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Oral Surgery > Medical Emergency > Flashcards

Medical Emergency Flashcards

1
Q

best management is

A

PREVENTION

  • a good history and physical is essential
  • review recent issues if the patient has not been in for some time

any recent changes in medical status?

any new or recent lab studues?

a proper history will provide a baseline reference in the event of an emrgency

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2
Q

when emergency happens primary goal?

A

STABILIZE the patient until arrival of emergency medical team

follow BASIC guidelines

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3
Q 
steps in management of medical emergencies 
P
A
B
D
C
A

positioning

airway

breathing

circulation

differential diagnosis, definitive care, drugs, defibrillation

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4
Q

obtain baseline vital signs

A

PULSE PRESSURE
SATURATION OF OXYGEN
BLOOD PRESSURE

THIS IS SO CRUCIAL TO OBTAIN BASELINE

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5
Q

loss of consciousness can come from

A

syncope

hypoglycemia

seizures

MI

CVA/ stroke

Anaphylaxis

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6
Q

after administer LA to patient , starts sweating and eyes are closed

dizzy and nauseated

A

syncope likely

hypotension
bradycardia
low saturation pressure of oxygen

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7
Q

syncopy

A

physcogenic reaction leading to parasympathetic response with sudden vasodilation producing bradycardia and cerebral ischemia

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8
Q

manifestations of syncope

A

dizziness

pallow

sweating

nausea

hypotension

loss of consciousness, possible seizure

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9
Q

tx for sncopy

A

trendelenberg positoin

CAB - circualtion, airway and breathing

oxygen

spirits of ammonia

apply a cool wet towel to forehead

it will take 24 hours for patients body to fully recover

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10
Q

hypoglycemia vs hyperglycemia

A

hypoglycemia is more common – seen with diabetics who take insulin and forget to eat or do not take their normal oral intake

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11
Q

manifestations of hypoglycemia

A 
hunger 
headache
sweating
pallor
confusion, irritability
possible resulting in loss of consciousness
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12
Q

tx of hypoglycemia in conscious pt. in unconscious pt?

A

conscious– give sugar

unconscious – 50 ml of 50% dextrose IV or 1 mg of glucagon IM

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13
Q

signs of syncope but in terms of circulation the blood pressure or pulse is

A

blood pressure and pulse is not altered much in hypoglycemia but hypotension in syncope

but do FINGER STICK

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14
Q

finger stick but not low … next?

A

does patient have facial weakness slurring or bad speech? No – consider other medical condition if yes — consider CVA and activate EMS and provide supplemental oxygen

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15
Q

angina/ MI

include manifestations

A

due to heart’s oxygen demand being greater than supply associated with exertion, anxiety or with coronary athersclerotic dsease

manifestation

  • crushing pressure on chest may radiate shoulder, neck, arm and mandible
  • dizziness
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16
Q

treatment of angina/ MI

A

100 % oxygen
position
sublingual nitroglycerine
(0.3-0.4 mg) every five minutes up to three doses - check VS (vital signs) prior to administration

  • if symptoms persist an MI must be assumed and EMS activated

MONA

  • morphine
  • oxygen
  • nitroglycerine
  • aspirin - full strength – ask patient to chew it up
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17
Q

nitroglycerine amount and what it does

A

vasodialtion

  1. 3 - 0.4 mg every five minutes up to three doses
    - CHECK VITAL SIGNS PRIOR TO ADMINISTRATION
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18
Q

chest pain and pt. becomes unconscious

A

make sure you elicit that they are unconscious

then check pulse – carotid - at least 5 not more than 10 seconds

CPR - until AED is available
- AED = automated external defibullator

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19
Q

stroke think

A

FAST

  • facial weakness
  • arm drift
  • speech alteration
  • TIME
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20
Q

stroke looks like

A

syncopy and hypoglycemia too

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21
Q

hyperventialion looks like

A

often caused by severe anxiety / panic attack

manifestations
- palpations
chest pain
tachycardia
dizziness
numbness and tingling on extremeties
muscle pain and cramp (carpopedal tetany)
22
Q

common causes of anaphylaxis

A

foods

insect venoms

latex

medications

23
Q

common causes of anaphylaxis

A

foods

insect venoms

latex

medications

24
Q

cross reactivity of foods ___ avoid___

A

bananas, avocados,

avoid latex use

25
Q

decrease in BP and Pulse
yes - consider?
- no

A

yes - consider syncope

no - consider other causes like hypoglycemia or stroke

26
Q

treatment of hypoglycemia
conscious pt?
unconscious pt?

A

conscious
- give sugar

unconscious
- 50 ml of 50% dextrose IV OR 1 mg glucagon IM

27
Q

if patient has facial weakness or slurring of speech

A

consider CVA

  • activate EMS
  • supplemental O2
28
Q

pt blood sugar is 140?

A

below this is normal so at this or higher is prediabetic

29
Q

patient states he has chest pain/ tightness and is nauseated treat as? why does this happen

A

angina
- due to hearts oxygen demand being greater than supply associated with exertion, anxiety or with coronary athersclerotic disease

30
Q

manifestation of angina / MI

A

crushing pressure on the chest and may radiate shoulder, neck, arm and mandible

dizziness

31
Q

could substitute what in MONA

A

nitrous oxide

usually 
M -- morphine
O- oxygen
N - nitroglycerin 
A - aspirin

general offices may not have the access to morphine - so can use nitrous oxide

32
Q

treating the pt with chest pain and he becomes unconscious, what do you do

A

Consider BLS (basic life support) protocol

Poisition 
Circulation
Airway 
Breathing 
D - Diff. dx

so begin CPR and place AED as soon as possible

33
Q

supplement oxygen over what %

A

want greater than 94%

34
Q

if think stroke think FAST means

A

F - facial weakness
A - arm drift
S - speech alteration
T - TIME

35
Q

supine position when

A

unconscious pt. and thinking cerebrovascular - stroke accident

36
Q

managment of cerebrovascular sccident/ stroke

A

if conscious - put patient into a comfortable position
- if unconscious, supine position

monitor vitals 
administer oxygen 
transport to ER via EMS 
basic support as required 
- maintain airway 
IV acess may be useful if trained
37
Q

patient is breathing deeply and rapidly
pt. states they are feeling dizzy and numb
thinking?

A

hyperventilation

38
Q

tx for hyperventilation

A

stop procedure

positino pt. into comfortable position

calm patient

breathe C02 enriched air through face mask or paper bag

consider IV sedation

39
Q

clinical manifestations of anaphylaxis

respiratory effects?
skin?
gastro?
cardio?

A

skin - flushing, pruritus, urticaria, angioedema

upper respiratory - congestion, rhinorrhea

lower respiratory = bronchospasm, throat or chest tightnedd, hoarsness, wheezing, shortness of breathe, cough

GI= oral pruritis, cramps, nausea, vomiting, diarrhea

cardio = tachycardia ,bradycardia, hypotension/ shock , arrhythmias, ischemia, chest pain

40
Q

anaphylaxis prsentation with hives

A

only about 10-20% of cases will present with hives or other cutaneoues manifestations

80% food-induced, fatal anaphylaxis cases were not associated with cutaneous signs or symptoms

41
Q

incidence of latex induced anaphylaxis

A

1-6% population - up to 16 million

8-17% incidence among health care workers

42
Q

aawareness of cross sensitivity with what foods?

regarding latex induced anaphylaxis prevention

A 
banana 
avocado 
chestnuts 
kiwi
stone fruit
43
Q

treatment of anaphylaxis

A

immediate with epinephrine

no contraindications in anaphylaxis - longer wait more fatal

antihistamine - oral or parenteral - if oral use liquid or chewable tablet

call 911

44
Q

repeat epi with anaphylaxis when

A

10-15 minutes after first if symptoms persist or increase

repeat antihistamine + H2 blocker if symptoms persist

observe for 4 hours

45
Q

additional measures fo tx of anaphylaxis

A

corticosteroids

supplemental O2 - airway maintenance

IV fluids, vasopressor therapy

46
Q

tx of mild allergic reactions?

mode of action

A

diphenhdramine - Benadryl –

prevetnts histamine from binding H1 receptors on certain tissues

INHIBITS

  • vasodilation
  • increases capillary permeability
  • itching

BEST WHEN GIVEN EARLY - PREVENT SYMPTOMS FROM PROGRESSING
- should be administered on a regular schedule to prevent allergic symptoms while the allergen is still in the bod

47
Q

dose of diphenhydramine

A

determined by severity of the symptoms

oral = 25-50 mg upon onset of symptoms then repeated every 6 hrs for 4-6 days

IM = 25-50 mg into lateral thigh, deltoid, or buttoc

rarely IV administration

pediatric dose - 1,g/ kg

  • refer to ER or PC for monitor at least 24-48 hours post
48
Q

immediatley after anaphylaxis

A

stop procedure
call 911
administer 100% oxygen

take vitals

adminster epi SC/IM/IV at .3-.5 mg

child = 0.1mg/kg SC or IM

49
Q

main effects of epinephrine

best for?

A

MOST IMPORTANT DRUG FOR ANAPHYLAXIS –
will cause OPPOSITE EFFECTS OF HISTAMINE

EPI CAUSES
1 . VASOCONSTRICTION – counteracts the profound hypotension that can cause circulatoy collapse and cardiac arrest

  1. BRONCHODILATION
    - it counteracts the smooth muscle contrction of the bronchioles (bronchiospams) that can lead to hypoxia
50
Q

cyanosis in lips could be sign of

A

Asthma attack

51
Q

tx for asthma attack

A

comfortable position

administer oxygen and maintain airway

administer MDI / bronchiodilator – albuterol

2-4 puffs ASAP - may repeat 10 minutes as required

consider use of SQ epinephrine 0.5-1.0 mg (1:1000) if attach persists

52
Q

seizure what to do

A

remove all dental instruments and supplies from patient mouth

position patient and PROTECT patient

position airway and DO NOT PLACE ANYTHING IN PT MOUTH IS SEIZING

If no history known of seizures - contact EMS (or if severe)

Oral Surgery (26 decks)

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