vasodilator
    • Venous only not arteries
  • Reduce preload, reduce strain on heart
  • Pain relief – not tx
  • Take pulse
  • Need satisfactory BP before giving

Aspirin 300milligrams crushed or chewed if MI

  • Don’t swallow
  • Needs absorbed in oral mucosa – don’t want it diluted
    • Wait 10 mins before water
  • Edentulous – crush between 2 spoons
  • Slows down platelet aggregation
30
Q

ABCDE asthma

A

A – difficult

B – inc rate with wheeze

C – inc rate

D – alert

E - tripods

31
Q

mild/moderate asthma Vs acute/severe asthma

A

Mild/moderate – normal HR and resp rate but some chest tightness

Acute/severe – resp rate 25 breaths/min or more, HR 120bpm or more

Life threatening – heart rate 140 or below, resp 8 or below and ???

Change tx depending on which one

Cannot complete sentence – straight to hospital big concern

32
Q

tx asthma

A

Cannot complete sentence – straight to hospital big concern

Tx

  • Salbutamol 100micrograms per actuation
  • Spacer device when appropriate

Breathe in hold breath for 10 secs

If no improvement – HR increasing, use spacer – 10 times into it, allow them to breath into into 20 secs no more, anymore breath in their own CO2 – bad

Bronchoconstrictor so BVM goes into stomach, risk of contents going into lungs – need intubated

33
Q

tx choking

A

“Can you cough?” If yes, able to breathe

If cannot breathe in – 5 back blows, then 5 ab thrusts

If unable to ab thrust – chest compressions – gets higher airway pressure, more success

34
Q

hypoglycaemia ABCDE

A

A – initially talking

B – initially inc rate

C- initially increased rate

D – initially alert

E – irritable, confused, pulse

  • Type 1 diabetics tend to*
  • Not normal people as able to control blood glucose*
35
Q

hypoglycaemia Tx

A

Glucose of any description

  • 3 sweets in emergency bag = 20mg

Glucagon 1milligram IM injection

  • If unconscious
  • Pierce vile, gently roll to combine, draw and inject with Z track technique
  • Then give sugar – if not will relapse into hypo
36
Q

seizure/fits ABCDE

A

A – compromised

B - ?

C - ?

D – unresponsive

E – seizure activity, incontinence

37
Q

Tx seizure/fits

A
  • Ensure safe environment
  • If repeated or prolonged consider Midazolam 10milligrams via the buccal mucosa
    • Resp depression
    • Hypotension
    • Unpredictable drug
38
Q

syncope ABCDE

A

A – compromised

B – reduced rate

C – reduced rate and pressure

D – unresponsive

E – pale, clammy

  • Mainly young females*
  • Vagal nerve – breaks heart rate, if severed 300bpm*
39
Q

Tx syncope

A

elevated legs

40
Q
A

BDS3 BAMS Patient Safety (12 decks)

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