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BDS4 Exam Perp > Sedation/medical emergencies questions > Flashcards

Sedation/medical emergencies questions Flashcards

1
Q

Why is written consent is gained prior to sedation?

A
  • To allow patient sufficient time to consider information provided
  • Patient might be amnesic on the day of sedation and forget that they consented
  • the consent should also be confirmed verbally at the day of sedation
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1
Q

In what circumstances consent for sedation is not gained in a separate appointment?

A
  • If patient is in acute pain and needs treatment ASAP
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2
Q

What drug is used for IV sedation and what is the preparation for it ?

A

Midazolam 2mg bolus in 1mg/ml increments every 60 seconds with dose varying from 2-10mg

7.5 mg recommended

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3
Q

What vital signs would you monitor before, during and after sedation?

A
  • heart rate
  • blood pressure
  • oxygen saturation
  • breathing rate
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4
Q

what is the weight cut off for sedation?

A

BMI 35

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5
Q

What drug is used to reverse the effect of midazolam?

A
  • Flumazenil
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6
Q

What advice would you give to patient after sedation? (5)

A
  • no operating machinery or driving
  • Stay off social media
  • No physical activity for the next 24h
  • No involvement in business or signing legal documents
  • No important decision making
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7
Q

What is postural hypotension

A

It is an excessive fall in blood pressure when an upright position is assumed caused by a failure of the auto regulatory systems which normally maintain blood pressure on standing

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8
Q

What is the order of the regulatory systems in postural hypotension? (5)

A

1 - venous pooling in the legs
2- poor venous return
3- fall in stroke volume
4 - fall in cardiac output
5- patient continues to lose consciousness

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9
Q

What are the risk factors in the elderly for postural hypotension?

A
  • lifestyle - such as sedentary lifestyle
  • Medications - polypharmacy
  • Cardiovascular disease - medications
  • Diabetes
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10
Q

What would you do differently for a patient with postural hypotension? (4)

A
  • Allow the dental chair to sit up gradually over a period of couple minutes
  • Let the patient take their time while standing and guide them
  • Allow the patient to take deep breaths while standing
  • Schedule appointments 30-60 mins after eating and taking medication
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11
Q

What may have caused the patient to lose consciousness after standing up from the dental chair due to postural hypotension?

A
  • Fainting/syncope
  • Fear anxiety or emotional trauma
  • Diabetic emergency - hypoglycaemic shock or ketacidosis
  • Hyper ventilation
  • Dehydration
  • Standing up too quickly
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12
Q

What is ABCDE ?

A

A - airway
B - breathing
C - circulation
D - disability
E - exposure (AVPU)

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13
Q

How to assess airway?

A
  • check mouth for any obstruction if patient cannot speak
  • Jaw thrust
  • Oropharyngeal adjuncts ( measure from incisors to angle of mandible)
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14
Q

How to assess breathing?

A

Put ear close to mouth and and look at chest movement and sound of breathing
* RR 12-15 breaths per minute
* abnormal sounds : wheezing, strider, snoring

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15
Q

How to assess circulation?

A

Check carotid pulse by fingers and assess quality, rhythm , rate and patient colour and temperature

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16
Q

How to assess disability?

A

Using AVPU
Alert = consious
Verbal = check vocals
Pain = respond to painful stimulus
U = unresponsive to any stimulus

17
Q

How to check exposure?

A
  • Look around for any clinical signs on the body, for example rash
18
Q

What are the indications for inhalation sedation?

A
  • Medical - conditions worsened by stress such as epilepsy, hypertension, IHD , asthma
  • Social - phobia, dental anxiety, severe gag reflex
  • Dental - traumatic or complex procedures
19
Q

What are the contraindications of inhalation sedation (3)

A
  • unable to nose breath :
    ^blocked nasal airway
    ^common cold or flu
    ^tonsilitis
    ^poor cooperation to nose/mouth breathe - must be able to coordinate nasal breathing with mouth open
  • 1st trimester of pregnancy
  • severe COPD
20
Q

What are the indications of intravenous sedation?

A
  • Medical
    ^ conditions worsened by stress
    ^ conditions affecting cooperation such as mental/physical illness = Parkinson’s
  • Social - phobias, anxiety, severe gag reflex and fainting
  • Long, complex and traumatic dental procedures
21
Q

What are the contraindications of intravenous sedation? (9)

A
  • Severe systematic disease or special needs
  • intracranial pathologies
  • Severe COPD
  • Myasthenia gravis
  • Hepatic insufficiency
  • pregnancy and lactation
  • uncooperation
  • unaccompanied (very old or very young)
  • procedure too long for IV sedation (more than 50 minutes)
22
Q

What safety features are in the Quantiflex MDM machine present when giving inhalation sedation? (9)

A
  • Oxygen flush button
  • Reservoir bag
  • Scavenger system
  • Coloured cylinders - black for O2 and blue for NO
  • minimum oxygen delivery at 30%
  • Pin index to prevent gas mixture
  • one way expiratory valve
  • Oxygen monitor built-n
  • NO stops when oxygen stops
23
Q

What is the advantages of using inhalation sedation over midazolam? (8)

A
  • Quicker onset
  • Rapid recovery
  • Flexible duration of use
  • Not metabolised = safer
  • less post op side effects
  • no needles required
  • no amnesia
  • can be used in children under the age of 10
24
Q

What medications are in the dental emergency kit including quantities and uses ? (7)

A
  • Adrenaline IM injections = 1:1000 , 0.5mg/ml = anaphylactic shock
  • Aspirin dispersions = 300mg = suspected MI
  • Glucagon IM injection = 1mg = hypoglycaemic shock
  • Glyceryl Trinitrate (GTN) spray = 400 microg = angina
  • Salbutamol 100 microgram per puff = asthma attack
  • Midazolam 10mg (buccal) = more than 5 minutes epileptic seizure
25
Q

When might a referral for GA be made? (7)

A
  • medical history contraindicates sedation
  • uncooperative with phobia of needles
  • uncooperative children under the age of 12
  • medically compromised patients
  • extensive and long dental treatment
  • children requiring complete comprehensive treatment
  • benefits of GA outweigh the risks
26
Q

What are the stages of anaesthesia? (4)

A
  • Induction
  • Excitement
  • Surgical anaesthesia
  • Respiratory paralysis / overdose
27
Q

What needs to be included in a GA referral letter (for a child)? (7)

A
  • Patient details
  • Guardian details
  • GMP and GDP contact details
  • Medical history
  • Dental history and justification of GA
  • Radiographs to back up justification
  • Treatment plan for during GA
28
Q

What is the definition of conscious sedation?

A
  • A technique in which a drug is used to induce central nervous system depression to enable treatment to be carried out but with verbal consent maintained with the patient throughout the period of sedation
  • the drugs used should not lead to loss of consciousness
  • patient should remain conscious, retain protective reflexes and is able to understand and respond to verbal commands
29
Q

What is GABA and what is it’s function?

A

*Gamma-amino butyric acid is an amino acid which acts a neurotransmitter in the central nervous system
*Inhibits nerve transmission in the brain
* calming the nervous activity

30
Q

How does benzodiazepines act in the CNS?

A
  • act on receptors in the CNS to enhance the effect of GABA in the cerebral cortex and motor circuits
  • thus inhibiting CNS nuerotransmitters
31
Q

What is the half life of midazolam?

A
  • 90 - 150 minutes
  • metabolised in the liver
  • which means it have a fast recovery time
32
Q

What should you assess before IV sedation? (8)

A
  • Heart rate
  • Oxygen saturation
  • Blood pressure
  • Weight and height for BMI
  • ASA classification
  • medical history and medication list
  • Cooperation level
  • Fitness, baseline and screening tool
33
Q

What is the ASA classification mean?

A

It is a physical status classification system for assessing the fitness of patients before surgery from the American society of anaesthesia

34
Q

What is ASA class 1

A

normal healthy patient

35
Q

What is ASA class 2

A

mild systemic disease - well controlled
* Asthma
* Epilepsy

36
Q

What is ASA class 3

A

severe systemic disease
* stable angina
* COPD

37
Q

What is ASA class 4

A

Severe systemic disease that is a constant threat to life
* Severe COPD
* Unstable angina

38
Q

What is ASA class 5

A

moribund patient who is not expected to survive without the operation

39
Q

What is ASA class 6

A

declared brain dead patient who’s organs are being removed for donor purposes

40
Q

What is the time interval for monitoring vital signs of a sedation patient?

A

every 5 minutes

41
Q

On what ASA class is it safe to carry dental treatment?

A

ASA1
* ASA 2 and 3 care should be given while treatment

BDS4 Exam Perp (72 decks)

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