Week 1 Medical Emergency

Question 1

Name some cardiovascular emergencies that can occur in a dental setting.

Answer 1

• Syncope- Chest Pain (Angina, Myocardial Infarct)- Sudden loss of consciousness (W/o pulse/respiration) ‘Cardiac Arrest’

Question 2

What is the best way to avoid a medical emergency?

Answer 2

By a careful assessment of the patient through a detailed, social, medical and medication history. Dental practitioners must be trained and have aplan for emergency management and be aware of the signs and symptoms of a patient experiencing a medical emergency.

Question 3

What is the OHTs role?

Answer 3

NAME?

Question 4

What is a syncope?

Answer 4

‘transient self-limiting loss of consciousness’ - fainting- Usually leads to a loss of postural tone/falling- Onset is almost always rapid- Recovery = rapid, spontaneous and complete. - Common- The prevalence of syncope increases with age and it can cause significant morbidity in the elderly.

Question 5

What are the signs and symptoms of syncope?

Answer 5

NAME?

Question 6

How do you manage syncope in a conscious patient?

Answer 6

NAME?

Question 7

How do you manage syncope in a unconscious patient?

Answer 7

NAME?

Question 8

What is loss of consciousness?

Answer 8

• The patient will suddenly lose consciousness, and there is no pulse or respiration- Suspected cardiac arrest and is generally due to ventricular tachycardia, ventricular fibrillation, a systole electrochemical dissociation. - Manage as per a syncope when there is no signs of breathing of the patient and the patient doesn’t regain consciousness.

Question 9

Chest pain in a medical emergency?

Answer 9

NAME?

Question 10

How do you manage chest pain?

Answer 10

• Make the patient comfortable- Anti anginal medication and angina management if the patient has angina- If there is no medical history of angina, or patient has angina and reports pain as much worse than usual - manage it as a suspected acute MI:Then call for 000, Red Bag, Monitor vital signs and administer oxygen, give aspirin (300mg chewed or dissolved before swallowing), reassure the patientIf the patient loses consciousness commence basic life support.

Question 11

How do you manage an Angina?

Answer 11

NAME?

Question 12

Medication and Angina management?

Answer 12

• Some patients may have their own medication as they are accustomed to treating their angina. - If they don’t have their own medication:Glyceryl Trinitate sublingually is a drug of choice to shorten the attack, and administration would be decided on by the team.

Question 13

When should Glyceryl Trinitate not be administered?

Answer 13

Within 3-5 days tadalafil (Cialis) Within 24hrs of sildenafil (Viagra)Within 24hrs of vardnafil (Levitra)

Question 14

How can you prevent Ocular Emergency?

Answer 14

NAME?

Question 15

Ocular emergency, where can injury come from?

Answer 15

• Chemicals (irrigation solutions)- Foreign bodies (calculus/filling fragments)- Penetrating objects (burs/endodontic instruments)

Question 16

How do you manage a chemical ocular emergency?

Answer 16

• Cease dental treatment- Remove contact lenses if present- Continued irrigation with eye open and exposed to water (preferably by tap) for at least 20minutes- If small chemical injury - arrange an appointment with GP for review on same day- If moderate-strong chemical injury call 000 and continue irrigation until assistance arrives- Keep chemical to show GP/medical team

Question 17

Management of foreign body ocular emergency?

Answer 17

• Cease dental treatment- Do not touch eye surface and do not attempt to remove foreign body- Continued irrigation with eye open and exposed to water (preferably by tap) for five minutes- Inspect visually to assess if foreign body flushed away- If not continue irrigation for further 15minutes- If foreign body gone arrange an appointment with GP for review- If foreign body still present arrange for transfer of patient/staff member to the emergency department

Question 18

Management of penetrating eye injury?

Answer 18

• Cease dental treatment- Call 000 and for assistance - Do not touch eye surface and do not attempt to remove- Do not irrigate- Do not wrap - Cover eye with shield and tape to stabilise - Reassure patient/staff member- Keep broken parts to show medical team - Arrange for transfer of patient/staff member to the emergency department.

Question 19

What are some respiratory emergencies?

Answer 19

Hyperventilation Syndrome, Acute Asthma, Inhaled/Swallowed objects, Ludwig’s Angina, Anaphylaxis

Question 20

What are symptoms of breathing difficulties?

Answer 20

Wheezing, Stridor, Shortness of breath, Increased use of accessory muscles, coughing spasms, Altered level of consciousness, Cyanosis

Question 21

What is a wheeze?

Answer 21

It is something that is heard on expiration, it is mot commonly associated with asthma. Wheezing is an unreliable indicator of the severity of an asthma attack, may even be absent in a severe attack.

Question 22

What is stridor?

Answer 22

Type of wheeze, but on inspiration - high pitched breath sound. Usually indicative of obstructed, narrowed airway. Common sound when foreign body obstruction.

Question 23

Define shortness of breath

Answer 23

Difficulty speaking at normal pace, physical exhaustion

Question 24

What is cyanosis?

Answer 24

Bluish discolouration of the skin and mucous membranes due to excessive concentration of deoxyhaemoglobin which is caused by deoxygenation.

Question 25

What is hyperventilation syndrome?

Answer 25

The patient ‘hyperventilates’ - or is ‘over breathing’This is extremely common with patients that suffer from anxiety, dental phobia, or an acute panic attack.

Question 26

What are symptoms of hyperventilation syndrome?

Answer 26

Symptoms are often confused with syncope, acute asthma attack or myocardial infarcation

Question 27

How do you prevent hyperventilation syndrome?

Answer 27

NAME?

Question 28

How do you manage hyperventilation syndrome?

Answer 28

• Cease dental treatment - Reassure patient and encourage them to slow their breathing- Ask the patient to rebreathe their expired air by cupping their hands close over, but not obstructing, their mouth and nose- Don’t give oxygen immediately- If patient is non responsive to the above management, and symptoms persist for 5-10minutes or if prolonged spasms in hands and feet. Call 000 and for Red Bag and assistance and monitor patient and perform basic life support until assistance arrives.

Question 29

Describe an acute asthma attack.

Answer 29

NAME?

Question 30

In regards to a acute asthma attack, what should you document?

Answer 30

NAME?

Question 31

If symptoms of an asthma attack occur what should you do?

Answer 31

NAME?

Question 32

What are the clinical features of a mild asthma attack?

Answer 32

Physical exhaustion/altered conscious state: NOAltered consciousness in children: NOIncrease accessory muscle use in children: NOTalks in: SentencesPulse rate: Less than 100/minHospital admission needed: NO

Question 33

What are the clinical features of a moderate asthma attack?

Answer 33

Physical exhaustion/altered conscious state: NOAltered consciousness in children: NOIncrease accessory muscle use in children: SomeTalks in: PhrasesPulse rate: Adult: to 120/min, Children: 100 to 180/minHospital admission needed: Most likely

Question 34

What are the clinical features of a sever/life threatening asthma attack?

Answer 34

Physical exhaustion/altered conscious state: YESAltered consciousness in children: YESIncrease accessory muscle use in children: MarkedTalks in: WordsPulse rate: Adult: greater than 120/min, Children: greater than 180/minHospital admission needed: Yes, high dependency or intensive care unit

Question 35

How do you manage a MILD asthma attack?

Answer 35

Give 4x puffs of short acting bronchodilator inhaler via a spacer.1 puff at a time, asking the patient to take four breaths in and out of the spacer after each puff. Wait four minutesIf there is no improvement, repeat the first step. This is the 4x4x4 rule.

Question 36

How to in a dental setting manage a mild asthma attack?

Answer 36

NAME?

Question 37

How do you manage a moderate or severe asthma attack?

Answer 37

• Call 00 and for red bad.- 4x4x4 rule - continue this method until assistance arrives, whilst giving oxygen continuously (6L/min) - Consider giving salbutamol 5mg - Monitor patient and perform basic life support until assistance arrives.

Question 38

How can a scenario of an inhaled or swallowed object occur?

Answer 38

NAME?

Question 39

How do you manage an inhaled/swallowed object?

Answer 39

• Cease dental treatment- Check to identify if object is present in patients mouth, or clothes: If yes, remove it. Identify all missing parts. If no: Sit patient upright. - Check vital signs and for symptoms of breathing difficulty - If none - do not allow the patient to eat or drink- Arrange for chest radiograph (if longer than 1 hour to obtain, GP may also refer to GI radiography depending on nature on foreign object- Ask dental assistant to search suction filters and tubing to locate the object.

Question 40

How do you manage a inhaled or swallowed object if there is a partial airway obstruction?

Answer 40

Call 000- Reassure the patient and encourage them to relax, breathe deeply and try to dislodge the object by coughing- Look at all spit and expectorant for the object- If the patient is unable to cough up the object, give up 5 back blows between the shoulder blades using the heel of the hand.

Question 41

How do you manage a inhaled or swallowed object if there is complete airway obstruction?

Answer 41

Call 000- Reassure the patient and encourage them to relax, breathe deeply and try to dislodge the object by coughing- Look at all spit and expectorant for the object- If the patient is unable to cough up the object, give up 5 back blows between the shoulder blades using the heel of the hand.- Check the breathing, if no signs of breathing then give up to 5 chest thrust. Monitor patient and perform basic life support until assistance arrives.

Question 42

Describe the foreign body flow chart.

Answer 42

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