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4TH YEAR > TG Medical Emerfency > Flashcards

TG Medical Emerfency Flashcards

1
Q

Drugs and equipment used for medical emergencies?

A
  1. Transportable source of oxygen
  2. Disposable plastic airways
  3. Adrenaline autoinjector (EpiPen) x2
  4. Pulse oximeter
  5. Glucose (fast-acting oral glucose)
  6. Glyceryl trinitrate spray
  7. Short-acting bronchodilator (reliever) inhaler and spacer
  8. Aspirin
  9. BP monitor
  10. BG monitor
  11. Defibrillator
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2
Q

How to administer oxygen for a breathing patient?

A

Via a mask (6-8L/min) or nasal prongs (2L/min)

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3
Q

How to administer oxygen for a patient who is not breathing

A

Bag-valve mask or else start mouth to mouth resuscitation

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4
Q

What is a disposable plastic airway used for?

A

To secure the oral airway and facilitate mouth to mouth resuscitation or ventilation with oxygen

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5
Q

What is aspirin used for in medical emergencies?

A

For a suspected heart attack

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6
Q

What are common dental allergies?

A

Antibiotics, latex, LA and acrylates (bond, materials)

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7
Q

What is urticaria?

A

Transient erythematous lesions that vary in size, often filled with fluid. They are itchy and tend to persist for 24 hours

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8
Q

What is acute angioedema?

A

Acute angiodema (may co-exist with urticaria) as single or multiple lesions. They may be painful or cause burning sensation

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9
Q

Acute angioedema and urticaria are associated with?

A

Anaphylaxis.

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10
Q

Management of mild urticaria?

A

Stop treatment
Remove or stop administration of the allergen
Recommend oral anti-histamine.

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11
Q

Management of extensive urticaria or angioedema, or swelling involving eyelids, lips or tongue?

A

Stop treatment
Remove or stop administration of the allergen
Refer for urgent medical attention; systemic corticosteroids may be indicated

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12
Q

Management of urticaria or angioedema with associated hypotension and evidence of anaphylaxis?

A

Stop treatment
Remove or stop administration of the allergen
Call 000
Give intramuscular injection of adrenaline (epipen)

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13
Q

What is anaphylaxis?

A

It is a severe immediate onset hypersensitivity reaction to an allergen affecting multiple organs

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14
Q

What are the signs and symptoms of anaphylaxis?

A

Swellling of tongue, blockage of airway, hypotension, bronchospasm

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15
Q

What are the signs and symptoms of anaphylaxis?

A

Swellling of tongue, blockage of airway, hypotension, bronchospasm

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16
Q

What is the management of anaphylaxis?

A

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

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17
Q

Why is EpiPen injected into the thigh?

A

Better blood flow in thigh so you have faster absorption

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18
Q

Why is adrenaline injected in anaphylaxis

A

Adr reverses the effects of anaphylaxis by reducing throat swelling, opening the airways, and maintaining heart function and blood pressure.

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19
Q

What is the dosage of adr in an autoinjector?

A

Child 10-20kg? = 150 micrograms
Adult or child more than 20kg? = 300 micrograms

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20
Q

What is syncope?

A

Acute hypotensive episode, resulting in loss of consciousness

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21
Q

Common cause of syncope in dental settings?

A

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.

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22
Q

Management of syncope? If the patient feels faint

A

Stop dental treatment
Lay the patient horizontally
Raise the patient’s legs
Measure heart rate
Assess consciousness by talking to the patient

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23
Q

Management of syncope? If the patient loses consciousness

A

Stop dental treatment
Raise the patient’s legs to a position higher than the heart
Measure patient’s blood pressure and heart rate

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24
Q

Post op for LOC syncope?

A

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.

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25
Q

If patient does not regain consciousness?

A

Call 000
Start basic life support
Place patient on their side
Maintain tx until pt regains consciousness or help arrives

26
Q

Symptoms of acute coronary syndrome?

A

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

27
Q

What will patients with stable angina experience?

A

Episodic retrosternal chest discomfort that lasts less than 10 minutes or less and subsides promptly with rest

28
Q

What causes angina pain?

A

Physical activity
Emotional stress

29
Q

Management of angina? With history of angina

A

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

30
Q

Management of unresolving angina or suspected heart attack?

A

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

31
Q

Management of cardiac arrest or loss of consciousness?

A

Stop dental treatment
Call 000
Give basic life support - CPR, defib
Maintain treatment until help arrives

32
Q

What is hypoglycaemia?

A

Low blood glucose levels at below 4mmol/L

33
Q

Signs and symptoms of hypoglycaemia?

A

Hunger, confusion, slurred speech, sweating, tiredness, shaking, palpitations

34
Q

Management of hypoglycaemia? If patient is conscious and cooperative

A

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

35
Q

Management of hypoglycaemia? If patient is drowsy, uncooperative or unconscious

A

Stop dental treatment
Call 000
Start basic life support till help arrives

36
Q

Methemoglobinaemia is what?

A

Haemoglobin oxidises into methemoglobin, and there is reduced oxygen carrying capacity.

37
Q

Signs of methemoglobinaemia?

A

Cyanosis, slate grey skin discolouration - most common
Headache, light headedness, shortness of breath, fatigue

38
Q

Management of methemoglobinaemia?

A

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

39
Q

What is stroke?

A

Blood clot in the brain

40
Q

Signs and symptoms of stroke?

A

Facial weakness, unilateral weakness, speech difficulty

41
Q

What is the FAST acrynoym stand for?

A

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

42
Q

Management of stroke?

A

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?

43
Q

Should you give aspirin for stroke?

A

No, because you don’t know if the stroke is hemorrhagic or ischaemic.

44
Q

What are seizures?

A

Sudden spasm of muscle, jerking movements of head, arms, legs and loss of consciousness

45
Q

Management for seizures?

A

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

46
Q

What is status epilepticus?

A

Continuous seizure activity or repeated seizures without full recovery of consciousness between attacks. This is a medical emergency, call 000

47
Q

What to do following a seizure that has been completed?

A

Observe the patient for 30 minutes
Do not allow patient to drive home
Advise patient to seek urgent medical review

48
Q

Management for seizures that last for more than a few minutes or loss of consciousness, or status epilepticus?

A

Call 000
Maintain airway
Monitor patient until assistance arrives

49
Q

Temporary paralysis of the periocular muscles caused by?

A

LA injected into the parotid gland causing facial nerve anaesthesia

50
Q

Management of temporary paralysis to periocular muscles?

A

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.

51
Q

Management of chemical eye injuries

A

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

52
Q

Hyperventilation syndrome?

A

Occurs when pt over breathes, associated with anxiety, panic attacks

53
Q

Management of hyperventilation syndrome?

A

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

54
Q

Management of hyperventilation if symptoms last for more than 5-10 minutes?

A

Call 000
Monitor until help arrives

55
Q

Management of acute asthma attack? If asthma attack is mild to moderate

A

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

56
Q

Management of acute asthma attack? If asthma attack is severe or life threatening?

A

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

57
Q

Which is worse inhaling or swallowing objects?

A

Inhaling, all inhaled objects must be removed

58
Q

What is partial obstruction of airway?

A

Breathing is laboured
Breathing is noisy
Some movement of air can be felt from mouth

59
Q

Complete obstruction of airway is when?

A

There may be attempts to breath
No breathing sounds
Air does not emit from nose or mouth

60
Q

Management of inhaled or swallowed objects? If the object has fallen down the oropharynx

A

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

61
Q

If patient is conscious with signs of airway obstruction?

A

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

62
Q

If patient is unconscious with airway obstruction?

A

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.

4TH YEAR (11 decks)

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