Medical Emergency

Question 1

best management is

Answer 1

PREVENTION

• a good history and physical is essential
• review recent issues if the patient has not been in for some time

any recent changes in medical status?

any new or recent lab studues?

a proper history will provide a baseline reference in the event of an emrgency

Question 2

when emergency happens primary goal?

Answer 2

STABILIZE the patient until arrival of emergency medical team

follow BASIC guidelines

Question 3

steps in management of medical emergencies 
P
A
B
D
C

Answer 3

positioning

airway

breathing

circulation

differential diagnosis, definitive care, drugs, defibrillation

Question 4

obtain baseline vital signs

Answer 4

PULSE PRESSURE
SATURATION OF OXYGEN
BLOOD PRESSURE

THIS IS SO CRUCIAL TO OBTAIN BASELINE

Question 5

loss of consciousness can come from

Answer 5

syncope

hypoglycemia

seizures

MI

CVA/ stroke

Anaphylaxis

Question 6

after administer LA to patient , starts sweating and eyes are closed

dizzy and nauseated

Answer 6

syncope likely

hypotension
bradycardia
low saturation pressure of oxygen

Question 7

syncopy

Answer 7

physcogenic reaction leading to parasympathetic response with sudden vasodilation producing bradycardia and cerebral ischemia

Question 8

manifestations of syncope

Answer 8

dizziness

pallow

sweating

nausea

hypotension

loss of consciousness, possible seizure

Question 9

tx for sncopy

Answer 9

trendelenberg positoin

CAB - circualtion, airway and breathing

oxygen

spirits of ammonia

apply a cool wet towel to forehead

it will take 24 hours for patients body to fully recover

Question 10

hypoglycemia vs hyperglycemia

Answer 10

hypoglycemia is more common – seen with diabetics who take insulin and forget to eat or do not take their normal oral intake

Question 11

manifestations of hypoglycemia

Answer 11

hunger 
headache
sweating
pallor
confusion, irritability
possible resulting in loss of consciousness

Question 12

tx of hypoglycemia in conscious pt. in unconscious pt?

Answer 12

conscious– give sugar

unconscious – 50 ml of 50% dextrose IV or 1 mg of glucagon IM

Question 13

signs of syncope but in terms of circulation the blood pressure or pulse is

Answer 13

blood pressure and pulse is not altered much in hypoglycemia but hypotension in syncope

but do FINGER STICK

Question 14

finger stick but not low … next?

Answer 14

does patient have facial weakness slurring or bad speech? No – consider other medical condition if yes — consider CVA and activate EMS and provide supplemental oxygen

Question 15

angina/ MI

include manifestations

Answer 15

due to heart’s oxygen demand being greater than supply associated with exertion, anxiety or with coronary athersclerotic dsease

manifestation

• crushing pressure on chest may radiate shoulder, neck, arm and mandible
• dizziness

Question 16

treatment of angina/ MI

Answer 16

100 % oxygen
position
sublingual nitroglycerine
(0.3-0.4 mg) every five minutes up to three doses - check VS (vital signs) prior to administration

• if symptoms persist an MI must be assumed and EMS activated

MONA

• morphine
• oxygen
• nitroglycerine
• aspirin - full strength – ask patient to chew it up

Question 17

nitroglycerine amount and what it does

Answer 17

vasodialtion

0. 3 - 0.4 mg every five minutes up to three doses
   - CHECK VITAL SIGNS PRIOR TO ADMINISTRATION

Question 18

chest pain and pt. becomes unconscious

Answer 18

make sure you elicit that they are unconscious

then check pulse – carotid - at least 5 not more than 10 seconds

CPR - until AED is available
- AED = automated external defibullator

Question 19

stroke think

Answer 19

FAST

• facial weakness
• arm drift
• speech alteration
• TIME

Question 20

stroke looks like

Answer 20

syncopy and hypoglycemia too

Question 21

hyperventialion looks like

Answer 21

often caused by severe anxiety / panic attack

manifestations
- palpations
chest pain
tachycardia
dizziness
numbness and tingling on extremeties
muscle pain and cramp (carpopedal tetany)

Question 22

common causes of anaphylaxis

Answer 22

foods

insect venoms

latex

medications

Question 23

common causes of anaphylaxis

Answer 23

foods

insect venoms

latex

medications

Question 24

cross reactivity of foods ___ avoid___

Answer 24

bananas, avocados,

avoid latex use

Question 25

decrease in BP and Pulse yes - consider? - no

Answer 25

yes - consider syncope no - consider other causes like hypoglycemia or stroke

Question 26

treatment of hypoglycemia conscious pt? unconscious pt?

Answer 26

conscious - give sugar unconscious - 50 ml of 50% dextrose IV OR 1 mg glucagon IM

Question 27

if patient has facial weakness or slurring of speech

Answer 27

consider CVA - activate EMS - supplemental O2

Question 28

pt blood sugar is 140?

Answer 28

below this is normal so at this or higher is prediabetic

Question 29

patient states he has chest pain/ tightness and is nauseated treat as? why does this happen

Answer 29

angina - due to hearts oxygen demand being greater than supply associated with exertion, anxiety or with coronary athersclerotic disease

Question 30

manifestation of angina / MI

Answer 30

crushing pressure on the chest and may radiate shoulder, neck, arm and mandible dizziness

Question 31

could substitute what in MONA

Answer 31

nitrous oxide ``` usually M -- morphine O- oxygen N - nitroglycerin A - aspirin ``` general offices may not have the access to morphine - so can use nitrous oxide

Question 32

treating the pt with chest pain and he becomes unconscious, what do you do

Answer 32

Consider BLS (basic life support) protocol ``` Poisition Circulation Airway Breathing D - Diff. dx ``` so begin CPR and place AED as soon as possible

Question 33

supplement oxygen over what %

Answer 33

want greater than 94%

Question 34

if think stroke think FAST means

Answer 34

F - facial weakness A - arm drift S - speech alteration T - TIME

Question 35

supine position when

Answer 35

unconscious pt. and thinking cerebrovascular - stroke accident

Question 36

managment of cerebrovascular sccident/ stroke

Answer 36

if conscious - put patient into a comfortable position - if unconscious, supine position ``` monitor vitals administer oxygen transport to ER via EMS basic support as required - maintain airway IV acess may be useful if trained ```

Question 37

patient is breathing deeply and rapidly pt. states they are feeling dizzy and numb thinking?

Answer 37

hyperventilation

Question 38

tx for hyperventilation

Answer 38

stop procedure positino pt. into comfortable position calm patient breathe C02 enriched air through face mask or paper bag consider IV sedation

Question 39

clinical manifestations of anaphylaxis respiratory effects? skin? gastro? cardio?

Answer 39

skin - flushing, pruritus, urticaria, angioedema upper respiratory - congestion, rhinorrhea lower respiratory = bronchospasm, throat or chest tightnedd, hoarsness, wheezing, shortness of breathe, cough GI= oral pruritis, cramps, nausea, vomiting, diarrhea cardio = tachycardia ,bradycardia, hypotension/ shock , arrhythmias, ischemia, chest pain

Question 40

anaphylaxis prsentation with hives

Answer 40

only about 10-20% of cases will present with hives or other cutaneoues manifestations 80% food-induced, fatal anaphylaxis cases were not associated with cutaneous signs or symptoms

Question 41

incidence of latex induced anaphylaxis

Answer 41

1-6% population - up to 16 million 8-17% incidence among health care workers

Question 42

aawareness of cross sensitivity with what foods? | regarding latex induced anaphylaxis prevention

Answer 42

``` banana avocado chestnuts kiwi stone fruit ```

Question 43

treatment of anaphylaxis

Answer 43

immediate with epinephrine no contraindications in anaphylaxis - longer wait more fatal antihistamine - oral or parenteral - if oral use liquid or chewable tablet call 911

Question 44

repeat epi with anaphylaxis when

Answer 44

10-15 minutes after first if symptoms persist or increase repeat antihistamine + H2 blocker if symptoms persist observe for 4 hours

Question 45

additional measures fo tx of anaphylaxis

Answer 45

corticosteroids supplemental O2 - airway maintenance IV fluids, vasopressor therapy

Question 46

tx of mild allergic reactions? | mode of action

Answer 46

diphenhdramine - Benadryl -- prevetnts histamine from binding H1 receptors on certain tissues INHIBITS - vasodilation - increases capillary permeability - itching BEST WHEN GIVEN EARLY - PREVENT SYMPTOMS FROM PROGRESSING - should be administered on a regular schedule to prevent allergic symptoms while the allergen is still in the bod

Question 47

dose of diphenhydramine

Answer 47

determined by severity of the symptoms oral = 25-50 mg upon onset of symptoms then repeated every 6 hrs for 4-6 days IM = 25-50 mg into lateral thigh, deltoid, or buttoc rarely IV administration pediatric dose - 1,g/ kg * refer to ER or PC for monitor at least 24-48 hours post

Question 48

immediatley after anaphylaxis

Answer 48

stop procedure call 911 administer 100% oxygen take vitals adminster epi SC/IM/IV at .3-.5 mg child = 0.1mg/kg SC or IM

Question 49

main effects of epinephrine | best for?

Answer 49

MOST IMPORTANT DRUG FOR ANAPHYLAXIS -- will cause OPPOSITE EFFECTS OF HISTAMINE EPI CAUSES 1 . VASOCONSTRICTION -- counteracts the profound hypotension that can cause circulatoy collapse and cardiac arrest 2. BRONCHODILATION - it counteracts the smooth muscle contrction of the bronchioles (bronchiospams) that can lead to hypoxia

Question 50

cyanosis in lips could be sign of

Answer 50

Asthma attack

Question 51

tx for asthma attack

Answer 51

comfortable position administer oxygen and maintain airway administer MDI / bronchiodilator -- albuterol 2-4 puffs ASAP - may repeat 10 minutes as required consider use of SQ epinephrine 0.5-1.0 mg (1:1000) if attach persists

Question 52

seizure what to do

Answer 52

remove all dental instruments and supplies from patient mouth position patient and PROTECT patient position airway and DO NOT PLACE ANYTHING IN PT MOUTH IS SEIZING If no history known of seizures - contact EMS (or if severe)