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Flashcards in Medical Emergencies 1 Deck (23):
1

5 conditions that increase chance of adverse event occurring in dental surgery

-ischaemic heart disease
-diabetes
-asthma
-allergies
-polypharmacy

2

principles of emergency management ABCDE

Airways
breathing
circulation
disability
exposure

3

3 reasons dental pts at inc risk of upper airway obstruction

-blood/ saliva in mouths for prolonged periods of time
-LA prevents normal protective pharyngeal reflexes
-dental equipment in oral cavity for long time, possibility of aspiration

4

symptoms of upper airway obtsruction 3

-sudden onset
-coughing/ spluttering
-difficulty breathing

5

signs of upper airay obstruction 3

-paradoxical chest and abdominal movement (see saw respiration)
-use of accessory muscles of respiration
-central cyanosis is a late sign

6

signs of partial airway obstruction :
-inspirationay stridor =
-expiratory wheeze
-gurgling=
-snoring

-inspirationay stridor = obstruction at or above larynx
-expiratory wheeze = lower airway obstruction
-gurgling= liquid/ semi-solid foreign material in upper airway
-snoring= pharynx partially occluded by tongue or palate

7

management of upper airway obstruction 4

-simple manoevres: head tilt/ chin lift/ jaw thrust
-remove visible foreign body
-airway adjuncts
-high flow oxygen

8

4 conditions presenting with breathing problems

-hyperventilation
-asthma
-angina
-heart failure

9

explain look, listen, feel for breathing problems

look 4: sweating, central cyanosis (blue tongue), use of accessory muscles of mastication, abdominal breathing, count respiratory rate
listen 3: gurgling, stridor, wheeze
feel: movement of air on your cheek

10

normal respiratory rate (breaths) in
a. adults
b. children

a. adults: 12-20 breaths/min
b. children: 20-30 breaths/min

11

what does inc/ dec resp rate suggest

inc: in trouble
big decrease: very bad

12

what to do to manage breathing 2

-call ambulance
-use bag and mask/ pocket mask

13

define hyperventilation

minute ventilation exceeds metabolic demands resulting in haemodynamic changes
associated with panic disorder, may be acute or chronic

14

5 symptoms of hyperventilation

-shortness of breath/ wheeze
-chest pain/ palpitations
-belching/ dry mouth
-dizziness
-paresthesia/ circumoral numbness

15

management of hyperventilation 4

-stop tx, reassure pt
-encourage re-breathing of CO2 via paper bag or cupped hands
-[small dose of benzodiazepines eg lorazepam- may depress respiration BAD]
-consider anxiety management before next appointment

16

how to diagnose asthma 4

-more than one of: wheeze, breathlessness, chest tightness, cough
-symptoms worse at night and early morning
-occur in response to exercise, allergen exposure or drugs eg aspirin, beta blockers
-occur in association with atopy/ family history of asthma/ atopy

17

risk factors for severe asthma 7

*BE AWARE OF PSYCHOSOCIAL ISSUES WITH ASTHMA*

previous nr fatal asthma
-previous ventilation or resp acidosis
-prev hospitalisation esp in last year
-req 3+ classes of asthma meds
-heavy use of beta 2 agonist
-repeated ED attendances
-brittle asthma

18

common causes of asthma attack in dental setting 5

-LA with vasoconstrictors. sulphites --> bronchospasm
-sedative/ GA
-penecillin allergy more common in asthmatics
-NSAIDS
-other drugs eg aspirin, barbituates, beta blockers, cyanoacrylates, mefanamic acid, morphine, pancuronium, suxamethonium

19

4 symptoms of mild asthma

-increasing wheeze
-complaints of chest tightness
-inc resp rate
-tachycardia

20

symptom of moderate asthma

increasing symptoms of mild asthma

21

symptoms of severe asthma 4

-inability to complete sentences in 1 breath
-resp rate >25 /min
-tachycardia >110 /min
-use of accessory muscles

22

symptoms of life threatening asthma 4

-cyanosis
-resp rate

23

how to manage asthma attack in dental setting 2

-ABCDE
-high flow oxygen 10-15l/min
-salbutamol 4-6 puffs every 10 mins using spacing device/ nebuliser in severe attack