W18 66 emergency drugs in dental surgery Flashcards
What are the contents of the red emergency drug boxes in the dental hospital?
Epinephrine 1:1000
Hydrocortisone
Chlorphenamine
Salbutamol
Atropine
GTN spray
Aspirin
Midazolam
Dextrose
Glucagon
What else might dental practices stock for mild allergic reactions?
Antihistamines - cetirizine, chlorphenamine, loratidine
Pg368 - Emergency drugs in dental practice summary table
Read the summary table/print on wall
What routes might be quicker than intravenous in an emergency?
Intramuscular, sublingual, buccal and intra nasal routes
When is oxygen indicated?
Any medical emergency with hypoxaemia - eg acute cardiac, respiratory, CNS disorders
How much oxygen should be delivered?
High flow - 15L per minutes
How is oxygen delivered?
Via a full face mask
What is the target saturation of oxygen using pulse oximetry?
94-98%, above 10kPa
What is adrenaline?
An endogenous catecholamine
When is adrenaline indicated?
Anaphylaxis, cardiac arrest
What are the actions of adrenaline?
Bronchdilatation
Peripheral vasoconstriction
Increased myocardial contractility
How much adrenaline should be administered in anaphylaxis and what is the typical presentation of adrenaline?
1:1000, meaning 1mg in 1ml IM. Only want to administered 500mg though so half, 0.5mls.
May be repeated at 5 min intervals if no improvement.
What is the presentation of adrenaline for cardiac arrest?
1mg in 10mls (1:10,000) IV
What type of reaction is anaphylaxis?
Severe type 1 hypersensitivity reaction.
What happens in anaphylaxis?
Leads to the release of vasoactive mediators like histamine, leading to vasodilatation, swelling of the upper airways, low blood pressure so anaphylactic shock.
What are the signs and symptoms of anaphylaxis?
Flushing and swelling of face
Generalised itching
Bronchospasm and laryngospasm
Rapid weak pulse; hypotension, pallor; finally cardiac arrest
Why is adrenaline the treatment for anaphylaxis?
Reverses vasodilatation, bronchoconstriction and angioedema
Since stimulates alpha and beta adrenergic receptor stimulating activity
When is aspirin indicated?
For suspected acute myocardial infarction
What is the emergency treatment for suspected acute myocardial infarction?
MONAR
Morphine, Oyxgen, Nitrates (GTN), Aspirin, Reperfusion therapy
How much aspirin is delivered for acute MI?
300mg dispersible or chewable, stat
When would you suspect an acute MI?
After severe chest pain (angina) that isn’t going away, sweating, nausea etc, that doesn’t go away after a puff of GTN
How do you treat hypoglycaemia in a conscious patient?
Initially 10-20g go glucose given by mouth either as liquid form or granulate sugar.
Approx 10g of glucose is available from: non diet lucozade, Coca Cola 100ml, Ribena blackcurrant 19mL (diluted), 2 teaspoons of sugar
If necessary repeat in 10-15 minutes
When might you use glucagon?
If glucose cannot be given by mouth, is infective or if hypoglycaemia leads to unconsciousness.
What is glucagon?
An endogenous peptide hormone produced from alpha cells in the pancreas. Presented as hydrochloride powder for reconstitution.
What is the action of glucagon and why might it not work?
Mobilises glycogen from the liver. Converts our body stores into glucose. Takes about 5-10mins to work.
Needs sufficient glycogen storage for this - eg sometimes won’t work in starved or malnourished patients.
What is the dose of glucagon given?
1mg intramuscular (or subcutaneous) injection
What is GTN?
Glyceryl trinitrate. It’s converted into nitric oxide in the body = a potent vasodilator.
What are the actions of GTN?
Coronary artery vasodilatation - to reduce coronary workload, relieving pain from angina
Reduction in myocardial oxygen consumption
What is the dose and route of GTN?
Sublingually 2 sprays (300mg / spray) (can come in tablet form too)
What should you take caution with when giving GTN?
Given in cases of angina - sit them down
Caution with getting up after, as will lower blood pressure greatly.
What is midazolam?
Benzodiazepine agent (fast-acting)
GABA agonist (inhibitory neurotransmitter), so damps down the brain quickly.
Water-soluble, rapid onset of action
What are the indications for midazolam?
Anti-epileptic, sedation
What is the presentation of midazolam?
Oromucosal solution. Different syringes (dosing) for different ages. Adult dose usually 10mg.
In the form of Bucolam usually (midazolam is a schedule 3 controlled drug so needs to be ordered on the special FP10CDF form, but doesn’t require storage in custody in the form of Bucolam).
How is midazolam delivered?
Full amount of solution is inserted slowly into the space between the gum and the cheek. Rapidly absorbed by buccal mucosa into bloodstream and readily crosses the BBB to hopefully stop the fit within a minute or two.
What are the 2 phases of a generalised seizure and their signs/symptoms?
Tonic phase: aura, sudden loss of consciousness, rigid, falls, may give out a cry, cyanosis
Clonic phase: jerking limb movements, tongue may be bitten
May be frothing of mouth, urinary incontinence
What is the treatment for seizures?
Safety position, oxygen, recovery position, blood glucose check? (as can have hypoglycaemia fits). Medication after 5 mins (but get it ASAP as every minute the brain is getting less oxygen).
When should you ring 999 because of a seizure (according to NICE)?
Status epilepticus (when 1 seizure turns to another to another etc)
High risk of recurrence
1st seizure
Difficulty monitoring the patient
When should medication for a seizure be administered?
Medication should only be administered if fits are prolonged (convulsive movements lasting 5 minutes or more) or recur in quick succession.
What if you cannot give buccal liquid midazolam 10mg?
Rectal diazepam
What is salbutamol?
Short-acting b2 adrenoceptor agonist
How is salbutamol presented?
In an inhaler (blue)
What is the action of salbutamol?
Bronchodilator
How much salbutamol should you deliver in an asthma attack?
Most attacks response to 2 puffs (200mg) of a patients inhaler (with spacer device!)
Further puffs if the patient doesn’t respond rapidly - upto 10 puffs - saves someone from needing further treatment like nebulisers etc
