W13 44 cardiac arrest and emergencies in dental surgery

Question 1

What is the chain of survival for a cardiac arrest?

Answer 1

Early recognition and call for help to prevent cardiac arrest
Early CPR to buy time
Early defibrillation to restart the heart
Post-resus care to restore quality of life - can’t let them remain hypoxic, hypertensive and will cause end-organ damage

Question 2

What do you do if someone is in cardiac arrest outside of hospital?

Answer 2

Call for help and AED if available
Start CPR
30:2 compressions to breath, 5-6cm depth of chest, 100-120 beats per min
Use AED as soon as it arrives and continue until help arrives

Question 3

ALS - what should you ensure during CPR?

Answer 3

Ensure high quality chest compressions
Minimise interruptions to chest compressions
Give oxygen
Use waveform capnography
Continuous compressions when advanced airway in place
Vascular access (intravenous or intraosseous)
Give adrenaline every 3-5mins
Give amiodarone after 3 shocks

Question 4

What reversible causes should be treated for cardiac arrest?

Answer 4

Hypoxia
Hypovolaemia
Hypo-/hyperkalaemia/metabolic
Hypothermia
Thrombosis - coronary or pulmonary
Tension pneumothorax
Tamponade - cardiac
Toxins

Question 5

What immediate post-cardiac arrest treatment should be issued?

Answer 5

Use ABCDE approach
Aim for SpO2 of 94+98%
12-lead ECG
Treat precipitating cause
Targeted temperature management

Question 6

Read pg437/438 for some images of different heart conditions eg AF, VF, VT

Answer 6

Read lol

Question 7

Which rhythms are shockable?

Answer 7

AF with fast ventricular response
Ventricular fibrillation - pt is in cardiac arrest
Ventricular tachycardia without a pulse

Question 8

What do you do in the respiratory emergency of asthma?

Answer 8

Give oxygen to all hypoxaemic patients with acute severe asthma to maintain an SpO2 level of 94-98%. Lack of pulse oximetry should not prevent the use of oxygen.
Administer salbutamol via space or nebuliser

Question 9

What concerning signs of asthma are there?

Answer 9

Severe breathlessness
Tachypnoea
Tachycardia
Silent chest!
Cyanosis (blue lips start)
Collapse (or start becoming confused)

Question 10

What are other causes (not epilepsy) of seizures?

Answer 10

Febrile seizures (typically in children under 4 with infections or post-vaccination)
Alcohol withdrawal seizures

Question 11

What should you do in a seizure (that stops)? (neurological emergency)

Answer 11

Take an ABCDE approach
Most terminate by themselves in 20-30
Patients are usually drowsy afterwards, keep them

Question 12

What is an EEG?

Answer 12

21 electrodes place over regions of the skull. Electroencephalogram.

Question 13

What are fits caused by?

Answer 13

Overfiring of certain brain areas

Question 14

How do you manage an epileptic seizure?

Answer 14

Do not restrain
Remove objects that may cause injury
Once seizure has stopped place in recovery position

Question 15

When should you call for help during a seizure?

Answer 15

If it is the persons first seizure
They have injured themselves badly
They have trouble breathing after the seizure (eg if aspirated vomit)
One seizure immediately follows after another with no recovery in between (status epilepticus)
Seizure lasts for 2 min longer than is usual for them OR seizure lasts for more than 5mins and you don’t know how long their seizures usually last

Question 16

What endocrine emergencies are there?

Answer 16

Hypoglycaemia

Question 17

What is hypoglycaemia?

Answer 17

Occurs when glucose levels in blood fall below a set point - usually below 4mmol/L (72mg/dL)

Question 18

What are some symptoms of hypoglycaemia?

Answer 18

Irritability/confusion
Sweating/clamminess/pallor
Tachycardia
Hunger
Dilated pupils
Coma

Question 19

What is the treatment of hypoglycaemia?

Answer 19

15-20g of fast acting carbohydrate such as glucose tablets
If unable to take oral treatments glucagon can be used - SC (subcutaneous = under the skin)

Question 20

What are the symptoms of hyperglycaemia and DKA - diabetic ketoacidosis?

Answer 20

Frequently passing urine
Thirst
Feeling tired and lethargic
Blurry vision
Abdominal pain nausea, vomiting
Breathing changes (deep sighing breaths)
Smell of ketones on breath (like pear drops)
Collapse/unconsciousness

Question 21

What are some implications of persistent hyperglycaemia?

Answer 21

Persistent hyperglycaemia increases risk of cardiac disease, chronic kidney disease, other organ failures, wound healing impairment.

Question 22

What is the minimum you should do in an anaphylaxis?

Answer 22

Recognise they are serious ply unwell
Early call for help
Initial assessment and treatments based on ABCDE approach
Adrenaline therapy if indicated (IM or IV)
Investigation and follow-up by an allergy speciakist

Question 23

How much adrenaline do you give in anaphylaxis?

Answer 23

500mg!!

Question 24

What are the 3 main signs of anaphylaxis?

Answer 24

Sudden onset and rapid progression of symptoms
Life-threatening airway and/or breathing and/or circulation problems
Skin and/or mucosal changes (flushing, urticaria, angioedema)

Question 25

Do skin reactions always occur in anaphylaxis?

Answer 25

No, alone are not a sign. Can be subtle or absent. Can also be gastrointestinal symptoms eg vomiting, abdominal pain, incontinence.

Question 26

EXAM POTENTIAL - what are the CPR guidelines for treating anaphylaxis?

Answer 26

Assess using ABCDE approach
Diagnosis - look out for 3 main symptoms
Call for help - lie to flat with raised legs (if breathing allows)
Adrenaline (give IM 0.5g unless used to using IV)
Extra equipment and skill used

Question 27

(Exam potential pt 2) - what is done in anaphylaxis when skills and equipment become available?

Answer 27

Establish airway
High flow oxygen
IV fluid challenge
Chlorphenamine
Hydrocortisone
Monitor - pulse oximetry, ECG, blood pressure

Question 28

View links on pg442

Answer 28

Just some guidelines, maybe give em a read in spare time?