special care dentistry

Question 1

when suspicious of a medical emergency, in what order should you assess the patient?

Answer 1

A- airway
B- breathing
C- circulation
D- disability
E- exposure

Question 2

what are the main causes of airway obstruction?

Answer 2

infection
inflammation
swelling

Question 3

what does it suggest if the patients chest is not rising or falling?

Answer 3

there is a mechanical problem e.g. broken/fractured ribs or muscle weakness

Question 4

what happens are 84% oxygen saturation?

Answer 4

the tongue and finger nails go blue

Question 5

what happens at 60% oxygen saturation?

Answer 5

blue tongue

Question 6

what is the optimum airway position?

Answer 6

the tripod position
the patient stands with arms open leaning against something

Question 7

name emergency conditions you may come across in the dental setting

Answer 7

• anaphylaxis
• angina
• MI
• cardiac arrest
• choking
• hypoglycaemia
• seizures
• syncope

Question 8

what are the signs and symptoms of anaphylaxis?

Answer 8

A- swelling of airway, noisy breathing
B- increased breathing rate, wheeze
C- increased pulse, hypotension
D- loss of consciousness
E- rash, swelling

Question 9

how do you manage a pt going into anaphylactic shock?

Answer 9

• call ambulance
• remove trigger if possible
• lie pt flat, on left side if pregnant
• if life threatening- give epi pen
  intramuscular adrenaline 1:1000, 0.5mg
• repeat if no response after 5 minutes + IV fluid bolus
• establish airway, give oxygen, monitor pulse etc.

Question 10

how do you give an IM injection of adrenaline?

Answer 10

-place thumb on ampule and break vial away from you
- put tension on skin and go directly into muscle, aspirate
- inject all liquid
- pull half way out and release tension then withdraw full needle

Question 11

what are the symptoms of angina?

Answer 11

A- pt can still speak
B- increased breathing, short of breath
C- increased pulse, usually due to anxiety
D- alert
E- pale, clammy, central crushing chest pain which radiates into the arm

Question 12

what is the cause of angina?

Answer 12

narrowing or occlusion of blood vessels due to plaque deposits
chest pain after stairs = 1/3 vessel occluded with plaque

Question 13

what is the difference between angina and myocardial infarction?

Answer 13

A- chest pain on exercise and settled with rest
MI- rupture of plaque in blood vessel , causes jelly like substance to occlude entire vessel

Question 14

how do you treat a pt with angina?

Answer 14

• if strong radial pulse- give 2 puffs of GTN spray sublingually (400mg)
• 300mg aspirin crushed under tongue or chewed- don’t give pt water for 10 mins
• get pt to hospital ASAP

Question 15

what are the symptoms of an asthma attack?

Answer 15

A- difficult to complete sentences
B- increased rate with wheeze
C- increased pulse
D- alert
E- tripod position , anxious, may be synotic

Question 16

what are the three classifications of asthma attack?

Answer 16

mild to moderate- normal HR, resp. rate, may have tight chest
severe- resp. rate> 25, heart rate >115, audible wheeze
life-threatening- heart rate<40, resp rate <8

Question 17

how do you treat a pt having an asthma attack?

Answer 17

salbutamol inhaler (bronchodilator)
hold breath for 10 seconds and repeat
if severe- use spacer for 20 seconds and repeat every 3-5 mins
100mg per actuation of salbutamol

Question 18

what are the symptoms of hypoglycaemia?

Answer 18

A- initially talking
B- initially increased breathing rate
C- initially increased pulse
D-initially alert
E- irritable, confused, pale

Question 19

how do you treat a pt with hypoglycaemia?

Answer 19

glucose- sugary drink, 3 glucose tablets
glugacon- 1mg intramuscular injection
mix liquid a powder and give injection and once conscious again, give more sugar

Question 20

how do you treat a pt who appears to be having a seizure?

Answer 20

• ensure a safe environment
• if repeated/prolonged: midazolam 10mg squirted onto buccal mucosa
  -time it- should last about 2 mins
• don’t give oxygen as typically they will be sick

Question 21

what is the role of midazolam?

Answer 21

sims to relax smooth muscle
may slow down breathing of cause hypertension
not predictable

Question 22

what are the signs and symptoms of a syncope?

Answer 22

A- compromised airway
B- reduced breathing rate
C- reduced pulse and blood pressure
D- unresponsive
E- pale and clammy

Question 23

define vasovagal

Answer 23

vagus nerve slows down the heart to normal- without it, would be 300bpm
vagal tone gets strong and quickly drops the heart rate to 10bpm

Question 24

why are two needles used when giving emergency adrenaline?

Answer 24

the first needle can get blunted when drawing from the ampule and this would be painful to inject the pt with

Question 25

what does INR stand for?

Answer 25

international normalised ratio

Question 26

what is the drug action of warfarin?

Answer 26

a vitamin K antagonist

Question 27

how do you measure capcity?

Answer 27

AMCUR
acting
making decisions
communicating decisions
understanding decisions
retaining memory of the decision

Question 28

what are the principles of the AWI act?

Answer 28

benefit the pt
minimum intervention
wishes of adult
consult relevant others
residual capacity