Medical Emergency

Question 1

What should you always do in medical emergency?

Answer 1

Assess ABCDE

Airway, breathing, circulation, disability, exposure

Question 2

What will you find in ME kit in dental practice?

Answer 2

Adrenaline 1:1000
Aspirin 300mg
Gluco-gel
Midazolam buccal solution- 10mg
GTN stay/tab
Oxygen
Salbutamol

Question 3

Difference between faint and collapse?

Answer 3

Collapse = loss of postal tone
Faint = transient loss of consciousness due to inadequate cerebral perfusion

Question 4

Common cause faints?

Answer 4

Decrease BP caused by over activation vagal (stress/ pain)
Postural hypotension - standing up too quick
Predisposition - drugs decrease BP

Question 5

Signs and symptoms of faint?

Answer 5

Signs: slow and weak pulse, low BP, loss consciousness
Symptoms: palor, nausea, dizzy, sweating

Question 6

Management of faint

Answer 6

1. ABCD
2. Lay flat and elevate legs
3. Pt should regain consciousness - few mins
4. Admin oxygen
5. If still unresponsive - CPR/999

Question 7

Name difference types of syncope

Answer 7

1. Neurogenic syncope - tongue biting, prodrome, thunder headache
2. Cardiogenic syncope - arrhythmia
3. Vasovagal syncope - 3P’s - posture, provoking, prodrome, TLOC

Question 8

What increases risk of hypoglycaemia?

Answer 8

Insulin controlled diabetics, poor control

Normal blood sugar 4-7mmol/L

Question 9

Signs and symptoms seen with hypoglycaemia?

Answer 9

Sign: confusion, sweating, tachycardia
Symptoms: irritability, confusion, sweating, blurred vision, headache, fast HR

Question 10

Management hypoglycaemia?

Answer 10

1. ABC + measure blood sugar levels
2. If conscious and co-operative - oral glucogel 10-20mg - repeat 10-15 min if needed
3. Unconscious - 1mg IM glucagon - recheck blood glucose - administer oral glucose when regain consciousness
4. Severe (hospital) - 75ml 20% dextrose over 10 mins

Question 11

How to manage anaphylaxis?

Answer 11

1. Remove/ stop cause
2. ABC
3. IM adrenaline - 0.5mg 1:1000
4. Oxygen - high flow 15L/min
5. Nebulise with beta agonist

Question 12

Who would be at highest risk of asthma attack?

Answer 12

Those on multiple medication, poorly controlled, those w/ hospital admission

Question 13

Acute asthma?

Answer 13

Inability to complete sentence, RR >25, tachycardia

Question 14

Manage asthma attack?

Answer 14

1. Sit upright
2. ABC
3. Admin 100% oxygen
4. Spacer - 4 puffs initially - 2 puffs every 2 mins up to 10
5. if worsening 999 (cyanosis, exhaustion, bradycardia, low consciousness

Question 15

Sign/ symptom of acute coronary syndrome?

Answer 15

Sign: progressive onset crushing pain, irregular HR, collapse
Symptom: chest pain, nausea, sweating, pallor, SOB, palpitation

Question 16

Management acute coronary syndrome?

Answer 16

1. ABC
2. MONA

• GTN - 2 puffs sublingual - repeat after 3 min
• Aspirin 300mg chewed/ dispersed

Question 17

What is adrenal insufficiency?

Answer 17

Inadequate production of adrenal hormones

Question 18

Cause adrenal insufficiency - primary and secondary?

Answer 18

Primary: addisons, haemorrhage, sepsis, infectious disease
Secondary: idiopathic, adenoma, Sheehans

Question 19

Signs and symptoms of adrenal insufficiency?

Answer 19

Sign: hyperkalaemia, fever, hypotension, hypoglycaemia
Symptoms: weakness, dizzy, nausea, sweat, SOB

Question 20

Management adrenal insufficiency?

Answer 20

1. AVOID - modify steroids regime
2. High flow oxygen
3. Sign of crisis 999
4. Hospital - IV hydrocortisone

Question 21

What is a seizure?

Answer 21

Transient, abnormal electrical brain activity

Question 22

Diff between partial and generalised seizure?

Answer 22

Partial - onset focal area of brain

Generalised - originate from both hemispheres of brain

Question 23

Management of seziure

Answer 23

1. Dont restrain - try to protect from injuries
2. Convulsion ended - place in recovery position
3. Admin oxygen
4. Typically last 1-3min - beyond 2 min risk of status epileptics (risk brain hypoxia)
5. Give adult 10mg buccal midazlolam

Question 24

Difference types of stroke?

Answer 24

1. Ischemic

2. Haemorragic

Question 25

Management of stroke?

Answer 25

1. ABC 2. Oxygen 3. Unconscious - secure airway and recovery position 4. 999

Question 26

How to become aware of stroke

Answer 26

FAST | Face, arms, speech, test all 3

Question 27

How to manage cardiac arrest and what is the most common cause?

Answer 27

Ventricular fibrillation 1. ABC 2. Oxygen 3. Early defib/ CPR

Question 28

Signs of cardiac arrest?

Answer 28

LOC, absent breathing, loss pulse, pupil dilation

Question 29

How to manage choking?

Answer 29

1. Encourage coughing 2. Back blows if ineffective - up to 5 blows - support chest (blows between shoulder blades) 3. Abdo thrust - give up to 5 4. Not relieved - alternate 5. CPR if unresponsive

Question 30

Asthma in hospital

Answer 30

``` O- oxygen S - salbutamol H - hydrocortisone (IM) or oral prednisolone I - ipratroium bromide T - theophylline M- magnesium E - escalate ```