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1
Q

What is the acronym for starting BLS on a baby?

A

SSSABCR

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2
Q

What does SSSABCR mean?

A

Safety
Stimulate - shake shoulders and use voice
Shout - for help
Airway - head tilt, chin lift or jaw thrust
Breathing - stop here and do 5 rescue breaths then move onto pulse
Circulation - brachial arm pulse absent or below 60bpm start CPR
Reassess - call 999 if no improvement

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3
Q

How do you perform CPR on a baby?

A

Initial 5 rescue breaths over mouth and nose
15 compressions to 2 rescue breaths
Compressions:
- 1/3 depth of child 100-120 per minute
- trace along ribs find xiphisternum and place thumb and then then thumb and fingers above this and squeeze down with thumbs and place rest of fingers around back - encircling technique
- hold mandible with c shape grip not on the neck

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4
Q

How do you help a choking baby?

A

Hold child on forearm and place hand around mandible in c shape and lay on knee for stability and angle downwards
Heal of hand on top of back for 5
Support head on occupy - flip them onto other arm and do sharp finger thrusts for 5
If child becomes unconscious start CPR and phone ambulance

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5
Q

How do you help a choking small child

A

Ask them if they are choking and encourage them to cough
Go down on knees, arm on front of shoulders and heel of hand of back slaps for 5
Stand them up and use dominant hand find half way between belly button and xiphisternum and do 5 thrusts
If unconscious start CPR and call ambulance

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6
Q

What should you comment on in X-ray reporting?

A

Type of X-ray
Age of pt, date
Quality
Dentition - teeth, dentition, missing, impacted
Restorations - how restored, overhangs, fractures
Trauma
Caries
PAP
Perio bone levels, calculus
Endo, how compacted, material mm from apex, instruments
TMJ
Other pathology/cysts

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7
Q

What are the 4 criteria for SIRS?

A

Temp <36ºor >38º
WBC count <4 or >11 thousand/mm3
Pulse over 90bpm (tachycardia)
Respiratory rate over 20bpm (tachypnoea)
2 out of 4 requires for sepsis syndrome - urgent referral

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8
Q

In SIRS, when else should you refer urgently?

A

Spread of infection to pharyngeal or submandibular space
Systemic manifestations and immunocompromised
Trouble swallowing or breathing
Rapidly progressing infection

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9
Q

What antibiotics should be given for dental abscess?

A

Always try local measures before - drain by extraction, through canal or by soft tissue incision
Amoxicillin - 500mg tablet x3 daily for 5 days
Metronidazole - 400mg tablet x3 daily for 5 days

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10
Q

What is the formulation and max dose of lidocaine?

A

2% 1:80,000 adrenaline
6mg/kg

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11
Q

What is the formulation and max dose of lidocaine?

A

Articaine 4% 1:100,000 adrenaline
7mg/kg

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12
Q

What is the formulation and max dose of prilocaine?

A

3% prilocaine with felypressin 0.03IU/ml
8mg/kg

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13
Q

What are the side effects of LA?

A

Allergy - rash, tingling, breathing problems
Seizure, cardiac arrest
Nausea, vomiting, dizziness, headache, blurred vision
Twitching muscles
Nerve damage, continuing numbness, weakness or pins and needles
Haematoma
Tachycardia

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14
Q

How can you check anaesthesia?

A

Question to pt
Check by percussion to tooth
Probe to gingivae/tooth

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15
Q

How should everything in the station be wiped?

A

Start from top - dental light, control surfaces, full length of all the cables
Then change to new wipes - dental chair, spittoon
New wipes again - bench top surfaces, computed keyboard and mouse

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16
Q

How do you deal with a choking adult?

A

ABCDE
Are you choking
5 back slabs between shoulder blades
5 abdominal thrusts between belly button and sternum
Continually check for object dislodging
Re-evaluate ABCDE
BLS if still not resolved
Send pt to hospital to check for other injuries/rib fracture

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17
Q

What is a type N steriliser?

A

Non-vacuum, passive air removal, takes unwrapped solid products, non-hollowed, non-lumened

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18
Q

What is a type B sterilised?

A

Vacuum, active air removal, takes packaged instruments, lumened, hollow, cannulated or porous

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19
Q

What are the stages of a steriliser?

A

Air removal
Sterilising
Drying
Cooling

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20
Q

What are the parameters of sterilisation?

A

134-137º, 2-2.3bar pressure for a minimum holding time of 3 minutes

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21
Q

What types of water can be used for sterilisation?

A

Reverse osmosis
Distilled
Sterile
De-ionised

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22
Q

What are the daily steriliser tests?

A

Wipe clean
Change water
Automatic Control Test (ACT)
Steam penetration test (Bowie-Dick/Helix)

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23
Q

What are the weekly steriliser tests?

Study These Flashcards
A

ACT
Steam penetration test
Vacuum leak test
Automatic Air Detector Function Test

24
Q

What are the quarterly sterilisation tests?

Study These Flashcards
A

Validation Report (collecting data for effectiveness of steriliser)

25
What are the yearly sterilisation tests?
Annual Report - by insurance company for safety eg - check pressure release valves
26
What should be checked after sterilisation?
Instruments non-overlapping with hinged instruments open Check for recent print-out Check if colour change of packaged instruments: - instrument packaging - brown to pink - Helix/Bowie-Dick - yellow to blue If unsure - take tray of instruments back to beginning - cleaning in AWD or manual cleaning
27
What meds should be given to a pt having an asthma attack?
Salbutamol inhaler - short acting selective beta2-agonist, relaxes smooth muscles in the bronchi causing bronchodilation
28
What are the signs of an asthma attack?
Airway constriction/bronchoconstriction Fast breathing Wheeze Gasping Clutching chest Blushing Tachycardia - probs regular
29
How should you administer salbutamol?
Inhaler - 100micrograms per actuation Shake, press, inhale, hold 10 seconds Or 4 actuations in large volume spacer 20 seconds inhalation then put on O2 Repeat as required
30
What level of oxygen should be given in an asthma attack?
100% oxygen 15l/min flow rate
31
What medication is given for anaphylaxis and how does it work?
Adrenaline - vasoconstrictor, bronchodilator and increases contractility of myocardium
32
What are the signs of anaphylaxis?
Airway constriction/bronchoconstriction Fast, irregular breathing Stridor Blushing Tachycardia but weak pulse Urticaria Angioedema
33
What can a pt in anaphylactic shock not do?
Perfuse their organs
34
How should adrenaline be administered for pts in anaphylactic shock?
1/2 of a 1ml ampule 1:10,000 = 500micrograms IM injection Aspirate as can generate arrhythmias Use Z-track technique to inject into thigh or bicep - spread skin, advance needle in skin, aspirate, inject 30s, ull out, release tension Say would normally prepare needle, remove clothing, alcohol wipe skin but its life threatening and saves time
35
How can you differentiate asthma from anaphylaxis?
Check medical history or series of events leading to episode Asthma only has respiratory symptoms and those caused by the lack of oxygen - tachycardia Anaphylaxis is systemic presenting with a weaker pulse, urticaria (hives on skin) And angioedema (swollen face)
36
What is the black waste stream?
Household waste - packaging, hand towels
37
What is the orange waste stream?
Low risk clinical waste: - swabs, dressings and other non-sharp clinical waste eg - dam, microbrush
38
39
What is the yellow waste stream?
High risk clinical waste (not on our clinic): Body parts including teeth
40
What is the red waste stream?
Specialist hazardous waste: - dispose of amalgam in white box with red lid - sill/leak proof - mercury supressant in lid - amalgam waste, amalgam capsules, amalgam filled teeth
41
What is the blue waste stream?
Sharps including vials with medication or pharmaceuticals remaining
42
What are the 3 As and 2 Ns for disposing sharps?
Always dispose of sharps in the sharps box immediately after use Always keep out of reach of children and non-authorised personnel Always close sharps box between use using temporary closing mechanism Never retrieve anything from sharps box Never fill more than 3/4 full
43
How do you handle a blood spillage?
Stop what you’re doing Apply appropriate PPE Cover spill with disposable paper towels Any sodium hypochlorite/sodium dichloroisocyanurate - liquid/powder/granules 10,000pm Leave for 3-5 minutes, use scoop to take up the gross contamination and put into oranges waste Clean with water and general purpose neutral detergent disinfectant wipes
44
What do you do if a child starts choking on a Hall crown?
ABCDE Are you choking? 5 back slaps between shoulder blades - child can be lying on thigh or across knee 5 abdominal thrusts between belly button or sternum Continually check for object dislodging Re-evaluate ABCDE BLS if still not resolved Send to hospital to check for other injuries
45
What medication should be given for hypoglycaemia?
Glucagon - increases the concentration of glucose in the blood by promoting gluconeogenesis and glycogenolysis to convert glycogen to glucose
46
What are the hypoglycaemic levels for diabetics?
Hypoglycaemic coma - normal = 5-7mmol Unconscious = <3mmol
47
What are the signs of hypoglycaemia?
Pale Shaky Sweaty Clammy Dizzy Hungry Confusion Blurred vision Loss of consciousness - must mention this as it defines tx
48
How do you treat hypoglycaemia in a pt who is conscious and cooperative?
Administer oral glucose 10-20g or sugary drink
49
How do you treat hypoglycaemia in a pt who is unconscious or uncooperative?
1mg IM glucagon injection and oral glucose when they regain consciousness as they will have deleted their glycogen stores
50
What if a hypoglycaemic pt becomes conscious and refuses to drink glucose?
Another IM injection of glucagon
51
How do you inject glucagon?
Inject diluting solution in vial with glucagon powder Swirl to mix (don’t shake it will foam up) Z-track technique into thigh or bicep: - spread skin, advance needle in, aspirate, inject 30s, pull out, release tension Say you would normally prepare needle, remove clothing, alcohol wipe skin, but it’s life threatening and this saves time
52
What medication should be given during epileptic seizures?
Midazolam - a short acting benzodiazepine - enhances the effect of the neurotransmitter GABA on the GABA receptors resulting in neural inhibition
53
What are the signs of epileptic seizures?
Loss of consciousness Uncontrollable muscle spasms Drooling Tonic (falls rigid) Clonic (sharp jerky movements) Hypotension Hypoxia Loss of airway tone
54
What should you do to the pt if they have a seizure?
Do not try to restrain convulsive movements - ensure the pt is not at risk from injury Secure airway
55
How is midazolam administered for seizures?
100% oxygen, 15L/min If fit is prolonged (>5 minutes) give midazolam 2ml oromucosal solution, 5mg/ml topically into buccal cavity (10mg) - repeat after 5 minutes if not worked - check expiry date and form of midazolam is compatible with buccal administration, choose appropriate dose by age
56
What should you do after seizures subside?
Recovery position and check airway Refer to hospital if: first seizure, seizure is atypical, injury was caused or difficult to monitor pt
57
What are the 6 handpiece safety checks?
Back cap checked - grip and turn anticlockwise Bur security check - force to remove bur Tension to handpiece fitted to coupling Bur rotated laterally - sin bur along finger Attempts to move bur laterally from side to side Handpiece sound tested when running for 5 seconds, view bur movement

5 OSCE (23 decks)

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