Dental Emergencies: Choking and Emergency Drug Kit

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Questions and Answers

In managing a choking patient with a mild airway obstruction, what is the MOST appropriate initial step?

  • Encourage the patient to cough effectively. (correct)
  • Administer back blows.
  • Perform abdominal thrusts immediately.
  • Immediately call emergency services.

Which of the following is LEAST likely to be a sign of choking?

  • Struggling to breathe
  • Forceful coughing
  • Cyanosis
  • Patient is able to speak clearly (correct)

What is a key preventative measure to minimize choking incidents in the dental office?

  • Using a rubber dam during procedures. (correct)
  • Having patients rinse with chlorhexidine before the dental procedure.
  • Avoiding the use of small dental instruments.
  • Ensuring patients do not eat before appointments.

For an adult experiencing anaphylaxis, what is the recommended initial intramuscular dose of adrenaline (1:1000)?

<p>500 micrograms (C)</p> Signup and view all the answers

A patient in the dental chair develops sudden respiratory distress, urticaria, and angioedema. After calling for help, what is the next MOST important step?

<p>Administer oxygen and prepare adrenaline for intramuscular injection. (A)</p> Signup and view all the answers

Why is it essential to lay an anaphylactic patient flat and elevate their legs?

<p>To improve cerebral blood flow and counteract hypotension. (A)</p> Signup and view all the answers

A patient with asthma starts wheezing and struggling to breathe. They use their inhaler, but their condition worsens. What is the next MOST appropriate step?

<p>Administer oxygen and give up to 10 puffs of salbutamol inhaler within 2 minutes. (B)</p> Signup and view all the answers

During an asthma attack in the dental office, what is the recommended oxygen flow rate?

<p>15 L/min (A)</p> Signup and view all the answers

An asthmatic patient is having difficulty breathing, and their pulse oximetry reading is low. Despite using their inhaler multiple times, their condition is deteriorating. What should be considered?

<p>Calling emergency services immediately. (B)</p> Signup and view all the answers

A patient in the waiting room begins to experience a seizure characterized by jerking movements and loss of consciousness. What is the FIRST action the dental team should take?

<p>Clear the area of any potentially harmful objects and protect the patient from injury. (A)</p> Signup and view all the answers

A patient has been having a seizure for longer than 5 minutes. What is the next MOST appropriate step?

<p>Administer Midazolam orobuccally as per the appropriate dosage. (D)</p> Signup and view all the answers

After a seizure, a patient is confused and drowsy. What should the dental team do to ensure their safety?

<p>Ensure the patient has fully recovered and is accompanied by a responsible person before discharge. (A)</p> Signup and view all the answers

A patient suddenly becomes pale, diaphoretic, and reports feeling lightheaded in the dental chair. What is the MOST likely cause?

<p>Syncope (fainting) (A)</p> Signup and view all the answers

What is the recommended position for a patient experiencing syncope in the dental chair?

<p>Trendelenburg (supine with legs elevated) (A)</p> Signup and view all the answers

After a syncopal episode, a patient recovers consciousness but appears confused and reports feeling nauseous. What should the dental team consider?

<p>Reconsidering the diagnosis and monitoring vital signs. (C)</p> Signup and view all the answers

During a dental procedure, a patient suddenly develops facial drooping, slurred speech, and arm weakness. What condition is MOST likely occurring?

<p>Stroke (A)</p> Signup and view all the answers

What is the MOST crucial immediate action when a patient is suspected to be having a stroke?

<p>Call emergency services immediately. (A)</p> Signup and view all the answers

While awaiting emergency services for a patient experiencing a stroke, what should the dental team avoid?

<p>Administer aspirin. (D)</p> Signup and view all the answers

A diabetic patient becomes pale, sweaty, and confused during a dental appointment. What condition should you suspect?

<p>Hypoglycemia (B)</p> Signup and view all the answers

What is the FIRST step in managing a conscious hypoglycemic patient in the dental office?

<p>Administer 15-20g of a quick-acting glucose source. (C)</p> Signup and view all the answers

A patient becomes unconscious and is known to be hypoglycemic. What is the MOST appropriate course of action?

<p>Administer intramuscular glucagon and call emergency services. (C)</p> Signup and view all the answers

A patient with a history of adrenal insufficiency is scheduled for a dental extraction. What modification to their treatment plan might be necessary?

<p>Consult with the patient's physician regarding supplemental steroid administration. (C)</p> Signup and view all the answers

A patient is showing signs of adrenal crisis. After calling emergency services, what is the MOST critical immediate action the dental team should take?

<p>Administer the patient's hydrocortisone injection as per their emergency plan. (C)</p> Signup and view all the answers

If a patient in the dental office experiences an adrenal crisis, what is the recommended oxygen flow rate?

<p>15 L/min (A)</p> Signup and view all the answers

Which of the following signs is MOST indicative of sepsis?

<p>Patient looks unwell with a red flag present (D)</p> Signup and view all the answers

In the management of suspected sepsis in the dental office, what is the PRIORITY action, after initial assessment?

<p>Call emergency services ('Red Flag Sepsis') (C)</p> Signup and view all the answers

When managing suspected red flag sepsis, it is important to pre-alert the hospital. Which of the following would you include in your handover?

<p>The patients antibiotic allergies (B)</p> Signup and view all the answers

A patient with known angina begins to experience chest pain during a dental procedure. What is the FIRST step in managing this situation?

<p>Have the patient administer their glyceryl trinitrate (GTN) spray. (B)</p> Signup and view all the answers

A patient is given GTN spray for angina, but the chest pain does not subside after a few minutes. What is the next MOST appropriate action?

<p>Call emergency services and consider administering aspirin. (D)</p> Signup and view all the answers

During dental treatment, a patient suddenly collapses and loses consciousness. What is the MOST likely cause?

<p>Cardiac Arrest (B)</p> Signup and view all the answers

A patient in cardiac arrest loses consciousness and stops breathing. After calling emergency services, what is the next MOST appropriate action?

<p>Begin cardiopulmonary resuscitation (CPR). (B)</p> Signup and view all the answers

What is the recommended method for a dental practice team to stay prepared for medical emergencies?

<p>Attending an annual MERRT (Medical Emergency Response and Resuscitation Training) session. (C)</p> Signup and view all the answers

As a dental professional, what ongoing responsibility do you have regarding medical emergencies?

<p>Keep updated on changes in medical emergency protocols. (A)</p> Signup and view all the answers

What is the significance of familiarizing yourself with the emergency drug kit in your dental practice?

<p>To avoid potential mistakes during a medical emergency. (B)</p> Signup and view all the answers

What is included in the key features of dealing with all medical emergencies?

<p>Keep calm (B)</p> Signup and view all the answers

What medication is not included in the emergency drug kit?

<p>Ibuprofen (B)</p> Signup and view all the answers

A patient in the dental chair suddenly experiences difficulty breathing, begins coughing forcefully, and is grasping at their throat. What is the MOST appropriate initial assessment?

<p>Assess the severity of the airway obstruction by asking 'Are you choking?' (B)</p> Signup and view all the answers

During dental treatment, a patient with a known allergy suddenly develops a rash, difficulty breathing and angioedema. After calling for help and administering adrenaline intramuscularly, what is the next MOST important step in managing this patient?

<p>Position the patient lying flat and elevate their legs, while continuing to monitor vital signs. (B)</p> Signup and view all the answers

A known asthmatic patient in the dental chair begins to wheeze and struggle to breathe. They have used their inhaler with minimal relief. What is the MOST appropriate next step?

<p>Administer oxygen at 15L/min via a non-rebreather mask and continue to administer puffs from their inhaler every few minutes. (C)</p> Signup and view all the answers

A patient with a history of epilepsy experiences a seizure in the dental chair characterized by tonic-clonic movements lasting 3 minutes. What is the MOST important aspect of managing the patient DURING the seizure?

<p>Ensure the area is clear of any instruments and protect the patient from injury, without restraining them. (D)</p> Signup and view all the answers

A patient who reports feeling anxious becomes pale, diaphoretic, and reports feeling lightheaded shortly after local anesthetic administration. You suspect syncope. After placing the patient in a supine position, what is the next MOST appropriate step?

<p>Administer oxygen via nasal cannula and monitor vital signs. (A)</p> Signup and view all the answers

Flashcards

What is GTN used for?

GTN is a medication used for Angina.

Key actions for medical emergencies?

Key actions: Keep calm, reassure, lead/support, monitor/record.

Signs of choking?

Coughing, struggling to breathe, grasping throat, cyanosis.

Anaphylaxis triggers?

Known allergy, food, drugs, latex are all triggers.

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Signs of anaphylaxis?

Sudden onset, angioedema (swelling), flushing, urticaria (rash), respiratory distress are all signs

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Symptoms of Cardiac Arrest?

Sudden onset, chest pain, sweating, light headed, nausea may signal a cardiac issue.

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Asthma management?

Assess if life threatening (999), sit upright, 2 puffs Salbutamol (max10 over 2 mins), give oxygen.

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When to use Midazolam oromucosal?

Prolonged or repeated.

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How to administer a salbutamol inhaler?

Use space device & repeat dose if necessary.

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Signs of a Seizure/Epilepsy?

Loss of consciouness, rigidity, jerking, mouth frothing

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Epilepsy management?

Move instruments, place supine, cushion head and call for help

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Things NOT to do during a seizure?

Do not restrain, put anything in mouth or move unless in danger

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Fainting: Signs?

Pale, sweating, slow pulse, low blood pressure.

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Fainting management?

Lie flat, elevate legs, glucose when conscious, check responsiveness.

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Stroke signs?

Face drooping, arms limp, speech slurred, time to call 999.

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Stroke management?

Act fast/call 999, give oxygen, make comfortable, DO NOT give aspirin.

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Hypoglycaemia signs?

Shaking, slurred speech, sweating, blurred vision are all signs of...

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Hypoglycaemia management?

Offer 15-20g quick-acting glucose if able to swallow, if not, call 999, give glucagon.

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Adrenal crisis signs?

collapse, pallor, hypotension, diarrhea

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Adrenal crisis management?

Call 999, lie flat, give oxygen, use hydrocortisone emergency kit.

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Sepsis triggers?

Chemotherapy, infection are some potential causes.

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Sepsis signs?

Unwell, high heart rate, high O2 needed, with no urine created.

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Sepsis management?

Call 999, use sepsis tool, give oxygen and pre-alert the hospital.

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Signs and Symptoms of Myocardial Infarction (MI)?

Crushing chest pain often radiating and potential loss of consciousness.

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What is cardiac arrest caused by?

Sudden loss of heart function, patient collapses and loses consciousness

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What should you do in the even of cardiac arrest?

Call 999 in the event of this happening.

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Study Notes

  • Most common medical emergencies in the dental setting: Part 4

Emergency Drugs Kit - Know When Know Dosages

  • The emergency drugs kit includes GTN, Adrenaline, Midazolam, Oxygen, Aspirin, Glucagon, Glucose, and Salbutamol

Key features of dealing with all medical emergencies

  • Keep calm
  • Provide reassurance
  • Lead and/or support
  • Monitor and record

Choking / Foreign Body Airway Obstruction (FBAO)

  • Signs of choking include coughing, struggling to breathe, grasping for throat, and cyanosis
  • A patient experiencing choking or foreign body airway obstruction is unlikely to be able to explain what is happening
  • Triggers for choking include eating/drinking, tablets, neurological or cerebral impairment, reduced ability to swallow (such as with cancer treatment or Parkinson's), and eating lunch
  • To manage choking, assess severity, including mild airway obstruction (effective cough) versus severe airway obstruction (ineffective cough)
  • Prevention includes risk assessment, taking a history, and using a rubber dam
  • https://www.nature.com/articles/s41407-019-0150-2#citeas

Anaphylaxis

  • Signs include sudden onset, angioedema (swelling), flushing, urticaria (rash), respiratory distress, stridor/wheezing, hypotension, and tachycardia
  • Symptoms include itchiness, difficulty breathing, and feeling of tongue or face swelling up
  • Triggers include known allergies (food, drugs, latex) and unknown allergens
  • Management includes ABCDE, removing the trigger, calling SBAR, lying the patient flat/elevating legs, giving O2 at 15L/min, and administering an intramuscular injection (500mg/ 0.5ml Adults)
  • Repeat intramuscular injection after 5 minutes until an adequate response is achieved
  • Risk assessment, taking a history, preparation, and communication with the team are examples of preventative measures
  • https://www.nature.com/articles/s41415-020-1789-y

Asthma

  • Signs of asthma include difficulty breathing, expiratory wheezing, breathlessness, fast pulse, RR > 25/min, and pulse >110/min
  • Life-threatening signs include cyanosis, exhaustion, altered level of consciousness, RR<8/min, and pulse <50/min
  • Symptoms may include stating, "cannot breathe" and looking for inhaler
  • Triggers of asthma include allergy, fear, stress, extreme weather, and pollutants
  • Management includes ABCDE, assessing if situation is life-threatening, sitting upright, and supporting 2 puffs of Salbutamol, continue to maximum of 10 puffs over 2 mins
  • Provide O2 15L/min and if no improvement call 999 SBAR
  • Keep taking prescribed inhaler every 2 minutes until help arrives
  • Prevention constitutes risk assessment, taking a history, preparation, and communicating with the team
  • https://www.nature.com/articles/s41415-020-1789-y
  • https://www.nature.com/articles/bdjteam20188#citeas

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