TG Medical Emerfency

Question 1

Drugs and equipment used for medical emergencies?

Answer 1

1. Transportable source of oxygen
2. Disposable plastic airways
3. Adrenaline autoinjector (EpiPen) x2
4. Pulse oximeter
5. Glucose (fast-acting oral glucose)
6. Glyceryl trinitrate spray
7. Short-acting bronchodilator (reliever) inhaler and spacer
8. Aspirin
9. BP monitor
10. BG monitor
11. Defibrillator

Question 2

How to administer oxygen for a breathing patient?

Answer 2

Via a mask (6-8L/min) or nasal prongs (2L/min)

Question 3

How to administer oxygen for a patient who is not breathing

Answer 3

Bag-valve mask or else start mouth to mouth resuscitation

Question 4

What is a disposable plastic airway used for?

Answer 4

To secure the oral airway and facilitate mouth to mouth resuscitation or ventilation with oxygen

Question 5

What is aspirin used for in medical emergencies?

Answer 5

For a suspected heart attack

Question 6

What are common dental allergies?

Answer 6

Antibiotics, latex, LA and acrylates (bond, materials)

Question 7

What is urticaria?

Answer 7

Transient erythematous lesions that vary in size, often filled with fluid. They are itchy and tend to persist for 24 hours

Question 8

What is acute angioedema?

Answer 8

Acute angiodema (may co-exist with urticaria) as single or multiple lesions. They may be painful or cause burning sensation

Question 9

Acute angioedema and urticaria are associated with?

Answer 9

Anaphylaxis.

Question 10

Management of mild urticaria?

Answer 10

Stop treatment
Remove or stop administration of the allergen
Recommend oral anti-histamine.

Question 11

Management of extensive urticaria or angioedema, or swelling involving eyelids, lips or tongue?

Answer 11

Stop treatment
Remove or stop administration of the allergen
Refer for urgent medical attention; systemic corticosteroids may be indicated

Question 12

Management of urticaria or angioedema with associated hypotension and evidence of anaphylaxis?

Answer 12

Stop treatment
Remove or stop administration of the allergen
Call 000
Give intramuscular injection of adrenaline (epipen)

Question 13

What is anaphylaxis?

Answer 13

It is a severe immediate onset hypersensitivity reaction to an allergen affecting multiple organs

Question 14

What are the signs and symptoms of anaphylaxis?

Answer 14

Swellling of tongue, blockage of airway, hypotension, bronchospasm

Question 15

What are the signs and symptoms of anaphylaxis?

Answer 15

Swellling of tongue, blockage of airway, hypotension, bronchospasm

Question 16

What is the management of anaphylaxis?

Answer 16

Stop treatment
Remove or stop administration of the allergen
Lie the patient flat
Give an intramuscular injection
Call 000
Give supplemental oxygen and airway support if needed
Be prepared to give CPR if necessary
Repeat adr every 5 minutes until the patient responds or until help arrives

Question 17

Why is EpiPen injected into the thigh?

Answer 17

Better blood flow in thigh so you have faster absorption

Question 18

Why is adrenaline injected in anaphylaxis

Answer 18

Adr reverses the effects of anaphylaxis by reducing throat swelling, opening the airways, and maintaining heart function and blood pressure.

Question 19

What is the dosage of adr in an autoinjector?

Answer 19

Child 10-20kg? = 150 micrograms
Adult or child more than 20kg? = 300 micrograms

Question 20

What is syncope?

Answer 20

Acute hypotensive episode, resulting in loss of consciousness

Question 21

Common cause of syncope in dental settings?

Answer 21

Vasovagal syncope - occurs due to reaction to pain, anxiety, fear
Orthostatic hypotension - occurs when standing up after lying down for an extended period of time.

Question 22

Management of syncope? If the patient feels faint

Answer 22

Stop dental treatment
Lay the patient horizontally
Raise the patient’s legs
Measure heart rate
Assess consciousness by talking to the patient

Question 23

Management of syncope? If the patient loses consciousness

Answer 23

Stop dental treatment
Raise the patient’s legs to a position higher than the heart
Measure patient’s blood pressure and heart rate

Question 24

Post op for LOC syncope?

Answer 24

They should regain consciousness quickly. Allow patient to recover slowly, do not discharge them prematurely, measure standing BP, discourage driving, refer for medical assessment if patient is elderly, has multiple LOC, recovers slowly.

Question 25

If patient does not regain consciousness?

Answer 25

Call 000 Start basic life support Place patient on their side Maintain tx until pt regains consciousness or help arrives

Question 26

Symptoms of acute coronary syndrome?

Answer 26

Crushing or heavy chest pains, pains that radiate to arm, neck, back and jaw, shortness of breath, nausea, sweating *diabetes patient will have no pain

Question 27

What will patients with stable angina experience?

Answer 27

Episodic retrosternal chest discomfort that lasts less than 10 minutes or less and subsides promptly with rest

Question 28

What causes angina pain?

Answer 28

Physical activity Emotional stress

Question 29

Management of angina? With history of angina

Answer 29

Stop dental treatment Measure BP, heart rate and pulse oximetry Assess consciousness by talking to the patient Use glyceryl trinitrate spray (with pt sitting down) If pain persists despite 3 doses of GTN, treat as a heart attack If patient recovers, do not continue dental treatment and refer to doctor

Question 30

Management of unresolving angina or suspected heart attack?

Answer 30

Stop dental treatment Call 000 Give aspirin 300mg orally (chewed or dissolved before swallowing) Measure BP, heart rate, pulse oximetry Start supplemental oxygen if SaO2 is less than 90% and titrate toSao2 90-96% if possible Provide reassurance until help arrives

Question 31

Management of cardiac arrest or loss of consciousness?

Answer 31

Stop dental treatment Call 000 Give basic life support - CPR, defib Maintain treatment until help arrives

Question 32

What is hypoglycaemia?

Answer 32

Low blood glucose levels at below 4mmol/L

Question 33

Signs and symptoms of hypoglycaemia?

Answer 33

Hunger, confusion, slurred speech, sweating, tiredness, shaking, palpitations

Question 34

Management of hypoglycaemia? If patient is conscious and cooperative

Answer 34

Stop dental treatment Administer glucose: - Children 5 or younger or less than 25kg: 5g - Children 6 or older or more than 25kg: 10mg - Adults: 15mg If glucose is not available, give fast-acting glucose foods: jelly beans, jam After 15 mins if the blood glucose concentration has not returned to normal, repeat dose of glucose If 3 or more doses are required to restore BG levels, seek medical help If symptoms improve, patient should eat a longer acting carbohydrate to prevent recurrence Keep patient under observation, do not allow patient to drive, advise medical review by doctor

Question 35

Management of hypoglycaemia? If patient is drowsy, uncooperative or unconscious

Answer 35

Stop dental treatment Call 000 Start basic life support till help arrives

Question 36

Methemoglobinaemia is what?

Answer 36

Haemoglobin oxidises into methemoglobin, and there is reduced oxygen carrying capacity.

Question 37

Signs of methemoglobinaemia?

Answer 37

Cyanosis, slate grey skin discolouration - most common Headache, light headedness, shortness of breath, fatigue

Question 38

Management of methemoglobinaemia?

Answer 38

Stop dental treatment Call 000 Start supplemental oxygen and airway support if needed Monitor blood pressure, heart rate, pulse oximetry until assistance arrives Start basic life support if required

Question 39

What is stroke?

Answer 39

Blood clot in the brain

Question 40

Signs and symptoms of stroke?

Answer 40

Facial weakness, unilateral weakness, speech difficulty

Question 41

What is the FAST acrynoym stand for?

Answer 41

Face - check face, has mouth dropped? Arms - can patient life both arms Speech - is the speech slurred? Can the patient understand? Time - time is critical. If you see any signs, call 000

Question 42

Management of stroke?

Answer 42

Stop dental treatment Call 000 Measure BP, heart rate, pulse oximetry Start supplemental oxygen if SaO2 is less than 90% and titrate to SaO2 90-96% Maintain airway Monitor vital signs until assistance arrives?

Question 43

Should you give aspirin for stroke?

Answer 43

No, because you don't know if the stroke is hemorrhagic or ischaemic.

Question 44

What are seizures?

Answer 44

Sudden spasm of muscle, jerking movements of head, arms, legs and loss of consciousness

Question 45

Management for seizures?

Answer 45

Stop dental treatment Ensure patient is not in danger in dental chair, or move them to floor Turn patient to the side to prevent aspiration avoid restraining the patient unless it is essential Wait until seizure stops Assess consciousness by talking to patient Maintain airways If there is vomit, remove it with suction, once the seizure has stopped NEVER PLACE ANYTHING IN THE MOUTH DURING SEIZURES

Question 46

What is status epilepticus?

Answer 46

Continuous seizure activity or repeated seizures without full recovery of consciousness between attacks. This is a medical emergency, call 000

Question 47

What to do following a seizure that has been completed?

Answer 47

Observe the patient for 30 minutes Do not allow patient to drive home Advise patient to seek urgent medical review

Question 48

Management for seizures that last for more than a few minutes or loss of consciousness, or status epilepticus?

Answer 48

Call 000 Maintain airway Monitor patient until assistance arrives

Question 49

Temporary paralysis of the periocular muscles caused by?

Answer 49

LA injected into the parotid gland causing facial nerve anaesthesia

Question 50

Management of temporary paralysis to periocular muscles?

Answer 50

Stop dental treatment Reassure the patient that it is temporary Advise patient not to rub their eyes Close the eye and cover with two eye patches - fold the first patch in half and palce over the eye, tape the second patch over the top of the folded patch Keep patient under observation until blinking ability starts to return, usually within 1 hr Do not allow patient to drive, must be escorted home. Check on patient by phone later that day or next day.

Question 51

Management of chemical eye injuries

Answer 51

Stop dental treatment Immediately irrigate eye with water Hold the eyelid open Remove contact lens Continue irrigation with water, poured from a cup or beaker or from tap for atleast 15 minutes Do not use eyecup as the continued flow of water is required If weak chemical injury and minor eye inflammation arrange for a medical review If caustic chemical injury or marked inflammation, call 000 and continue irrigation till assistance arrives Inform the medical team of the chemical that caused the injury

Question 52

Hyperventilation syndrome?

Answer 52

Occurs when pt over breathes, associated with anxiety, panic attacks

Question 53

Management of hyperventilation syndrome?

Answer 53

Stop dental treatment Encourage patient to slow their breathing and to breathe in through their nose and out mouth Reassure patient, explain the cause of symptoms and have them talk to you. Rebreathing into a bag is not recommended If patient does not recover rapidly, review the diagnosis

Question 54

Management of hyperventilation if symptoms last for more than 5-10 minutes?

Answer 54

Call 000 Monitor until help arrives

Question 55

Management of acute asthma attack? If asthma attack is mild to moderate

Answer 55

Stop dental treatment Sit patient upright Give 4 puffs of reliever via spacer, 1 puff at a time (shake inhaler before each puff) Ask patient to take 4 breaths in and out of spacer after each puff Wait 4 mins Give another 4 puffs If there is no improvement then treat as a severe asthma attack

Question 56

Management of acute asthma attack? If asthma attack is severe or life threatening?

Answer 56

Call 000 Start supplemental oxygen and airway support Give pufer via spacer, shaking inhaler before each puff - Adult or child older than 6 = 12 puffs - Child younger than 6 = 6 puffs Give 1 puff at a time, asking patient to take 4 breaths in and out of spacer after each puff If spacer not avaialbe, but a nebuliser is, give salbutamol 5mg by nebuliser driven by oxygen Reassess within minutes While waiting for assistance: - Repeat salbutamol dose as needed every 20 minutes - If lifethreatening give salbutamol continuously - Monitor the patient

Question 57

Which is worse inhaling or swallowing objects?

Answer 57

Inhaling, all inhaled objects must be removed

Question 58

What is partial obstruction of airway?

Answer 58

Breathing is laboured Breathing is noisy Some movement of air can be felt from mouth

Question 59

Complete obstruction of airway is when?

Answer 59

There may be attempts to breath No breathing sounds Air does not emit from nose or mouth

Question 60

Management of inhaled or swallowed objects? If the object has fallen down the oropharynx

Answer 60

Stop dental treatment Check whether the object is present and if so remove it If object not found, put patient in upright position If patient is stable and asymptomatic temporise dental treatment and refer for medical management - most swallowed objects will pass through without complications

Question 61

If patient is conscious with signs of airway obstruction?

Answer 61

Call 000 Reassure the patient and encourage them to relax, breathe deeply and try to dislodge the object by coughing If coughing doesn't work, give 5 back blows between the shoulder blades using the heel of hand If back blows not successful. give 5 chest thrusts delivered at the same compression points as CPR Alternate between back blows and chest thrusts

Question 62

If patient is unconscious with airway obstruction?

Answer 62

Call 000 Inspect back of throat for a foreign object and remove if possible Start CPR Perform cricothyroidotomy (if you know how to lol) Abdominal thrusts can cause internal organ damage, so not recommended.