special care dentistry Flashcards
when suspicious of a medical emergency, in what order should you assess the patient?
A- airway
B- breathing
C- circulation
D- disability
E- exposure
what are the main causes of airway obstruction?
infection
inflammation
swelling
what does it suggest if the patients chest is not rising or falling?
there is a mechanical problem e.g. broken/fractured ribs or muscle weakness
what happens are 84% oxygen saturation?
the tongue and finger nails go blue
what happens at 60% oxygen saturation?
blue tongue
what is the optimum airway position?
the tripod position
the patient stands with arms open leaning against something
name emergency conditions you may come across in the dental setting
- anaphylaxis
- angina
- MI
- cardiac arrest
- choking
- hypoglycaemia
- seizures
- syncope
what are the signs and symptoms of anaphylaxis?
A- swelling of airway, noisy breathing
B- increased breathing rate, wheeze
C- increased pulse, hypotension
D- loss of consciousness
E- rash, swelling
how do you manage a pt going into anaphylactic shock?
- 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.
how do you give an IM injection of adrenaline?
-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
what are the symptoms of angina?
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
what is the cause of angina?
narrowing or occlusion of blood vessels due to plaque deposits
chest pain after stairs = 1/3 vessel occluded with plaque
what is the difference between angina and myocardial infarction?
A- chest pain on exercise and settled with rest
MI- rupture of plaque in blood vessel , causes jelly like substance to occlude entire vessel
how do you treat a pt with angina?
- 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
what are the symptoms of an asthma attack?
A- difficult to complete sentences
B- increased rate with wheeze
C- increased pulse
D- alert
E- tripod position , anxious, may be synotic
what are the three classifications of asthma attack?
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
how do you treat a pt having an asthma attack?
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
what are the symptoms of hypoglycaemia?
A- initially talking
B- initially increased breathing rate
C- initially increased pulse
D-initially alert
E- irritable, confused, pale
how do you treat a pt with hypoglycaemia?
glucose- sugary drink, 3 glucose tablets
glugacon- 1mg intramuscular injection
mix liquid a powder and give injection and once conscious again, give more sugar
how do you treat a pt who appears to be having a seizure?
- 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
what is the role of midazolam?
sims to relax smooth muscle
may slow down breathing of cause hypertension
not predictable
what are the signs and symptoms of a syncope?
A- compromised airway
B- reduced breathing rate
C- reduced pulse and blood pressure
D- unresponsive
E- pale and clammy
define vasovagal
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
why are two needles used when giving emergency adrenaline?
the first needle can get blunted when drawing from the ampule and this would be painful to inject the pt with
what does INR stand for?
international normalised ratio
what is the drug action of warfarin?
a vitamin K antagonist
how do you measure capcity?
AMCUR
acting
making decisions
communicating decisions
understanding decisions
retaining memory of the decision
what are the principles of the AWI act?
benefit the pt
minimum intervention
wishes of adult
consult relevant others
residual capacity
