Strauss Emergency Flashcards
(108 cards)
2
Q
What is the protocol for an endotracheal tube?
A
- Induce to unconscious with Propofol or Brevital (barbiturates)
- Oxygenate the patient
- Paralyze with succinylcholine (depolarizing muscle relaxant)
- Place endotracheal tube using laryngoscope
- Patient breathes Sevoflurane or Isoflurane
3
Q
General anesthesia puts the patient into what stage of anesthesia?
A
Stage 3
4
Q
When do many deaths associated with sedation occur?
A
During recovery
5
Q
What is the biggest complication with sedation and GA cases?
A
Airway complication
6
Q
While treating a medical emergency, what is important to ensure someone is doing while the team is treating the patient?
A
Recording what is doen when and how much
7
Q
In any medical emergency, what must you think first?
A
- Airway
- Breathing
- Circulation
8
Q
What is the best treatment for a medical emergency?
A
Prevent it (know your patient)
9
Q
What is the term for the transient loss of consciousness as a result of a temporary decrease in cerebral blood flow with resultant ischemia?
A
Syncope
10
Q
What is the most common emergency in the dental office?
A
Syncope
11
Q
Why does syncope occur in the dental office?
A
Fight or flight kicks in but no muscle movement to pump blood to the brain so the patient faints
12
Q
What is the demographic for syncope?
A
Males 16-35
13
Q
What demographic do we normally not worry about syncope in from natural causes (e.g. could worry because of a medicine they take, but not worried that psychogenic will cause a syncope)?
A
Elderly
14
Q
When does vasovagal response syncope normally occur?
A
Nonpsychogenic; due to hunger, dehydration, exhaustion. Vagus nerve slows heart.
15
Q
Both psychogenic and non-psychogenic syncope are rare in what position?
A
Supine
16
Q
What is the first sign of syncope?
A
Diaphoresis
17
Q
What pulse should you check in a syncope patient?
A
Carotid because the BP will be in 30mmHg range will not be felt in wrist
18
Q
What will be the pulse of a syncope patient?
A
Bradycardia 30-50 bpm
19
Q
What is the ideal position for a syncope patient?
A
Astronaut - head and thorax in the same plane with feet elevated. Have the patient move their muscles to pump blood
20
Q
How long should it take to recover from syncope?
A
20 seconds
21
Q
What is the one relative contraindication to giving every patient oxygen in an emergency?
A
COPD patient who is oxygen driven. Dr Strauss says everyone gets oxygen in a medical emergency.
22
Q
What is the most important drug in the emergency kit?
A
Oxygen
23
Q
What are the 4 ventilatory statuses?
A
- Normal
- Decreased (e.g. seizure, airway compromised)
- Respiratory distress
- Ventilatory arrest or collapse
24
Q
What is the best immediate method of ventilation that gives 16% oxygen?
A
Mouth to mouth
25
Q
Mouth to mask ventilation gives how much oxygen?
A
16%, the same as mouth to mouth
26
What is the most efficient ventilator tool?
Endotracheal intubation
27
The chin thrust, neck tilt, and angle thrust airway opening maneuvers are designed to do what?
Bring the tongue forward off the pharyngeal wall
28
What is the term for a hollow plastic tube that physically separates the tongue from the pharyngeal wall and can attach to a bag valve mask set up?
Oral airway
29
Which is more well-tolerated in the awake patient: oral airway or nasal airway?
Nasal airway
30
What are 2 methods to get a surgical airway?
1. Cricothyrotomy
| 2. Tracheostomy
31
Is a tracheostomy an emergency procedure?
No, it's only for a long-term airway
32
What is an emergency airway for obstruction above the trachea?
Cricothyrotomy
33
What must be placed in cricothyrotomy to maintain the airway after the airway is opened with the blade handle?
Trach tube or anything solid and hollow
34
How long will the brain last without oxygen before unconsciousness?
6 seconds
35
What is the term for breathing that is more rapid or more deep than is required for normal maintenance of arterial PaO2, PaCO2, and blood pH?
Hyperventilation
36
What are the causes of hyperventilation?
Anxiety, pain, metabolic acidosis, hypercapnia, cirrhosis, organic CNS disorder
37
Palpitations during hyperventilation are what type of heart arrhythmias?
PVC
38
What are the neurologic manifestations of hyperventilation?
1. Perioral parasthesia
| 2. Carpopedal spasms due to hypocalcemia
39
If a patient is hyperventilating, how should you position them and what should they do?
1. Sit up
| 2. Have them breathe into a paper bad or hands
40
What is the term for acute paroxysmal chest pain as a result of coronary artery disease?
Angina
41
What is the term for angina associated with being at rest and having arrhythmias?
Prinzmetal angina
42
What are the steps for recognition and treatment of Angina?
1. Patient will have dull heavy pain in the chest and radiating to left arm
2. Give one of their nitroglycerine, wait 5 mins
3. If first nitro doesn't work, give 2nd nitro
4. If 2nd nitro doesn't work, the patient is having an MI until proven otherwise
43
If the patient is okay after the first dose of nitro, can you continue the appointment?
Yes
44
Can you give EPI to an angina patient?
Yes, 2 carpules
45
Myocardial necrosis and cell death resulting from a deficiency of blood flow to a region of myocardium
Myocardial infarction
46
What are symptoms that can differentiate MI from angina?
Diaphoresis, dyspnea, sense of impending doom
47
What will initial treatment of MI be?
Nitroglycerine
48
If the patient doesn't have their own nitroglycerine, what dose should be given?
150 grams
49
What narcotic can be given to an MI patient?
Morpine 2-5 mg q10min IV or SC
50
What is the term for the cessation of cardiac function as a result of non-functional arrhythmia?
Cardiac arrest
51
What is the best prevention of cardiac arrest?
Recognize an at-risk patient and prevent MI or angina
52
What are two terms that might cover a foreign body in the bronchus, or upper airway, or swallowing a foreign object?
1. Aspiration
| 2. Obstruction
53
What is the main obstruction area?
The vocal cords
54
Could aspiration or obstruction have any symptoms at all?
No, could be asymptomatic if swallowed
55
If the patient is coughing, what should be done?
Encourage coughing, trendelenburg position
56
What is the term for a state of hypersensitivity acquired through exposure to a particular allergen, re-exposure to which leads to an immunologic reaction?
Anaphylaxis
57
What is the character of a type I allergy?
AnaphylaxisImmediateIgE mediated
58
What is the character of a type IV allergy?
DelayedDermatologicCellular mediated
59
What is the treatment for a type IV skin allergy?
50 mg Benadryl
60
What is the treatment for anaphylaxis?
Epi 3.0 mg SC
61
What is the syndrome of cerebral disorders characterized by transient paroxyisms involved changes in the state of sensorium, motor activity, or consciousness?
Seizure disorders, absence, myoclonic, grand mal, tonic-clonic
62
What are the phases of seizure disorders?
ProdromalIctalPost ictal
63
How should the patient be positioned during the seizure?
Side on floor, maintain airway, but no mouth gag
64
What is given for status epilepticus (brain is in a state of persistent seizure, one continuous non-stop seizure for more than 30 minutes?
Diazepam 2-10mg IV
65
What are the symptoms of a local anesthetic overdose?
Talkative, excitedBP, HR, respiration increased, tinnitusThen seizures, cardiorespiratory depression
66
What can be given as an anticonvulsant?
Valium IV
67
What can be given for hypotension?
Ephedrin 25 mg IM
68
What 2 things can lead to local anesthetic overdose?
1. Liver disease
| 2. Plasma cholinesterase deficiency
69
What is the maximum dose of lidocaine?
4.4 mg/kg
70
What is the maximum dose of EPI?
0.2 mg
71
Maximum 2% xylocaine 1:100 EPI adult dose
8 carpules
72
What is the most common cause of hypotension?
From drugs (orthostatic hypotension)
73
What is a disorder of ANS in which syncope occurs when supine patient assumes an upright position, can occur from sitting to standing or lying to sitting?
Orthostasis hypotension
74
Are drugs needed in dental office emergencies?
No, when in doubt never medicate
75
What antihistamine is in the emergency kit?
Benadryl
76
What anticonvulsant is in the emergency kit?
Valium
77
What narcotic antagonist is in the emergency kit?
Narcan
78
What corticosteroid is in the emergency kit?
Hydrocortisone
79
What analgesic is in the emergency kit?
Morphine
80
What is the vasopressor in the emergency kit?
Ephedrine
81
Which antihypoglycemic is in the emergency kit?
50% dextrose
82
Which antiarrythmic is in the emergency kit?
Lidocaine
83
Which anticholinergic is in the emergency kit?
Atropine
84
Which coronary vasodilator is in the emergency kit?
Nitroglycerine
85
Which respiratory stimulant is in the emergency kit?
Ammonia spirit
86
Which oral antihypoglycemic is in the emergency kit?
Carbohydrate (icing)
87
Which bronchodilator is in the emergency kit?
Metaproteronol
88
What is the most important tool in the management of medical emergenies?
Common sense
89
Respiratory stimulants induce respiration via the nasal mucosa and medulla, increase respiration and heart rate, and are contraindicated in what patients?
1. Asthma
| 2. COPD
90
What is the ideal bronchodilator for acute allergic reactions and asthmatic reactions?
B2 agonist, Metaproteronol
91
What should be used in asthmatic attack first?
Patient's own mistometer (inhaler), if it does not work, give EPI
92
What is the consideration for emergency suction in the emergency kit?
1. Portable
| 2. Non-electric
93
What is the character of epinephrine?
1. Alpha and beta receptor agonists
2. Bronchodilator
3. Cardiac stimulator
4. Vasopressor
94
Which drugs are better at preventing histamine action rather than reversing it (can be used as a local anesthetic when allergy to lidocaine is noted)?
Antihistamine
95
Should antihistamine be given to an asthmatic?
No, will thicken bronchial secreations
96
Which antihistamine be given to an asthmatic?
1. Chlorpheniramine (Chlor-trimeton) 10mg/ml
| 2. Diphenhydramine (Benedryl) 50 mg/ml
97
Which are better at treating seizures as an anti-convulsant: benzodiazepines or barbiturates?
Benzodiazepine (Diazepam (vlium), Midazolam (versed) due to post-ictal depression
98
Which is given in higher dose as anticonvulsant-diazepam (valium) or Midazolam (versed)
Diazepam 5mg/mlMidazolam 1mg/ml
99
What is the narcotic reversal agent and dose?
0.4mg/ml Narcan
100
Why is morphine given?
To decrease workload on the heart due to pain or anxiety (e.g. MI or congestive heart failure)
101
When would morphine not be given?
In a head injury patient
102
What can be given if you give too much morphine?
Narcan (narcotic reversal agent)
103
When in doubt during an allergic reaction what should you give?
Corticosteroid (hydrocortisone)
104
What in the emergency kit can be used as a diagnostic tool in unconsciousness and seizures?
Antihypoglycemic (IV dextrose, oral sucrose)
105
IM glucagon is contraindicated in what patient?
Chronic hypoglycemia
106
What is used for severe bradycardia (less than 40-50 beats/min) associated with hypotension?
Atropine (anticholinergic)
107
What is a problem with atropine injections?
Will increase cardiac work and could increase an infarct
108
What is the drug of choice for chest pain because it is a potent vasodilator?
Nitroglycerine
109
What is the side effect of nitroglycerine?
Pulsating headache and flushing
