All Medical emergencies- written

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Questions and Answers

What does ABCDE stand found and why is it used?

Airway, breathing, circulation, disability, exposure. It is used to assess and treat the patient.

What does SBAR mean and why is it used?

Situation, background, assessment and recommendation. It is used to communicate effectively with emergency services.

What would you do for each ABCDE?

Airway= i will ensure the airway is not obstructed. Breathing= assess the breathing pattern/rate/sounds. Circulation= assess the colour of the patient and the pulse. Disability= assess the pupils reaction to light/ give painful stimuli to generate a possible reaction. Exposure= examine the patient fully/ respect the patients dignity and minimise heat loss

Who developed SBAR?

Originally developed by US military for communication on nuclear submarines but has now been introduced into many clinical settings relating to safety and calling for help to emergency services. Signup and view all the answers

What does SBAR stand for and what would you do in each step?

S= Situation. Identify yourself and the site you are calling from, identify the patient by name and reason for the call, describe your concern. B= Background. Explain medical history, patient background, possible diagnosis, current medications, allergies. A= Assessment. What are the vital signs, clinical impressions, concerns. R= Recommendation. Explain what you need, be specific with timeframe and the request, clarify expectations Signup and view all the answers

What are the three cardiac emergencies?

Angina, myocardial infarction (heart attack), cardiac arrest Signup and view all the answers

What is angina?

Angina is a feeling of pain or tightness, usually in your chest. Could be a sign of a heart problem. Signup and view all the answers

What are 7 symptoms of angina?

Sudden pain in chest, jaw, shoulders, arms, neck. It feels like a tight squeezing pressure, or dull ache. Makes you feel breathless, sick, dizzy, sweaty. Signup and view all the answers

What are 4 common reasons for angina?

Cold temperatures, stress, exercise and emotions Signup and view all the answers

How long does an angina attack normally last for?

Angina attacks usually last less than 10 minutes and should after resting for a few minutes or after taking angina medicine Signup and view all the answers

How would you treat angina attack (3) and what would you do if symptoms still persist?

<ol> <li>Stop what you are doing and rest. 2. Use medicine you have been prescribed- this is usually glyceryl trinitrate (GTN). 3. Take another dose after 5 minutes if first dose does not help. If symptoms persist 5 minutes after taking the second dose, call 999 for an ambulance, patient could be having a heart attack.</li> </ol> Signup and view all the answers

What causes angina?

Angina happens when the heart does not get enough blood. This is usually due to coronary heart disease, where the blood vessels supply blood to the heart become narrowed or blocked by fatty deposits. However, it can also be caused by the blood vessels tightening when they should be not. Signup and view all the answers

What is the treatment for angina? (3)

<ol> <li>Treat an angina attack if you have one with glyceryl trinitate. 2. Lower your chances of having an angina attack by using beta blockers. 3. Reduce your risk of having a stroke or heart attack by taking low dose aspirin (if not allergic) or statins.</li> </ol> Signup and view all the answers

What are beta blockers?

They lower blood pressure. These medicines block the effects of the hormone epinephrine, also known as adrenaline. Signup and view all the answers

What do NSAIDs stand for and what does it do?

Non-steroidal-anti-inflammatory drugs are medicines that reduce pain, fever, and inflammation. They are also used to prevent blood clots in some cases. Some common medicines used is naproxen, aspirin, ibuprofen, voltaren Signup and view all the answers

What are immunosuppressants, give 3 examples and its dental relevance?

Immunosuppressants are used to suppress the immune system for example after organ transplants or for autoimmune disease. Examples of medicines are steroids, ciclosporin, azathioprine, tacrolimus. Its dental relevance is risk of infection, delayed healing, gingival hyperplasia especially with ciclosporin. Signup and view all the answers

What are statins?

Statins are a class of medications used to lower cholesterol. They are prescribed for people who typically at at high risk of cardiovascular disease. Signup and view all the answers

What are antihypertensives medications, examples (3) and dental relevance?

They are used to manage blood pressure, common in patients with kidney disease or cardiovascular issues. Examples are beta blockers, calcium channel blockers like amlodipine, diuretics. Its dental relevance is gingival hyperplasia especially with calcium channel blockers =, xerostomia, bleeding tendencies. Signup and view all the answers

What are anticoagulants, examples (3) and dental relevance?

Anticoagulants are used to prevent blood clots. Examples are warfarin, apixaban, rivaroxaban. It’s dental relevance is risk of prolonged bleeding Signup and view all the answers

Summarise the treatment for angina (6)?

<ol> <li>Patient does not loose consciousness 2. GTN spray 400-800mg actuations sublingually 3.no relief, repeat 4. Aspirin unless allergic 5. Call 999 SBAR 6. Be prepared for CPR</li> </ol> Signup and view all the answers

What are implications of GTN spray?

Patient may have a serious allergic reactions e.g. lips, mouth tongue become swollen, struggling to swallow, lips can turn blur, grey, pale skin Signup and view all the answers

What is myocardinal infarction (heart attack)?

Death of Myocardinal heart muscle caused by loss of blood supply visually by a blood clot. Potentially very serious depending on the size of dead heart muscle. Patient may loose consciousness. Signup and view all the answers

Symptoms of myocardinal infarction? (7)

<ol> <li>Chest pain- feeling heaviness, pressure, tight 2. Pain that feels like it is spreading to other body parts. 3. Coughing or wheezing 4. Overwhelming feeling of anxiety 5. Feeling sick or being sick 6. Sweatness 7. Shortness of breath</li> </ol> Signup and view all the answers

How would you treat a heart attack in practiced compared to a hospital setting?

In practice while waiting for an ambulance, it may help to chew and then swallow a tablet of aspirin ideally 300mg and the person not being allergic. Call 999 SBAR and be prepared for CPR. In hospital it depends on the type of heart attack and how serious it is. The two main treatments are using medicines to dissolve the blood clots and surgery to help restore blood to the heart. Signup and view all the answers

What causes a heart attack?

Coronary heart disease (CHD) is the leading cause of heart attack. CHD is a condition where the major blood vessels (coronary arteries) that supply blood to the heart muscle become clogged by a build up of fatty deposits known as plaques. Before a heart attack, one of the plaques bursts, causing a blood clot to develop at the site of the rupture. This clot blocks the supply of blood to the heart, triggering a heart attack. Signup and view all the answers

How to recover from a heart attack?

Recovering from a heart attack depends on the amount of damage to the heart muscle. Reducing risk of a heart attack can come through a combination of lifestyle changes such as a healthy balanced diet, excercise and medicines such as statins which can help lower blood cholesterol levels. Signup and view all the answers

Implications of statins

Although further research is needed, statins may have anti-inflammatory, antioxidant and antimicrobial effects that could benefit periodontal health and wound healing. Signup and view all the answers

What is cardiac arrest?

Cardiac arrest is sudden loss of heart function, patient collapses and looses consciousness. It occurs when the heart unexpectedly stops beating. This electrical malfunction prevents blood from circulating properly, which can lead to brain damage, disability, or death if left untreated. Signup and view all the answers

What are the symptoms of cardiac arrest? (3)

<ol> <li>Sudden collapse and loss consciousness 2. No breathing or gasping for air 3. No response to shouting or shaking, often with no prior warning</li> </ol> Signup and view all the answers

How to treat cardiac arrest?

Call 999 SBAR and start CPR Signup and view all the answers

What causes a cardiac arrest?

Cardiac arrest is usually caused by a malfunction in a diseased heart electrical system, which can trigger abnormal heart rhythms like ventricular fibrillation Signup and view all the answers

What medications and emergency equipment is available? (8)

<ol> <li>Defibrillator 2. Epinephrine 3. Aspirin 4. Glucose/glucagon 5. Glyceryl trinitrate spray 6. Midazolam 7. Salbutamol 8.oxygen</li> </ol> Signup and view all the answers

Certain medications for heart conditions can lead to various oral side effects like what? (7)

<ol> <li>Xerostomia 2. Gingival hyperplasia 3. Altered taste sensation (dsgeusia) 4. Lichenoid reactions 5. Angioedema (swelling of tissues) 6. Mouthsores (ulcers) 7. Increase risk of tooth decay and gum disease</li> </ol> Signup and view all the answers

What are triggers for choking/foreign body airway obstruction (FBAO)?

Eating/drinking, tablets, neurological or cerebral impairments, reduced ability to swallow due to cancer treatment, Parkinson’s disease Signup and view all the answers

Signs and symptoms of choking?

Coughing, struggling to breathe or speak, grasping for throat, cyanosis (skin, mucous membranes and nails appear bluish or purplish), patient unlikely to be able to explain Signup and view all the answers

What is the management for choking?

<ol> <li>If someone is choking, ask the victim if they are choking, encourage them to cough. 2. Bend them forward and give up to 5 back blows to try and dislodge the blockage, check after each blow if something has come out. 3. If they are still choking, give up to 5 abdominal thrusts, hold around the waist and pull inwards and upwards above their belly button. 4. If they are still choking call 999. Patient can die within 3 minutes if the appropriate care is not given. Start CPR until help comes if patient collapses.</li> </ol> Signup and view all the answers

How to prevent choking?

Risk assessment, taking a history, use of rubber dam Signup and view all the answers

What are signs of anaphylaxis?

Sudden onsent angioedema (swelling), flushing, urticaria (rash), respiratory distress strider/wheezing, hypotension, tachycardia (increased heart rate than what is normal) Signup and view all the answers

What are symptoms of anaphylaxis?

Complain of itchiness, difficulty breathing, feels tongue/ face swell up, tired/confused, skin feels cold to touch Signup and view all the answers

What are triggers for anaphylaxis?

Known allergy: food, drugs, latex. Allergy may be unknown Signup and view all the answers

What are the prevention for anaphylaxis?

Risk assessment, taking history, preparation, communicate with team Signup and view all the answers

What is the management for anaphylaxis?

<ol> <li>ABCDE/remove trigger 2. Call SBAR 3. Lie flat/elevate legs 3. Use an adrenaline auto-injector (such as an EpiPen) if you have one- if not practice has adrenaline</li> </ol> Signup and view all the answers

What medication is used for anaphylaxis and the route?

Adrenaline ampule. Adults 500mg/0.5ml concentration 1:1000. Children 6-12 years 300mg/0.3ml and under 6 years is 150mg/0.15ml. The route is intramuscular injection and if symptoms have not improved after 5 minutes, use a second adrenaline auto-injector. Oxygen via a face mask may be give o2 15l/min Signup and view all the answers

What is anaphylaxis?

Anaphylaxis is a serious life-threatening allergic reaction that happens very quickly. It can be caused by food, medicine, or insect strings. Signup and view all the answers

What is asthma?

Asthma is a common lung condition that causes occasional breathing difficulties. It affects people of all ages. There’s no cure, but there are simple treatments that can help keep the symptoms under control. Signup and view all the answers

What are signs of asthma?

Difficulty breathing, a whistling sound when breathing (wheezing), coughing, tight chest, fast pulse RR>25/min PULSE>110/min Signup and view all the answers

What are symptoms of asthma?

May start saying cannot breathe, may look for inhaler, exhaustion Signup and view all the answers

What does the top and bottom blood pressure reading mean 120/80mmHg?

Top number is systolic pressure. This means the pressure in your arteries when your heart beats. A normal range is usually 90-120mmHg. The bottom number is the diastolic pressure. This measures the pressure in your arteries when your heart is resting between beats. A normally range is usually 60-80mmHg Signup and view all the answers

What are triggers for asthma?

Allergy, fear, stress, extreme weather, pollutants, infections like colds/flu, cold air, smoke, pollution Signup and view all the answers

What causes asthma?

Asthma is caused by swelling (inflammation) of the breathing tubes that carry air in and out of the lungs. This makes the tubes highly sensitive, so they temporarily narrow. Signup and view all the answers

How to prevent asthma?

Risk assessment, taking a history, preparation, communication with team Signup and view all the answers

When is asthma life threatening?

Asthma can be life threatening when there are signs of cyanosis, exhaustion, level of consciousness, RR <8/min pulse <50/min, must call 999 Signup and view all the answers

How to you manage asthma?

ABCDE, assess situation, if life threatening call 999 SBAR. If able to sit patient upright, support patient in having 2 puffs of salbutamol, continue to maximum of 10 puffs over 2 minutes, provide oxygen 15l/min if no improvement, call 999 SBAR, keeping taking inhaler ever 2 minutes until help arrives Signup and view all the answers

How to take salbutamol and what are nebulisers?

2 actuations inhaled, spacer can be used, actuations may be repeated, if not responding use a nebuliser solution and oxygen. Nebulisers use oxygen, compressed air, or ultrasonic powder to turn liquid medication into a mist for inhalation Signup and view all the answers

What is epilepsy?

Epilepsy is a chronic neurological disorder with frequent or occasional seizures. It is when the electrical signals in the brain become scrambled and there are sometimes sudden bursts of electrical activity. Signup and view all the answers

What are signs of epilepsy?

May loose consciousness, cry put as it in pain, becoming stiff, uncontrollable jerking and shaking ‘fit, collapsing, frothing at mouth Signup and view all the answers

What are symptoms of epilepsy?

May say can smell flowers, may feel an aura Signup and view all the answers

What are triggers for epilepsy?

Fear/stress, brain injury, brain tumour, drug abuse or alcohol misuse, a stroke, raised body temperature. Signup and view all the answers

What can you do to prevent epilepsy?

Risk assessment, taking a history, preparation, communication with team Signup and view all the answers

What is the management for epilepsy?

ABCDE, clear all instruments away, if in the dental chair place in supine or if standing easy to the floor and place a cushion under head, do not restrain or put anything in the mouth, call for help, time the seizure, call 999 if more than 5 minutes unless normal for them, give o2 15l/min, if more than 5 minutes administer midazolam orobuccally Signup and view all the answers

What medication is used for epilepsy?

Midazolam. Adults 10mg, 5-10 years 7.5mg and 1-5 years 5mgs. Administered on the oral buccal mucosa, kept in the fridge, needs mixing Signup and view all the answers

What is important to note when someone is having a seizure?

If they are having a seizure for the first time, has a seizure lasting more than 5 minutes, has lots of seizures in a row, has breathing problems or has seriously injured themselves Signup and view all the answers

Oral implications of antiepileptic drugs (AED)

Gingival hyperplasia especially with phenytoin you will see enlarged and inflamed gums, increased risk of dental caries due to xerostomia, oral trauma (seizures can cause injuries to the mouth, including tongue, cheek biting and tooth fractures), bleeding gums and others may cause delayed healing, medication induced b12 deficiency- some aeds can lead to a deficiency in b12, which can cause oral ulcers and glossitis Signup and view all the answers

What do you do when your seizure has finished?

No more dental treatment that day, try to talk to the patient to evaluate the level of consciousness, do not attempt to restrain as he or she may be confused, do not allow the patient to leave the practice until you are sure they have made a full recovery. Contact patients family if the patient want alone, do a brief oral examination for sustained injuries, depending in on state, discharge patient home with a responsible person Signup and view all the answers

What do you need to remember when a patient has epilepsy?

Never put fingers or anything in their mouth to try and prevent them biting their tongue- this will cause serious injury, do not try move the patient unless there are in immediate danger, do not restrain their movement whilst they are fitting, never try and bring them around, do not give anything to eat/drink until they are fully recovered Signup and view all the answers

What is fainting? Other terms used is syncope/vasovagal attack

Fainting is when you pass out for a short time Signup and view all the answers

What are signs of fainting?

Pale, sweating, slow pulse, low bp Signup and view all the answers

What are symptoms of fainting?

Feeling dizzy/light headed, feeling sick/nausea, vision changes, cold skin and sweating, feeling warm or hot Signup and view all the answers

What are triggers for fainting?

Stress, fear, hunger, standing up too quickly, taking drugs or drinking too much alcohol, heart problems, not eating or drinking enough Signup and view all the answers

How can you prevent fainting?

Risk assessment, taking a history, preparation, communicate with the team Signup and view all the answers

How to manage fainting?

ABCDE, Lay flat, elevate legs (raise), if pregnant, especially more than 28 weeks lay on side, usually the person who has fainted will wake up within 20 seconds, once consciousness regained offer glucose drink, if slow recovery reconsider diagnosis, if unresponsive check for signs of life. Signup and view all the answers

When do you call 999 when someone has fainted?

Patient is not breathing, cannot be woken within 1 minute, not fully recovered or has difficulty with speech/movement, fainted while lying down or exercising, chest pain or irregular heartbeat. Signup and view all the answers

What is sepsis?

Sepsis is life threatening. It can be hard to spot. There are lots of possible symptoms. It is a life threatening reaction to an infection. It happens when the immune systems overreacts to an infection and starts to damage your body’s own tissues and organs. You cannot get sepsis from another person. Signup and view all the answers

What are signs and symptoms of sepsis?

The person does not feel well and looks really unwell, heart rate <130/min, needs oxygen o2 oxygen saturation at 92%, acting confused, not making sense, blue, grey, pale, blotchy skin, lips or tongue, not passed urine in 18 hours, difficulty breathing, a rash that does not fade Signup and view all the answers

How to prevent sepsis?

Risk assessment, taking a history, preparation, observation, communicate with team Signup and view all the answers

How to manage sepsis?

ABCDE, call 999 ‘red flag sepsis’ give oxygen 15l/min, refer to GDP red flag sepsis tool Signup and view all the answers

What are triggers for sepsis?

People with a weak immune system- chemotherapy within last 6 weeks, infection, people over 75, diabetes, genetic disorder such as sickle cell disease or Down’s syndrome, recently had surgery or illness, babies under 1 or if they were born premature or mother had an infection whilst pregnant, woman who have had miscarriage, abortion, or given birth Signup and view all the answers

What is a stroke?

A stroke is when blood stops flowing to part of your brain. It can affect things like speech and movement and can take a long time to recover. A stroke needs urgent medical help in hospital because it can be life threatening, Signup and view all the answers

What are signs of a stroke?

Face dropping or weakness, arms are limp or weak, speech is slurred. Time to call 999 Signup and view all the answers

What can trigger a stroke?

Over 50 years old, you have sickle cell disease, unhealthy lifestyle such as alcohol, drugs, obesity, no excercise, high blood pressure (hypertension), diabetes, high cholesterol, stress, irregular and fast heartbeats Signup and view all the answers

How to prevent a stroke?

Risk assessment, taking a history, preparation, communicate with team Signup and view all the answers

What is the management for sepsis?

Act fast and call 999 SBAR, give oxygen to the patient, make the patient comfortable, do not give aspirin not all strokes are caused by blood clots, some strokes are caused by ruptured blood vessels and taking aspirin could make the bleeding strokes more severe. Signup and view all the answers

What is the treatment for a stroke in hospital?

Medicine to get rid of blood clots in the brain (thrombolysis), surgery to remove a blood clot (thrombectomy) or drain fluid from the brain, a procedure to stop pressure building up inside the skull or brain Signup and view all the answers

What is the treatment/medicines for a stroke?

Anticoagulants to stop blood clots forming, medicines to lower your blood pressure, statins to lower cholesterol Signup and view all the answers

What are oral implications of anticoagulants?

Swollen gums: blood thinners can cause gums to swell which make them sensitive and prone to bleeding. Receeding gums Signup and view all the answers

Oral implications of blood pressure medication?

Xerostomia, gingival hyperplasia particularly calcium channel blockers, changes in taste (metallic or complete loss of taste), lichenoid reactions, increased risk of gum disease, affects the oral cavity e.g. changes in salivary glands Signup and view all the answers

What are side effects of statins

Xerostomia, taste alterations (dysgeusia), oral ulceration, decreased pulp size due to calcifications which could potentially make root canal treatment more difficult Signup and view all the answers

What is hypoglycaemia (low blood sugar)?

Low blood sugar is usually where your blood sugar (glucose) is below 4mmol/l. It needs to be treated quickly to stop it getting worse. Low blood sugar usually affects those with diabetes who take insulin or some other diabetes medicines. It is rare in people without diabetes. Signup and view all the answers

What are signs of hypoglycaemia?

Shaking, slurred speech, tremors, blurred vision, confusion and aggression, feeling tired/weak, hungry, dizzy, tingly lips Signup and view all the answers

What are symptoms of hypoglycaemia?

Heart racing, feels dizzy, feels shaky Signup and view all the answers

What are hypoglycaemia triggers?

Stress, anxiety, missing medication, not eating, alcohol, change in diet Signup and view all the answers

How do you prevent hypoglycaemia?

Risk assessment, taking a history, preparation, communicate with team Signup and view all the answers

If you have severe low blood sugar, what can you get next?

Have a seizure or fit, become unconscious Signup and view all the answers

What is the management for hypoglycaemia?

ABCDE, offer 15-20mg quick acting glucose (orally) 15-20mg= 3 jelly babies. This is for a co-operative patient. Check blood sugar after 10-15 minutes. If blood sugar is still below 5mmol/l, have another glucose tablet or something to eat and check again after 10 minutes. Once symptoms have improved and blood sugar levels is above 4mmol/l, eat something that will keep your blood sugar up for longer such as biscuits, sandwich, or your next meal if it is due Signup and view all the answers

How would you treat someone with severe low blood sugar?

Do not give patient something to eat or drink as they will not be able to swallow properly (unconscious patient), put patient in recovery position, give glucagon injection (intramuscular) adult: 1mg intra muscular and chiller under 8 is 0.5mg. Call 999 SBAR. If they start to recover within 10 minutes of having a glucagon injection and can swallow safely, give food or drink that will raise their blood sugar. You must stay with patient until they are fully recovered Signup and view all the answers

What is adrenal crisis (addisons disease)?

Addisons disease, also known as primary adrenal insufficiency, is a rare disorder of the adrenal glands. The adrenal glands are 2 small glands that sit on top of the kidneys. They produce 2 essential hormones: cortisol and aldosterone. In addisons diseases, the adrenal gland is damaged and therefore, does not produce these hormones. It is a problem with the immune system which causes it to attack the outer layer of the adrenal gland (the adrenal cortex) which distrusts the production of steroid hormones aldosterone and cortisol Signup and view all the answers

What are signs of adrenal crisis?

Collapse, pallor, hypotension, vomiting, diarrhoea Signup and view all the answers

What are symptoms of adrenal crisis?

Lack of energy or motivation, feeling dizzy, feeling nauseous, increased thirst, low mood, muscle weakness Signup and view all the answers

What must people with Addisons disease be aware of?

People with Addisons disease must be constantly aware of the risk of sudden worsening of symptoms, called adrenal crisis. This can happen when the levels of cortisol in the body fall significantly. Adrenal crisis is a medical emergency, if left untreated it can be fatal. Signup and view all the answers

What are triggers of adrenal crisis?

Stress, anxiety, missing medication, in appropriate management Signup and view all the answers

How to prevent adrenal crisis?

Risk assessment, taking a history, preparation, drugs prior to treatment, communicate with patient, bring emergency hydrocortisone and adrenal crisis letter Signup and view all the answers

What is the management for adrenal crisis?

ABCDE, Call 999 and immediately say ‘adrenal crisis’, life flat, give oxygen 15l/min, use patients hydrocortisone emergency intra muscular injection Signup and view all the answers

If a patient is having a major surgery e.g. extraction with local or general anaesthetic what medication to they have to take?

Pre op= 100mg hydrocortisone intramuscular before anaesthesia. Post op= double dose oral medication for 24 hours, then return to normal dose Signup and view all the answers

If a patient is having minor dental treatment e.g. replacing a filling or scale and polish, and they have Addisons disease, what medication to they take?

Pre op= take an extra oral dose 60 minutes ahead of procedure. Post op= an extra dose where hypoadrenal symptoms occur afterwards, then return to normal dose. Signup and view all the answers

If patient with Addisons disease was going to have a root canal with local anaesthetic, what medications will they have to take?

Post op= double oral dose up to 20mg hydrocortisone, one hour prior to surgery. Post op= double dose oral medication for 24 hours. Then return to normal dose. Signup and view all the answers

What are oral implications for patients on long-term oral glucocorticoids for conditions like Addisons disease or other inflammatory disorder are at risk of adrenal crisis:

Oral ulcers, pigmented lesions on oral mucosa, xerostomia, dry lips, dental enamel defects Signup and view all the answers

Flashcards

ABCDE meaning?

Airway, breathing, circulation, disability, exposure. Used to assess and treat patients in emergencies.

SBAR meaning?

Situation, background, assessment, and recommendation. Used for effective communication with emergency services.

SBAR steps

S = Situation; B = Background; A = Assessment; R = Recommendation. Each step involves specific details about the patient's condition and needs.