TG Medical Emerfency Flashcards
Drugs and equipment used for medical emergencies?
- Transportable source of oxygen
- Disposable plastic airways
- Adrenaline autoinjector (EpiPen) x2
- Pulse oximeter
- Glucose (fast-acting oral glucose)
- Glyceryl trinitrate spray
- Short-acting bronchodilator (reliever) inhaler and spacer
- Aspirin
- BP monitor
- BG monitor
- Defibrillator
How to administer oxygen for a breathing patient?
Via a mask (6-8L/min) or nasal prongs (2L/min)
How to administer oxygen for a patient who is not breathing
Bag-valve mask or else start mouth to mouth resuscitation
What is a disposable plastic airway used for?
To secure the oral airway and facilitate mouth to mouth resuscitation or ventilation with oxygen
What is aspirin used for in medical emergencies?
For a suspected heart attack
What are common dental allergies?
Antibiotics, latex, LA and acrylates (bond, materials)
What is urticaria?
Transient erythematous lesions that vary in size, often filled with fluid. They are itchy and tend to persist for 24 hours
What is acute angioedema?
Acute angiodema (may co-exist with urticaria) as single or multiple lesions. They may be painful or cause burning sensation
Acute angioedema and urticaria are associated with?
Anaphylaxis.
Management of mild urticaria?
Stop treatment
Remove or stop administration of the allergen
Recommend oral anti-histamine.
Management of extensive urticaria or angioedema, or swelling involving eyelids, lips or tongue?
Stop treatment
Remove or stop administration of the allergen
Refer for urgent medical attention; systemic corticosteroids may be indicated
Management of urticaria or angioedema with associated hypotension and evidence of anaphylaxis?
Stop treatment
Remove or stop administration of the allergen
Call 000
Give intramuscular injection of adrenaline (epipen)
What is anaphylaxis?
It is a severe immediate onset hypersensitivity reaction to an allergen affecting multiple organs
What are the signs and symptoms of anaphylaxis?
Swellling of tongue, blockage of airway, hypotension, bronchospasm
What are the signs and symptoms of anaphylaxis?
Swellling of tongue, blockage of airway, hypotension, bronchospasm
What is the management of anaphylaxis?
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
Why is EpiPen injected into the thigh?
Better blood flow in thigh so you have faster absorption
Why is adrenaline injected in anaphylaxis
Adr reverses the effects of anaphylaxis by reducing throat swelling, opening the airways, and maintaining heart function and blood pressure.
What is the dosage of adr in an autoinjector?
Child 10-20kg? = 150 micrograms
Adult or child more than 20kg? = 300 micrograms
What is syncope?
Acute hypotensive episode, resulting in loss of consciousness
Common cause of syncope in dental settings?
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.
Management of syncope? If the patient feels faint
Stop dental treatment
Lay the patient horizontally
Raise the patient’s legs
Measure heart rate
Assess consciousness by talking to the patient
Management of syncope? If the patient loses consciousness
Stop dental treatment
Raise the patient’s legs to a position higher than the heart
Measure patient’s blood pressure and heart rate
Post op for LOC syncope?
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.
If patient does not regain consciousness?
Call 000
Start basic life support
Place patient on their side
Maintain tx until pt regains consciousness or help arrives
Symptoms of acute coronary syndrome?
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
What will patients with stable angina experience?
Episodic retrosternal chest discomfort that lasts less than 10 minutes or less and subsides promptly with rest
What causes angina pain?
Physical activity
Emotional stress
Management of angina? With history of angina
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
Management of unresolving angina or suspected heart attack?
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
Management of cardiac arrest or loss of consciousness?
Stop dental treatment
Call 000
Give basic life support - CPR, defib
Maintain treatment until help arrives
What is hypoglycaemia?
Low blood glucose levels at below 4mmol/L
Signs and symptoms of hypoglycaemia?
Hunger, confusion, slurred speech, sweating, tiredness, shaking, palpitations
Management of hypoglycaemia? If patient is conscious and cooperative
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
Management of hypoglycaemia? If patient is drowsy, uncooperative or unconscious
Stop dental treatment
Call 000
Start basic life support till help arrives
Methemoglobinaemia is what?
Haemoglobin oxidises into methemoglobin, and there is reduced oxygen carrying capacity.
Signs of methemoglobinaemia?
Cyanosis, slate grey skin discolouration - most common
Headache, light headedness, shortness of breath, fatigue
Management of methemoglobinaemia?
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
What is stroke?
Blood clot in the brain
Signs and symptoms of stroke?
Facial weakness, unilateral weakness, speech difficulty
What is the FAST acrynoym stand for?
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
Management of stroke?
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?
Should you give aspirin for stroke?
No, because you don’t know if the stroke is hemorrhagic or ischaemic.
What are seizures?
Sudden spasm of muscle, jerking movements of head, arms, legs and loss of consciousness
Management for seizures?
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
What is status epilepticus?
Continuous seizure activity or repeated seizures without full recovery of consciousness between attacks. This is a medical emergency, call 000
What to do following a seizure that has been completed?
Observe the patient for 30 minutes
Do not allow patient to drive home
Advise patient to seek urgent medical review
Management for seizures that last for more than a few minutes or loss of consciousness, or status epilepticus?
Call 000
Maintain airway
Monitor patient until assistance arrives
Temporary paralysis of the periocular muscles caused by?
LA injected into the parotid gland causing facial nerve anaesthesia
Management of temporary paralysis to periocular muscles?
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.
Management of chemical eye injuries
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
Hyperventilation syndrome?
Occurs when pt over breathes, associated with anxiety, panic attacks
Management of hyperventilation syndrome?
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
Management of hyperventilation if symptoms last for more than 5-10 minutes?
Call 000
Monitor until help arrives
Management of acute asthma attack? If asthma attack is mild to moderate
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
Management of acute asthma attack? If asthma attack is severe or life threatening?
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
Which is worse inhaling or swallowing objects?
Inhaling, all inhaled objects must be removed
What is partial obstruction of airway?
Breathing is laboured
Breathing is noisy
Some movement of air can be felt from mouth
Complete obstruction of airway is when?
There may be attempts to breath
No breathing sounds
Air does not emit from nose or mouth
Management of inhaled or swallowed objects? If the object has fallen down the oropharynx
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
If patient is conscious with signs of airway obstruction?
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
If patient is unconscious with airway obstruction?
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.
