medical emergencies

Question 1

what must be regularly done in practice?

Answer 1

stock and regularly check drugs and equipment

Question 2

CPD

Answer 2

GDC recommends 10hrs per cycle (2hrs pa)

Question 3

what does the BNF recommend as an emergency drug for the management of status epilepticus in GDP?

Answer 3

buccal midazolam

Question 4

adrenline

Answer 4

1ml ampoules or prefilled syringes of 0.5ml of 1:1000 solution IM

Question 5

aspirin

Answer 5

300mg dispersible tablets

Question 6

glucagon

Answer 6

1mg IM

Question 7

GTN spray

Answer 7

400mcg per metered dose

Question 8

midazolam

Answer 8

oromucosal solution 5mg/ml
topical buccal administration
not licensed <3m/>18yrs

Question 9

glucose

Answer 9

oral

Question 10

O2 cylinder

Answer 10

2 size D/CD or 1 size E

Question 11

salbutamol

Answer 11

inhaler

100mcg per acutation

Question 12

optional drugs

Answer 12

cetirizine 10mg
chlorphenamine 4mg
loratidine 10mg

Question 13

signs of anaphylaxis

Answer 13

upper airway oedema and bronchospasm
stridor and wheezing
tachycardia >110bpm, increased resp rate

Question 14

symptoms of anaphylaxis

Answer 14

abdo pain, vomiting, diarrhoea, sense of impending doom
flushing (/pallor)
symptoms of mild allergy

Question 15

managment of anaphylaxis

Answer 15

assess ABCDE
999
secure airway, help restore bp by laying flat and raising feet - DON’T stand
remove source if known
100% O2 15l/min
adrenaline 0.5ml (1:1000) IM, repeat after mins if needed
- children 6m-5yrs 0.15ml
- 6-11yrs 0.3ml
if cardiac arrest - BLS and early defibrillation

Question 16

tx if signs of mild bronchospasm

Answer 16

salbutamol inhaler 4 puffs (100mcg per actuation) large vol spacer, repeat as needed
refer to GP

Question 17

key signs of milder allergy

Answer 17

urticaria and rash (chest, hands, feet)
rhinitis, conjunctivitis
mild bronchospasm without evidence of severe SOB

Question 18

signs of life-threatening asthma

Answer 18

cyanosis or resp rate <8 per min
bradycardia <50
exhaustion, confusion, reduced consciousness level

Question 19

signs of acute severe asthma

Answer 19

unable to complete sentences in 1 breath
resp rate >25 per min
tachycardia (>110)

Question 20

tx of life-threatening asthma

Answer 20

999
assess pt
sit upright
100% O2 15l/min
2 puffs of pt own bronchodilator or salbutamol 4 puffs (100mcg per actuation) through large vol spacer, repeat as needed
- children 1 puff spacer every 15s (max 10), repeat at 10-20min intervals

Question 21

tx of acute severe asthma

Answer 21

assess pt
sit upright
100% O2 15l/min
2 puffs of pt own bronchodilator or salbutamol 4 puffs (100mcg per actuation) through large vol spacer, repeat as needed
- children 1 puff spacer every 15s (max 10), repeat at 10-20min intervals

if severe episode doesn’t respond to tx with bronchodilators within 5mins - hospital emergency

Question 22

ACS presentation

Answer 22

progressive onset of severe crushing pain in centre and across front of chest, may radiate to shoulders and down arms (usually left), neck, jaw, back

Question 23

symptoms of ACS

Answer 23

SOB
increased resp rate
pale and clammy skin
nausea and vomiting common
may have weak pulse/bp may fall

Question 24

tx of ACS

Answer 24

assess
100% O2 15l/min
GTN 2 puffs (400mcg per metered dose) sublingually, repeat 3mins if pain remains

if pt doesn’t respond to GTN

• 999
• aspirin 300mg dispersible tablet (chew/in water) - send note with pt
• if needed BLS

Question 25

signs of cardiac arrest

Answer 25

LOC absence of normal breathing loss of pulse dilation of pupils

Question 26

tx of cardiac arrest

Answer 26

999 BLS, 100% O2 vent 15l/min defib

Question 27

signs of epilepsy

Answer 27

``` sudden LOC rigid fall might give a cry becomes cyanosed (tonic phase) jerking movement of limbs, might bite tongue (clonic phase) ```

Question 28

symptoms of epilepsy

Answer 28

brief warning/aura | frothing from mouth and urinary incontinence

Question 29

epilepsy tx

Answer 29

``` assess don't try to restrain convulsive movements ensure pt not at risk from injury secure airway 100% O2 15l/min ``` seizure will typically last a few mins, pt might then become floppy but remain unconscious once pt regains consciousness they may remain confused

Question 30

epilepsy tx if fit repeated/prolonged (5 or more mins)

Answer 30

``` continue O2 10mg midazolam - use 2ml oromucosal solution 5mg/nl - topically into buccal cavity - not licensed for use in adults in status epilepticus, but is recommended by BNF ``` after convulsive movements have subsided, place pt in recovery position and check airway. Don't send pt home until recovered fully

Question 31

epilepsy - when should you call 999?

Answer 31

``` prolonged more than 5mins repeated 1st episode for pt atypical convulsion injury occurred difficulty monitoring pt ```

Question 32

signs of faint

Answer 32

feels faint dizzy lightheaded slow pulse LOC

Question 33

symptoms of faint

Answer 33

pallor and sweating | nausea and vomiting

Question 34

tx of faint

Answer 34

assess lay flat and if not breathless raise feet loosen any tight clothing around neck 100% O2 15l/min until consciousness regained

Question 35

signs of hypoglycaemia

Answer 35

aggression and confusion sweating tachycardia >110

Question 36

symptoms of hypoglycaemia

Answer 36

``` shaking and trembling difficulty in concentration/vagueness slurring of speech headache fitting unconsciousness ```

Question 37

tx of hypoglycaemia if pt conscious and cooperative

Answer 37

assess pt 100% O2 15l/min oral glucose 10-20g, repeat if necessary after 10-15mins

Question 38

tx of hypoglycaemia if pt unconscious or uncooperative

Answer 38

assess pt 100% O2 15l/min glucagon 1mg IM oral glucose 10-20g when pt regains consciousness

Question 39

hypoglycaemia - when should you call 999?

Answer 39

if pt does not respond or any difficulty is experienced

Question 40

key signs of a stroke

Answer 40

facial weakness, one eye may droop or pt may only be able to move one side of mouth arm weakness communication problems - slurred speech, pt is unable to understand what is being said to them

Question 41

tx of stroke

Answer 41

assess pt 100% O2 15l/min if unconscious and breathing secure airway and place in recovery position 999

Question 42

why are dental pts susceptible to aspiration and choking?

Answer 42

blood and secretions in mouth for prolonged periods suppressed pharyngeal reflexes due to LA imp material/dental equipment in mouths

Question 43

S+S of aspiration and choking

Answer 43

``` cough and splutter complain of difficulty breathing stridor 'paradoxical' chest or abdo movements cyanosed/LOC ```

Question 44

management of aspiration

Answer 44

encourage pt to cough vigorously 100% O2 15l/min salbutamol inhaler 4 puffs (100mcg per actuation), through a large-vol spacer, repeat as needed - children 1 puff every 15s (max 10) repeat at 10-20min intervals as needed if you suspect a large fragment has been inhaled/swallowed but there are no S+S - refer to hospital for xray and removal of fragment if necessary if pt symptomatic following aspiration refer to hospital as emergency

Question 45

management of choking

Answer 45

remove any visible foreign bodies in mouth and pharynx encourage pt to cough if pt unable to cough but remains conscious - back blows followed by abdo thrusts if LOC - BLS, may also help to dislodge foreign body 999