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BDS2; CHHD > Medical Emergencies II > Flashcards

Medical Emergencies II Flashcards

1. List the common medical emergencies in dentistry 2. Recognise the clinical signs and symptoms of common medical emergencies in dentistry 3. Understand the specific management of each common medical emergencies in dentistry 4. Recognise the essential drugs and equipment used to manage medical emergencies in dentistry 5. Understand the specific use of each essential drug and equipment used to manage medical emergencies in dentistry

1
Q

List common medical emergencies in dentistry

A

Asthma, anaphylaxis, angina, adrenal insufficiency, aspiration and chocking, epileptic seizures, hypoglycaemia, myocardial infarction, syncope

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2
Q

What can trigger asthma in the dental surgery

A

Stress, anxiety, infection and allergen exposure

- attack can be severe and progress to be life threatening

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3
Q

What are the clinical signs of acute severe asthma

A
  • inability to complete sentences in one breath
  • respiratory rate >25/min
  • tachycardia HR >110/min
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4
Q

What are the clinical signs of life threatening asthma

A

Cyanosis
Respiratory rate <8/min
Bradycardia HR <50/min
Exhaustion, confusion, decreased consciousness level

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5
Q

How is asthma managed

A
  1. Stop treatment and remove instruments from mouth
  2. Reassure patient and sit them in comfortable position
  3. Administer salbutamol (10 activations/min) with spacer
  4. Administer oxygen at rate of 15L/min
  5. Monitor vital signs
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6
Q

What are the different inhalers used to treat asthma

A
  • Brown beclomethasone inhaler is a steroid preventer which the patient will take daily - this is not used in a medical emergency
  • Salbutamol inhaler is a B2 agonist-reliever used in acute asthmatic attacks
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7
Q

Why is a spacer device used

A

Ensured the patient takes everything in and so delivery of the B-agonist into the lungs

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8
Q

What should be done if there is no rapid response features in a patient presenting with severe asthma

A
  • Call 999
  • Repeat salbutamol every 10 mins
  • Monitor vital signs
  • If unresponsive check B+C, if one or both are absent, start CPR
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9
Q

What is anaphylaxis

A

Severe, life-threatening, generalised or systemic hypersensitivity reaction (type I causing breathing and abdominal issues)

Can be hard to diagnose because it has inconsistent symptoms with a wide range of presentations

Using ABCDE is vital to diagnosis of anaphylaxis

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10
Q

What are the common triggers of anaphylaxis

A

Drugs (penicillin)
Latex
Additives in medicine

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11
Q

What are the sings and symptoms of anaphylaxis

A

Uticaria, erythema, rhinitis, conjunctivitis

Abdominal pain, vomiting, diarrhoea, sense of impending doom

Stridor, wheeze, hoarse voice (due to laryngeal oedema and bronchospasm), rapid breathing, fatigue, cyanosis, confusion

Respiratory arrest leading to cardiac arrest

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12
Q

How can anaphylaxis lead to cardiac arrest

A

Vasodilation occurs causing hypovolaemia and so low BP

This causes the patient to appear pale and clammy, and they will become drowsy and faint due to low oxygen perfusion in the brain

They will collapse and go into cardiac arrest

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13
Q

How is anaphylaxis managed

A
  • Call 999 as soon as anaphylaxis is suspected
  • Administer Adrenaline 500ug IM (0.5ml of 1:1000)
  • Lay patient flat and raise their legs to restore BP
  • Administer oxygen at rate of 15L/min
  • Reassure patient and monitor vital signs
  • If patient becomes unresponsive, check B + C and if one is absent start CPR
  • All patients treated for anaphylaxis must be sent to hospital in an ambulance
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14
Q

How is adrenaline administered during anaphylaxis

A

Adrenaline injection IM into anteriolateral fat (midway between hip and knee)

EpiPen auto injection IM - clothing can remain, this doesn’t contain the normal dose for anaphylaxis

Emirade pen has the full adult dosage and can be repeated after 5 mins

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15
Q

What are the signs and symptoms of angina

A
  • Acute chest pain of cardiac origin, crushing in nature
  • Can radiate to the jaw, neck, shoulder and back
  • Shortness of breath and increased respiratory rate
  • Fast and slow heart rates, low BP, poor peripheral perfusion
  • Altered mental state
  • Feeling faint
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16
Q

How is angina managed in a medical emergency

A

Calm and reassure patient
Sit them up in a comfortable position
Administer 2 sprays of GTN spray sublingually (800ug)
Administer oxygen at 15L/min and monitor vital signs
Repeat GTN spray after 5 mins if no response
No improvement after repeated dose GTN - suspected MI

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17
Q

How does GTN spray relieve angina

A

It is a vasodilator which reduces preload and after load by dilating coronary artery

18
Q

What are the signs and symptoms of MI

A
  • Includes all those for angina
  • Shortness of breath, nausea, vomitting
  • Pale clammy skin and can be cyanosed
  • Pulse is weak, irregular and BP may fall
  • Rapid loss of consciousness
19
Q

How can myocardial infarctions be managed

A
  1. Call 999
  2. Sit up in a comfortable position
  3. Give aspirin 300mg in single oral dose (crush/chew)
  4. Administer oxygen 15L/min and monitor vital signs
  5. If unresponsive check B + C, if one or both absent then start CPR

All patients treated for MI must be sent to hospital in an ambulance and inform the crew they have been given aspirin (because it is a blood thinner)

20
Q

What are the drugs given in cardiac emergencies

A

GTN spray and aspirin

21
Q

What can trigger an epileptic seizure

A

Stress, anxiety, dehydration/starvation, temperature extremities, bright/flashing lights

22
Q

What are the signs and symptoms of epileptic seizures

A
  • Brief warning/aura prior to fit
  • Tonic phase
  • Clonic phase
  • Lasts few minutes and then patient regains consciousness
  • May be confused (post-ictal confussion)
23
Q

What happens in the tonic phase of epileptic seizures

A

sudden loss of consciousness, become rigid, falls, may give a cry, can become cyanosed

24
Q

What happens in the clonic phase of epileptic seizures

A

Jerking movements of the limbs, toungue may be bitten, frothing, incontinence

25
Q

How are epileptic seizures managed

A
  • Stop all work and ensure surroundings are cleared
  • Do not restrain convulsive movement
  • Fitting may be a sign of hypoglycaemia - check blood glucose and if low give oral glucose/glucagon
  • Place in recovery position after convulsion, clear airway and give oxygen 15L/min
  • Most are self-limiting and only require protection from injury
  • Medication is given in status epilepticus
  • Send to hospital if there are any serious injuries
26
Q

How is status epilepticus managed

A

Call 999 and administer midazolam 10mg bucally

Patient must be sent to hospital after recovery

27
Q

What are the signs and symptoms of hypoglycaemia

A

Shaking, tremor
Irritated, aggressive, hard to concentrate, confused, disorientated
Thirsty, clammy, blurred vision, slurred speech
Headache, increased pulse rate
Fitting, seizure, loss of consciousness

28
Q

How is early stage hypoglycaemia managed

A

When the patient is conscious and has a gag reflex

  • give oral glucose (liquid, gel, powder, tablet)
  • can repeat after 10-15mins
29
Q

How is late stage hypoglycaemia managed

A

When the patient is uncooperative and unable to swallow

- give glucose gel by squeezing into buccal sulcus

30
Q

What do you do if a diabetic patient fails to respond to glucose during hypoglycaemia

A

When there is signs of life

  • measure blood glucose using automated blood glucose device (hypo = <3.0mmol/L)
  • give glucagon IM 1mglml
  • monitor vital signs (can take 10 mins for glucagon to work)
  • after regaining consciousness give oral glucose
  • re-measure blood glucose and check it has risen to >5.0mmol/L

When there is no signs of life

  • Call 999
  • CPR immediately
31
Q

Why might glucagon be inefficient in a patient who is having a hypoglycaemic episode

A

Their glucose stores may be inadequate e.g. in

  • long distance runners
  • anorexics
  • chronic alcoholics
32
Q

Why is it important that patients given glucagon take glucose when they are alert and able to swallow

A

Because they need to replenish the blood glucose as all the glycogen stores have been depleted by glucagon

33
Q

What is syncope and what are the common triggers

A

Temporary loss of consciousness due to cerebral hypoperfusion (vasovagal attack, simple faint)

Triggers include

  • stress, anxiety, fear, pain, sight of blood/injection
  • extremes of temperature, dehydration, starvation
  • IV injection of LA
  • postural hypotension
  • drug effects (antihypertensives ACEi, ARBs) and interactions
34
Q

What are the signs and symptoms of syncope

A 
Feeling weak, faint, dizzy, light headed
Pallor and sweating 
Nausea and vomiting 
Slow pulse rate
Low BP
Confusion 
Loss of consciousness
35
Q

How is syncope (vasovagal attack, simple faint) managed

A
  • Lay flat and raise legs to improve venous return and brain perfusion
  • Loosen tight clothing around neck
  • Administer oxygen at 15L/min
  • Monitor vital signs
  • Recovery is usually rapid but if not call 999 and reconsider diagnosis
  • If patent becomes unresponsive, check B + C and if one or both absent, start CPR
36
Q

What are the signs and symptoms of choking and aspiration

A
  • cough/splutter
  • difficulty breathing
  • noisy breathing with wheeze = aspiration, stridor = obstruction
  • may develop paradoxical chest and abdominal movements
  • may become cyanosed and lose consciousness
37
Q

How is choking and aspiration managed

A

If cough is active, encourage continuous cough

If cough is inactive

  • 5 sharp back blows between shoulder blades
  • 5 abdominal thrusts
  • repeat until object is out or dislodged

If patient collapses, becomes unresponsive/unconscious

  • call 999
  • check vital signs of life B + C if one or more absent, start CPR
38
Q

Why might adrenal insufficiency occur

A

Long term use of oral corticosteroids which can persist for years after stopping (because suppresses body’s normal production of corticosteroids)

Can be due to stress, trauma, iatrogenic (surgery/drug induced), infection or sepsis

39
Q

Signs and symptoms of adrenal insufficiency

A
  • Patient may become hypotensive under physiological stress
  • Irregular, weak and rapid pulse
  • Shock-like features
  • Confusion
  • Rapidly falling BP
  • Rapid loss of consciousness
40
Q

How is adrenal insufficiency managed

A

Call ambulance 999
Lay patient flat and raise legs
Administer oxygen 15L/min
Maintain airways and monitor viral signs
Measure blood glucose to rule out hypoglycaemia
If patient is unresponsive, check B + C, if absent start CPR

BDS2; CHHD (32 decks)

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