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DOH210 S1 > Week One: Medical Emergencies > Flashcards

Week One: Medical Emergencies Flashcards

1
Q

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

A
  • Syncope
  • Chest Pain (Angina, Myocardial Infarct)
  • Sudden loss of consciousness (W/o pulse/respiration) ‘Cardiac Arrest’
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2
Q

What is the best way to avoid a medical emergency?

A

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.

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3
Q

What is the OHTs role?

A
  • Manage symptoms
  • Call for help
  • Always maintain treatment until patient regains consciousness or assistance arrives.
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4
Q

What is a syncope?

A

‘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.
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5
Q

What are the signs and symptoms of syncope?

A
  • Depends on underlying conditions
  • Commonly the patient may report symptoms of feeling faint, or you may observe these:

The patient becomes pale and feels nauseated, sweaty and weak prior to loss of consciousness.

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6
Q

How do you manage syncope in a conscious patient?

A
  • Cease dental treatment
  • If the patient is in the dental chair, recline the chair so that it is horizontal (the patient should not be placed in head lower than heart position)
  • If not in the dental chair, ask the patient to lie down on the floor
  • Elevate the patients legs slightly.
  • Assess/monitor the patients consciousness by engaging the patient in conversation
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7
Q

How do you manage syncope in a unconscious patient?

A
  • Cease dental treatment
  • Assess airway, check for signs of breathing/respiration
  • If patient is in the dental chair, recline chair so that it is horizontal (the patient should not be placed in head lower than heart position)
  • Place the patient into the recovery position - left side if the patient is pregnant
  • Monitor the patients pulse and blood pressure
  • Stimulate the patient gently, rouse and place a cool compress on their forehead.
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8
Q

What is loss of consciousness?

A
  • 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.
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9
Q

Chest pain in a medical emergency?

A
  • Important to respond immediately - as it may result in a myocardial ischaemia secondary to coronary obstruction
  • can affect both elderly and young patients
  • Some patients with diabetes may have no symptoms
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10
Q

How do you manage chest pain?

A
  • 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 patient

If the patient loses consciousness commence basic life support.

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11
Q

How do you manage an Angina?

A
  • Medical History: Ensure that any patient with a history of Angina brings there medications to their appointments.
  • If the patient develops chest pain, cease treatment and call for help and Red Bag
  • Asses pulse, blood pressure and level of consciousness
  • Make the patient comfortable.
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12
Q

Medication and Angina management?

A
  • 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.
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13
Q

When should Glyceryl Trinitate not be administered?

A

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

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14
Q

How can you prevent Ocular Emergency?

A
  • Prevention is key

- Prevent with PPE personal protective equipment

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15
Q

Ocular emergency, where can injury come from?

A
  • Chemicals (irrigation solutions)
  • Foreign bodies (calculus/filling fragments)
  • Penetrating objects (burs/endodontic instruments)
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16
Q

How do you manage a chemical ocular emergency?

A
  • 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
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17
Q

Management of foreign body ocular emergency?

A
  • 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
18
Q

Management of penetrating eye injury?

A
  • 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.
19
Q

What are some respiratory emergencies?

A

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

20
Q

What are symptoms of breathing difficulties?

A

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

21
Q

What is a wheeze?

A

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.

22
Q

What is stridor?

A

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

23
Q

Define shortness of breath

A

Difficulty speaking at normal pace, physical exhaustion

24
Q

What is cyanosis?

A

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

25
Q

What is hyperventilation syndrome?

A

The patient ‘hyperventilates’ - or is ‘over breathing’

This is extremely common with patients that suffer from anxiety, dental phobia, or an acute panic attack.

26
Q

What are symptoms of hyperventilation syndrome?

A

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

27
Q

How do you prevent hyperventilation syndrome?

A
  • Observing the patient prior, (teamwork) and reassuring the patient, listening to their needs.
28
Q

How do you manage hyperventilation syndrome?

A
  • 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.
29
Q

Describe an acute asthma attack.

A
  • It can be fatal
  • Evaluate severity of symptoms and listen to the patient
  • Ensure/check with patient, that any patient who reports asthma brings the bronchodilator inhaler medication
30
Q

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

A
  • Type of medications used to manage asthma
  • Asthma action plan
  • Triggers
  • management
  • Last attack (when, trigger, how it was resolved)
31
Q

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

A
  • Cease dental treatment

- Reassure patient and make them comfortable whilst performing rapid physical assessment.

32
Q

What are the clinical features of a mild asthma attack?

A

Physical exhaustion/altered conscious state: NO
Altered consciousness in children: NO
Increase accessory muscle use in children: NO
Talks in: Sentences
Pulse rate: Less than 100/min
Hospital admission needed: NO

33
Q

What are the clinical features of a moderate asthma attack?

A

Physical exhaustion/altered conscious state: NO
Altered consciousness in children: NO
Increase accessory muscle use in children: Some
Talks in: Phrases
Pulse rate: Adult: to 120/min, Children: 100 to 180/min
Hospital admission needed: Most likely

34
Q

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

A

Physical exhaustion/altered conscious state: YES
Altered consciousness in children: YES
Increase accessory muscle use in children: Marked
Talks in: Words
Pulse rate: Adult: greater than 120/min, Children: greater than 180/min
Hospital admission needed: Yes, high dependency or intensive care unit

35
Q

How do you manage a MILD asthma attack?

A

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 minutes
If there is no improvement, repeat the first step.

This is the 4x4x4 rule.

36
Q

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

A
  • Assess patients status
  • Little or no improvement, manage the emergency as moderate or severe
  • If the patient recovers swiftly
  • Temporise the dental state
  • Make another dental appointment (if needed)
  • When the patient is breathing easily, discharge from care
  • Recommend that the patient takes their asthma medications strictly as described.
37
Q

How do you manage a moderate or severe asthma attack?

A
  • 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.
38
Q

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

A
  • Burs, clamps, prophy cups, mandrels etc…
  • Calculus debris, filling material during polishing etc…

This can all be prevented. Prevention is key. Example to prevent this is a rubber dam and also floss tied to a the clamp etc before placing the clamp..

39
Q

How do you manage an inhaled/swallowed object?

A
  • 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.
40
Q

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

A

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.
41
Q

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

A

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.

42
Q

Describe the foreign body flow chart.

A

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DOH210 S1 (15 decks)

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