Medical Emergency Flashcards
ABCDE
Airway
Breathing
Circulation
Disability
Exposure
ABCDE Startegy
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
Airway
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
aid for triple maneuverer
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
breathing
causes
- demand
- infection
- inflammation
recognition
- rate
- look
- listen
- feel
treatment
- posture
- oxygen
- bronchodilators
breathing sensitivity
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
circulation
causes
- arrhythmia
- ACS
- HF
- loss of fluids and bloods
recognition
- pulse check
- capillary refill
- limb temp
treatment
- treat cause
- elevate legs
- apply pressure
how to check circulation
Press on nail bed, reprofuse in under 2 secs is normal
Pulse – wrist (easy to access)
60 to 90 normal
bradycardia
less than 40 resting heart rate
normal physiological for athlete, rest sick (failing organs etc)
rhythm check
regularity of pulse, want normal sinus rhythm not arrhythmia
Fast arrhythmia – atrial fibrillation
normal rate but irregular rhythm
ectopic beats
if all well then ok
temperature range to know
Normally warm – highest is 37.8
If unwell – then 37.8 is lowest
how to take BP
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
disability
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
- first section of Glasgow Coma Scale
treatment
- optimise ABC
how to assess disability
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
exposure
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?
important thing to do when doing ABCDE assessment
keep differentials open
think of what category problem falls in rather than dx
emegency conditions
- Anaphylaxis
- Angina/MI
- Asthma
- Cardiac arrest
- Choking
- Hypoglycaemia
- Seizure/fits
- Syncope
oxygen
- 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
anaphylaxis ABCDE
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
anaphylaxis when to tx
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
side effects of adrenaline
Tremor
Heart rate inc
Resp rate inc
No mortality
key tx steps for anaphylaxis
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
how to inject adrenaline
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
adrenaline dose
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
key action points of adernaline
Peripheral vasoconstrictor
Central vasodilator – more blood to brain
Relive bronchospasm relax smooth muscle
Relive swelling
ABCDE angina and MI
A -talking
B – increased
C – increased
D – alert
E – pale, clammy, central chest pain
stable angina Vs unstable and acute coronary syndromes
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
tx angina and MI
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
ABCDE asthma
A – difficult
B – inc rate with wheeze
C – inc rate
D – alert
E - tripods
mild/moderate asthma Vs acute/severe asthma
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
tx asthma
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
tx choking
“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
hypoglycaemia ABCDE
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*
hypoglycaemia Tx
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
seizure/fits ABCDE
A – compromised
B - ?
C - ?
D – unresponsive
E – seizure activity, incontinence
Tx seizure/fits
- Ensure safe environment
- If repeated or prolonged consider Midazolam 10milligrams via the buccal mucosa
- Resp depression
- Hypotension
- Unpredictable drug
syncope ABCDE
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*
Tx syncope
elevated legs
