Emergencies Flashcards
1
Q
Drugs and substances that may produce allergic reactions
A
- Local anaesthetics
- Antibiotics
- Analgesics
- Anxiolytic drugs
- Dental materials
2
Q
Most common preservative in local anaesthetics that causes allergy
A
Paraben
3
Q
Most common antibiotic producing allergic reaction
A
-Penicillin
4
Q
Most common analgesics responsible for allergic reactions
A
- Codeine(narcotics)
- Aspirin (acetylsalicylic acid)-urticaria to anaphylactic shock
5
Q
Anxiolytic drugs that commonly cause allergy
A
-Barbiturates (mild-urticaria)
6
Q
Dental materials that commonly cause allergy
A
-Acrylic resins
-Antiseptics
-Radiograph processing solutions
-Gloves
(Mild-stomatitis and skin urticaria)
7
Q
Classification of allergic reactions
A
- Type I- Anaphylaxis
- Type II- cytotoxic hypersensitivity
- Type III- Immune complex mediated hypersensitivity
- Type IV-Cell mediated or delayed type hypersensitivity
8
Q
Types of allergic reactions
A
- Anapylaxis
- Urticaria
- Quinckes Edema
- Allergic Asthma
9
Q
Precautionary measures for allergy
A
- Questions about type of allergy
- Referral for allergy testing
- Prepared to deal with allergic reaction with drugs(adrenaline, hydrocortisone, antihistamines and oxygen)
10
Q
Anaphylaxis
A
- Acute respiratory and circulatory collapse
- Hoarseness of voice, anxiety, wheezing, irregular heart rate
- Fatal within 5-10 mins
11
Q
Anaphylaxis treatment
A
- Termination of treatment-patient put in Trendelenburg position
- Adrenalin(0.3-0.5ml) giving i.v or i.m
- Control of vitals
- Hypotension treatment wit NaCl(i.v)
12
Q
Anaphylactic shock treatment
A
- Adrenalin(0.5ml 0.1%) diluted in NaCl(o.9%) i.v
- Urbason (1-3mg/kg i.v)
- Salbutamol (5mg iv)
- Droperidol(for throes)
- CPR
13
Q
Urticaria
A
- Most common reaction
- Vesicles due to histamine and serotonin→ increased permeability of vascular structures
- Vesicles induce pruritis and burning sensation on skin→ limited or spread over body
- Severe reaction→fall in blood volume→ anaphylaxis
14
Q
Urticaria treatment
A
- Termination of treatment-patient in Trendelenburg position
- Adrenaline (0.3ml 0.1%) s.c, i.m or i.v
- Allergosan(1% 2ml) i.v or i.m
- Patient observed for 1 hour
- Oral antihistamines
15
Q
Quinckle’s Edema
A
- Swelling of soft tissues(lips, tongue, buccal mucosa, epiglottis)
- Obstruction of upper respiratory tract→ dyspnoea and difficulty swallowing
16
Q
Quincke’s edema treatment
A
- Adrenaline(0.3mk 0.1%) i.v or i.m
- Methylprednisolon i.v
- NaCl (0.9%) i.v
- Cricothyrotomy or coniotomy
17
Q
Normal blood pressure for adult is
A
under 140/90mmHg
18
Q
in patients with Bp of 140-160/90-95
A
- Can undergo dental surgery safely
- Above these values→ referred to doctor for further treatment
19
Q
Hypertension management
A
- Premedication before surgery
- Bp monitoring
- Aspiration before injection
- Avoiding Noradrenaline
- Short appoitments
20
Q
Hypertensive crisis
A
- Systolic >200/Diastolic >120mmHg
- Palpitations, increased heart rate, chest pain
- Headache
- Nausea, vomiting, tinitus
21
Q
Hypertensive crisis treatment
A
- Nifedipin tablet(20mg) under toungue
- Isoket spray
22
Q
Angina Pectoris
A
- Temporary ischemia in myocardium(reduced oxygen supply)
- pain(pressure or tightness) posterior to sternum(may radiate to left shoulder, neck, left arm, mandibular teeth)
- Precipitated by fatigue, stress→ subsides within 2-5 min after rest
23
Q
Angina Pectoris preventive measures
A
- Written consent from cardiologist
- Medication (5-10mg diazepam or 1.5-3 bromazepam orally 1 hour before surgery
- Carried out in hospital
- Small amounts of vasoconstrictors(aspiration)
- Short appoitments
24
Q
Angina Pectoris treatment
A
- Clear airway
- Nitroglycerinum (0.5mg tablet under tongue)-if needs to be repeated twice→MI
- Aspirin
- CPR
25
Myocardial Infarction
- Ischaemic necrosis of area of heart(blocking or coronary artery)
- Severe pain(increases) posterior to sternum→radiates to left shoulder or arm/neck region/mandibular teeth
- Does not subside with rest or nitrates
- Treatment avoided if occurred within 6 months(otherwise in hospotal)
26
Treatment of Myocardial infarction
- Improving airway
- Consult with cardiologist
- Nitroglycerinum tablet(0.5mg under tongue)
- Pain killers
- CPR
27
Asthma
- Stenosis of bronchi and bronchioles(Bronchioconstriction, edema and mucous production)
- Expiratory dyspnoea accompanied by non productive cough and wheezing
28
Asthma preventative measures
- Detailed medial history
- Sedative medication for stress management
- Pain control(to manage stress)
- Short appoitments
29
Treatment of Asthma
- Termination of treatment
- Improve airway
- Salbutamol
- Adrenaline(0.1%)
- Methylprednisolon i.v
30
Collapse
- Acute vascular insufficiency
- Reduced vessel tonus→hypoxia
→Pallor of face, shortness of breath, hypotension, consciousness preserved
31
Treatment of Collapse
- Termination of treatment-Trendelenburg position
- Improve airway
- CPR(ABC)
32
Syncope
- Mild transient brain ischaemia
- Loss of consciousness
- Pallor of face, bradycardia, SOB, hypotension
33
Treatment of syncope
- Termination of dental treatment-Trendelenburg position
- Improving airway
- Splashing water
- Ammonia
34
Diabetes mellitus
-Abnormalities in secretion mechanism and effect of insulin→ Alteration of carbohydrate, protein and lipid metabolism
35
Best time for surgery with diabetic patient
-Morning(1-1.5 h after breakfast)-peak insulin action
36
Administration of drugs for Diabetes Mellitus
- Mild analgesics and sedatives(w/tylenol) used
- Anxiolytic before procedure
- Corticosterioids(glycogenolytic action) and aspirin(hypoglycaemic action) avoided
37
Diabetic hypoglycaemia
- Blood glucose \<55mg/100ml
- Hunger, sweating, pallor, headache, mental confusion, blurred vision
- More severe→loss of consciousness, coma and death
38
Diabetic hypoglycaemia treatment
- Termination of treatment
- Sugar or honey
- 1mg Glucagon
39
Diabetic hyperglycaemia
- More rare
- Slow development
- Weakness, headache, nausea,, xerostomia, dehydration→coma
40
Diabetic hyperglycaemia
- Termination of treatment
- Full dose of insulin
41
Types of Haemorrhagic Diatheses
- Vascular disorders
- Thrombocytic disorder
- Disorders of coagulation
