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BDS4 Medical Emergencies > Medical Emergencies > Flashcards

Medical Emergencies Flashcards

1
Q

What are the steps in patient assessment in a medical emergency?

A
  1. AIRWAY
  2. BREATHING
  3. CIRCULATION
  4. DISABILITY
  5. EXPOSURE

Is patient awake? Are they unwell? How do they feel?

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2
Q

What does it suggest if a patient can speak to you?

A

No airway problem

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3
Q

What are the signs of airway obstruction?

A

See-saw respirations

Central cyanosis- blue tongue

Complete obstruction- no breathing sounds
Partial- noisy breathing

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4
Q

What can be done if a patients airway is not patent?

A

Use an oro-pharyngeal airway

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5
Q

How is an OPA sized?

A

Measure from angle of jaw to vertical height of incisors
-> usually orange for males and green for females

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6
Q

What is the normal respiratory rate?

A

12-20 breaths per min

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7
Q

What are the common causes of breathlessness in patients?

A

Increased demand

Infection

Inflammation in airways

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8
Q

How is breathing assessed?

A

Assess breathing rate- look for chest rising/falling, listen for breathing sounds
-> check for equal expansion on both sides of chest

Assess rhythm

Assess depth

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9
Q

Why is it important not to tell the patient you are counting their respiratory rate?

A

They may alter it

-> ask to feel pulse and put hand on shoulder at same time to feel rate

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10
Q

What can be done to help patients who are struggling to breathe?

A

Place patient in tripod postion- allows opening of intercostal muscles

Give oxygen- 15l/min

Bronchodilators- salbutamol

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11
Q

What is the normal resting HR?

A

60-90 bpm

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12
Q

What are the causes of irregular pulse/circulation?

A

Arrhythmias- if you suspect this end to A&E

ACS- unstable angina, STEMI, NSTEMI

Heart failure

Loss of fluid/blood

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13
Q

What checks can help us recognise circulatory issues?

A

Check pulse- assess regularity, strength, speed
-> count it against clock

Capillary refill test- press nail bed for 5 sec
-> reperfusion should occur within 2 secs

Check limb temp and colour
-> are the hands blue, pink, pale, mottled
-> >37.8 is a fever

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14
Q

What are the different ways of checking pulse? What is the minimum BP required to detect each?

A

Pulse on wrist- minimum systolic of 70mmHg

Brachial pulse- minimum systolic of 60mmHG

Carotid- minimum systolic of 50mmhg

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15
Q

What is meant by disability in a medical emergency assessment?

A

Gross neurological function deficit

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16
Q

What are the causes of disability/unconsciousness?

A

Hypoxia
Hypercapnia
Drugs and alcohol
Brain injury- cerebral hypo perfusion
Hypoglycaemia

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17
Q

What are the steps in recognising disability? (ACVPU)

A

Alert- is patient responding

Confusion

Verbal stimuli response

Painful pressure- apply pressure to trapezius and see if they try to move your hand away

Unresponsiveness- to all/any stimuli
-> assess pupils with light- do they respond equally in terms of time and size

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18
Q

What is done at the exposure stage of patient?

A

Check colour of hands , check neck vessels, check continence (have they soiled themselves)

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19
Q

What are the emergency conditions that a dentist may have to deal with?

A
  1. ANAPHYLAXIS
  2. ANGINA/MI
  3. ASTHMA
  4. CARDIAC ARREST
  5. HYPOGLYCAEMIA
  6. SEIZURES
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20
Q

For what patients is oxygen given in an emergency situation in the dental setting?

A

For all emergencies (given in combination with any emergency drug)

*harm from over-oxygenation only occurs over long periods not seen in dental setting

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21
Q

How is oxygen administered to patients?

A

Use non-rebreathing mask which delivers 90% oxygen at a rate of 15 litres/min (one tank lasts 25 min)

Put finger in bag to allow it to inflate/place finger over green valve

Place over patients face and tighten straps

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22
Q

What is anaphylaxis?

A

Severe systemic hypersensitivity reaction

-> can result in shock- inability to perfuse organs/tissues

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23
Q

What are the features of ABCDE assessment in patient with anaphylaxis?

A

A- swelling, hoarsness

B- increased rate, wheezing due to bronchoconstriction

C- increased rate, hypotension due to vasodilation, hypovolaemia

D- loss of consciousness?

E- rash, swelling , abdominal pain/cramps, diarrhoea

24
Q

When do we provide treatment for patients suffering from anaphylaxis

A
  • life-threatening airways = airway swelling/hoarseness, periorbital swelling, swollen lips and tongue
  • Life threating breathing – peripheral cyanosis (84% oxygen saturation) lips and finger nails blue
  • Life threating Circulatory – can’t palpate radial pulse (= less than 70 systolic BP)
  • If in any doubt
25
Q

What is used to treat anaphylaxis?

A

IM adrenaline (1:1000 concentration)
-> 0.5mg

  • Kits have 2 doses, only use half
26
Q

What are the actions of adrenaline systemically?

A
  • Peripheral vasoconstrictor
  • Central vasodilator
  • Bronchodilator
  • Improves efficacy of myocardium
  • Increases HR
27
Q

What position should the patient be in when administering adrenaline?

A

Lie down with legs above head (better response as it helps blood get into central circulation)

OR

With patient sitting- if breathing issue

28
Q

What are the steps in administering adrenaline?

A
  1. Traction applied to the side of the thigh
  2. Inject and advance into the muscle (can feel the change in texture)
  3. Aspirate - if blood – advance another 1mm and aspirate again
  4. Inject
  5. Once injected remove needle ½ of the way and let go of traction
  6. Remove the needle fully (prevents capillary action removing some of the drug)
29
Q

What do you do if patient does not improve after 5 mins of administering adrenaline?

A

Give another dose every 5 mins (different locations on thigh)

30
Q

Why do healthy patients experience no chest pain on exertion?

A

As less than 1/3rd of the diameter of coronary arteries are obstructed by atheroma

31
Q

What is stable angina?

A

Chest pain caused by ischaemia which is resolved by rest

32
Q

What is unstable angina? What causes it?

A

Presents as pain at rest

-> Fibrous membrane of the plaque in a coronary artery ruptures and the contents of the plaque fills the coronary arteries (close to an entire blockage

-> Blood leaks from the plaque and clotting of the blood occurs = thrombosis

-> Vasoconstriction occurs due to inflammation which can lead to Artery spasm

33
Q

How is unstable angina treated?

A

2 puffs of GTN spray sublingually- 400 mcg per puff

-> can be repeated

34
Q

What are the actions of GTN?

A

Dilates veins- reducing preload to the heart
-> reduces workload of myocardium

Provides symptomatic relief but does not treat underlying issue

35
Q

When should GTN be avoided

A

If patient has low BP as it can cause lack of consciousness

36
Q

What happens if GTN is not effective within a few minutes?

A

Treat as an MI, especially if patient feels episode is different from normal

37
Q

What are the features of the ABCDE assessment in patients suffering from an MI?

A

A- no issue, they can talk
B- Increased
C- Increased
D- alert
E- pale, hot/sweaty, central crushing chest pain

38
Q

How is an MI treated in emergency in dental setting?

A

Chew 1 aspirin tablet 300mg or crush and place under tongue in edentulous patients
-> aim to provide this within 10min of onset
-> don’t give patient any water for 10 min to avoid diluting drug or washing it into gut

39
Q

What is the purpose of aspirin?

A

Reduces platelet aggregation

40
Q

Where should different MIs be sent?

A

STEMI- jubilee

NSTEMI- Royal infirmary (thrombolysis)

41
Q

What are the features of mild and moderate asthma attack?

A

A: normal
B: chest tightness and normal respiratory rate
C: normal heart rate

42
Q

How is a mild and moderate asthma attack treated?

A

2 puffs salbutamol (100mcg per puff)
-> patient holds breath for 10 secs between
-> causes bronchodilation

43
Q

what are the features of an acute/severe asthma attack?

A

B- >25 breaths per min or audible wheeze
C- HR- >115bpm

44
Q

How is acute/severe asthma attack treated?

A

As patient cannot hold breath
-> Fill spacer device with 10 puffs and get them breath using it for up to 20 secs

45
Q

What are the features of life threatening asthma (moribund patient)

A

Breathing rate- less than 8 per min
HR- <40bpm

46
Q

How is life threatening asthma treated?

A

Intubate and attach BVM (volume 1.5L)
-> phone ambulance

47
Q

Why is a BVM volume 3x that of the tidal volume? What issue can this cause?

A

 Easy way to get higher air pressures in life threatening asthma conditions
 Only squeeze hard enough to see chest rise or else air will reach stomach and cause aspiration of contents

48
Q

What are the complications of salbutamol?

A
  • Tremor
  • tachycardia
  • tachyarrhythmias (rare)
49
Q

What are the features of the ABCDE assessment in a hypoglycaemic patient?

A

A: initially talking
B: initially increased rate
C: initially increased rate
D: initially alert
E: irritable, confused, pale

-> usually caused by inflammation, infection, allergy on top of underlying diabetes

50
Q

How is hypoglycaemia treated in emergency?

A

 If conscious whilst they still have swallowing reflex- give 3 glucose tablets (can be difficult to do), gel is better (sticks to lips and gums)

 If consciousness lost (<3)- use glucagon 1mg
-> combine fluid and powder (do not shake)
-> use same IM injection technique as before

51
Q

When is oxygen used in seizures?

A

Place oxygen mask next to the px whilst they are seizing and then put on the patient when they have stopped

-> most stop within 2 mins

52
Q

What are the features of the ABCDE assessment when a patient is having a seizure?

A

A: always assume compromised (head tilt chin lift)
B: variable - assess colour of patient
C: variable - assess veins on back of hand
D - unresponsive
E – seizure activity, incontinence

53
Q

What is the treatment for seizure in emergency in dental setting?

A

Midazolam- 10mg into buccal sulcus

54
Q

What is the treatment for seizure in emergency in dental setting?

A

Midazolam- 10mg into buccal sulcus

55
Q

What are the side effects of midazolam when used to treat seizure in an emergency?

A

Respiratory depression- hypoventilation

Hypotension

Sedation = loss of airway tone
-> do not attempt to reverse

56
Q

What are the features of an ABCDE assessment for syncope (faint)?

A

A – compromised
B – reduced rate
C – reduced rate and pressure
D – unresponsive
E – pale and clammy

-> raise legs- if there is no response within 5 mins this is not a fainting episode

BDS4 Medical Emergencies (1 decks)

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