Medical emergencies Flashcards
(12 cards)
Hypoglycaemia and seizure (12 mins) / Part A
Explain hypoglycaemia and drugs to a nurse
Correct drug/detailed action/description of emergency (signs and symptoms)
~ Hypoglycaemia - a drop in blood sugar causing symptoms such as shaking , sweating , pallor , blurred vision , confusion and loss of consiousness
A - initially talking
B - increased
C - increased
D - initially alert
E - confused, irritable and pale
if Conscious - offer 15-20mg oral glucose tablets
Give 15L oxygen and observe
If not conscious call 999 , state hypoglycaemia
Give 1mg of glucagon IM injection (remove orange cap and inject sterile water into vial and unvert it until powder is fully dissolved) , Inject at 90 degrees using the Z-track technique ( spread the skin, aspirate , inject at 90 degrees , inject for 30 seconds then remove) and once consious offer oral glucose
- Glucagon is a hormone that promotes glucogenesis and glycogenolysis ( glycongen to glucose) and releasing glucose form liver into blood stream, increasing blood glucose levels
Hypoglycaemia and seizure (12 mins) / Part B
Explain Epilepsy/Seizure and drugs to a nurse
Correct drug/detailed action/description of emergency (signs and symptoms)
~ Epilepsy
Epilepsy is a neurological condition where a person has a tendency to have repeated seizures due to abnormal electrical activity in the brain
~ Signs and symptoms
- Sudden collapse and loss of consiousness
- Rigidity and jerking movements of the limbs
- cyanosis
- noisy breathing
- forthing of mouth
A - compromised
B - irregular breathing
C - can be increased or decreased
D - unresposive
E - Siezure like activity
- call for help
- clear patient surrounding from hazards and do not put anything in mouth
- Provide Oxygen
- once jerking movements sieze put pt in recovery position and follow patients personalised care plan
- if siezure lasts for more than 5 minutes call 999 and administer 10mg of midazolam in the buccal sulcus
Midazolam - short acting benzodiazepine , enhances the effect of gaba neurtotransmitter causing inhibition of the central nervous system which result in reduced electrical activity in the brain
Asthma and Anaphylaxis (12 mins)
New nurse asks what they do if a patient has an asthma attack and how you can identify it. How do they treat it and use a spacer?
They ask what they do if it turns to anaphylaxis and how they will know it is anaphylaxis. What do you know about adrenaline and how do I use it?
Correct drug- detailed action. Description of emergency (signs and symptoms)
Part A - ASTHMA
~ Asthma
Asthma is a chronic lung condition where the airways become inflamed and narrowed, causing symptoms like wheezing, coughing, and shortness of breath, cyanosis , confusion and decreased level of consiousness
A - unable to complete a sentence
B - increased with wheezing
C - increased
D - alert
E - tripods
~ call for help
~ sit pt upright and admister 2 puffs of pt own inhaler or 2 puffs of salbutamol (100mcg) and observe
~ if no respose or if very severe call 999 , give them oxygen
~ Admister one more puff using a spacer every 60 seconds ( shake inhaler take cap off insert mouthpiece into end of spacer ) WITH tidal breathing for maximum of 10 puffs
- Salbutamol = short acting beta 2 agonist , bronchodilator and encourage muscle relaxation
Asthma and Anaphylaxis (12 mins)
New nurse asks what they do if a patient has an asthma attack and how you can identify it. How do they treat it and use a spacer?
They ask what they do if it turns to anaphylaxis and how they will know it is anaphylaxis. What do you know about adrenaline and how do I use it?
Correct drug- detailed action. Description of emergency (signs and symptoms)
Part B - Anaphylaxis
~ Anaphylaxis
Anaphylaxis is a severe, life-threatening allergic reaction that happens suddenly and can cause difficulty breathing, a drop in blood pressure, and loss of consciousness if not treated immediately.
Signs
- flushing and pallor
- wheezing
- stridor
- loss of consiousness
- skin swelling
A - swelling
B - increased
C - increased
D - loss of consiousness
E - rash or swelling
Call 999 and state anaphylaxis
lie flat and raise legs ,
administer adrenaline 1;1000 / 0.5mg intramuscular injection using the z track technique
Repeat every 5 minutes
Adrenaline stimulates alpha and beta adrenergic receptors causing constriction of blood vessels and relaxes smooth muscles in airway
Continue previous Q,
What is the difference between asthma and anaphylaxis as they have similar symptoms
- check medical history and series of events leading to the episode ( as anaphylaxis is caused by something)
-Asthma only has respiratory symptoms and those caused by hypoxia - Anaphylaxis is systemic presenting with a weaker pulse , uriticaria and angioedema
Choking adult (6 mins)
- ABCDE
- Are you choking?
- encourage them to cough
- Ask for help
- 5 back slaps between shoulder blades
- 5 abdominal thrusts between belly button and sternum
- continually check for object dislodging
- Re-evaluate ABCDE
- If not resolved call ambulance and BLS
Nurse sharps injury (6 mins)
A new 48-year-old patient is attending your practice for a routine first appointment.
During your examination, you observe an MO restoration on tooth 46 which requires replacement and the patient consents to have this treatment undertaken at the same visit.
Shortly after successful completion of the treatment, your dental nurse sustains a sharps injury from the needle used to deliver the local anaesthetic.
You have supervised the immediate first aid treatment of the injury to the dental nurse and arranged for them to be seen at an occupational health department.
You have now returned to the surgery to discuss the incident with the patient.
Undertake the following
- Explain the incident to the patient
- Outline the risks to the dental nurse and the patient
- Provide background information to the patient in order to achieve informed consent for blood borne virus testing
~ Explain nature of injury
- “ Hi my name is Ziyad and one of my colleague nurses has sustained something we call a sharps injury which is where she has accidentally cut herself on an object used on you which has been in contact with your bodily fluids.”
- “ I want to reassure you that there is no risk to yourself however there is a standard procedure we need to follow to assess if the staff member is at risk of any infectious disease ( Hep C , Hep B , HIV)
- “risk is extremely low , but if there is an infectious disease then we can treat the nurse to prevent infection - this needs to be done quickly”
- “ To assess the risk we will need two things from you
1. Answer list of questions which are sensitive in nature but this is a standard procedure to anyone in the same situation as you
2. Consent to take a blood sample to test for BBV
~ Explanation of risks from BBV to dental nurse
HIV 1 in 300 , Hep C 1 in 50 , Hep B 1 in 3
~ Explanation this is a standard procedure applied to all pts
- Clarify this is a universal process applied to all pts
- Clarify it is voluntary
- refusing to get tested wont have any effect on ongoing care
- will be noted
~ Explain there is no pressure
~ undertake review of medical history (8 qs)
~ Make sure pt understand options , prompt for Qs
~ Apologise for inconvenience and thank them for co-op
Local anaesthetic
- Common formulations and doses
- Assembly
- Side effects
- Anaesthesia check
~ Formulations and max doses
- Lidocaine 2% 1;80,000 adr - 4mg/kg
- Articaine 4% 1;100,000 adr - 6mg/kg
- Prilocaine with fellypressin 8mg/kg
~ Assembly
Check expiry date and badge number then assemble as normal
~ Side effects
- allergic reaction ( rash , tingling , breathing problems)
- Seizure or cardiac arrest
- Nausea , vomitting , dizziness
- Haematoma
- Tachycardia
- nerve damage
- twitching muscles
~ Checking for anaesthesia
- Ask pt
- Percussion to tooth
- Probe to gingivae
What are the 4 Criteria for SIRS and how to identify Sepsis syndrome?
- Temp more than 38 or less than 36
- WBCC less than 4000 or more than 12000
- Pulse more than 90
- RR more than 20 breaths per min
- 2 out of four is required to identify Sepsis which requires urgent referral
When would you refer even though Sepsis is not confirmed
- Spread of infection to pharyngeal or submandibular space
- Systemic manifestation and immunocompromised pt
- Trouble swallowing or breathing
- Rapidly progressing infection ( Raised tongue)
Patient attends with swelling, asks for radiograph and go through history , make a diagnosis and manage
- Radiograph shows an abscess associated with a tooth
- Abscess is pus enclosed in the tissues of the jaw bone at the apex of an infected tooth
- usually it originates from a bacterial infection that has accumulated.
- Causes of abscess
- Caries / Trauma / NCTSL / Perio
- Ask pt about symptoms
- Swelling/ Trismus / Dysphonia /, drooling/ inability to stick tongue out /
- ASK ABOUT TEMP / BREATHING/ PULSE RATE / LIMITED MOUTH OPENING/ SPEAKING
SIRS
