Medical Emergencies, CPR, BLS
Exam Pass Notes
Key Takeaways
- Know the emergency drugs and equipment needed in a dental practice.
- Assess unconscious patients systematically using the ABCDE approach.
- Recognise and manage common emergencies like syncope, angina, asthma attacks.
- Start CPR and use AED when appropriate for non-breathing patients.
- Administer oxygen frequently for emergencies.
- Always call ambulance for severe reactions and monitor patient until arrival.
Heart Issues
- Cardiac arrest is the sudden cessation of blood circulation due to the heart failing to contract effectively.
- Cardiac arrest can be caused by ventricular fibrillation, ventricular tachycardia, pulseless electrical activity, or asystole.
- A heart attack (myocardial infarction) is different from cardiac arrest but can potentially lead to it.
- Angina pectoris is chest pain due to insufficient blood flow to the heart muscle.
CQC Requirements
- CQC expects practices to follow Resuscitation Council UK guidelines on medical emergencies.
- Immediate access to an AED is recommended. If unavailable, a risk assessment for timely access should be documented.
- Recommended emergency drugs include adrenaline, aspirin, glucagon, GTN spray, midazolam, glucose, oxygen, and salbutamol.
- Recommended emergency equipment includes defibrillator pads, AED, oxygen cylinder, masks, airways, suction, protective equipment, scissors, and self-inflating bags.
- Regular checking of emergency drugs and equipment is advised.
Emergency Drug Kit
- Essential emergency drugs are GTN spray, salbutamol inhaler, adrenaline injection, aspirin, glucagon, glucose, and midazolam.
- Drugs should be in pre-filled syringes where possible.
- Intravenous drugs are discouraged.
ABCDE Assessment
- Assess airway, breathing, circulation, disability, and exposure in that order.
- Treat any life-threatening issues before proceeding.
- For airway, check for obstruction and clear it if needed.
- For breathing, check rate and adequacy. Give oxygen, call ambulance, and treat acute asthma/anaphylaxis if needed.
- For circulation, check pulse, skin colour, capillary refill, pupils. Consider CPR if inadequate.
- For disability, assess level of consciousness and expose patient if needed.
Defibrillation
- Defibrillation stops ventricular fibrillation and allows the heart to resume effective pumping.
- It should be done as soon as possible to avoid lactic acid buildup poisoning heart muscle.
- Modern AEDs automatically diagnose if a shock is needed.
CPR
- Start CPR if patient is unresponsive, has open airway, and inadequate or absent breathing.
- Give 30 chest compressions and 2 rescue breaths until AED attached.
- Follow AED prompts for analysing rhythm and shocks.
- Return to CPR after shocks.
- Rapid defibrillation minimises lactic acid buildup from ineffective pumping.
CPR Airway Management
- Keep airway open by tilting head back or pushing jaw forward if neck injury.
- Use artificial pharyngeal or nasal airways to keep it open.
- Use self-inflating bag with oxygen to assist breathing if needed.
Home Visits
- CQC expects risk assessment before home visits regarding medical risks and suitability of location.
- Remove practice defibrillator only if other practitioners will not be affected.
- Transport oxygen cylinders safely if needed.
- Non-invasive care generally does not require full emergency kit.
Adrenal Insufficiency
- Caused by insufficient steroid hormone production by adrenal cortex.
- Long-term steroids can suppress natural production.
- Crisis triggered by bodily stress like infections, trauma, surgery.
- Manage by maintaining ABC, calling ambulance, considering IV hydrocortisone.
Allergies
- Take thorough medical history of known allergies.
- Avoid latex and metals if patient has those allergies.
- Restrict antibiotic use to prevent sensitisation.
Anaphylaxis
- Severe life-threatening allergic reaction affecting breathing and/or circulation.
- Can be triggered by drugs, latex, etc.
- Treat by laying patient flat, giving oxygen, calling ambulance.
- Use adrenaline injection for severe reactions.
- Always send recovered patients to hospital for additional treatment.
Angina
- Chest pain due to insufficient blood flow to heart muscle.
- Precipitated by exertion, emotions.
- Manage by stopping treatment, giving GTN spray, oxygen, calling ambulance if severe.
Asthma
- Bronchial airway inflammation causing breathing difficulty.
- Manage mild attacks with salbutamol inhaler.
- For severe attacks, give oxygen and repeat salbutamol doses every 10 minutes until ambulance arrives.
- Use spacer device if available.
Choking and Aspiration
- Risk increased during dental treatment due to anaesthesia, materials in mouth, etc.
- If conscious, let patient cough. If ineffective, give 5 back blows followed by 5 abdominal thrusts.
- Unconscious patients may require CPR.
- Send patient to hospital if foreign body aspiration suspected.
Epileptic Seizure
- Caused by abnormal electrical brain activity.
- Types are partial (petit mal) and generalised tonic-clonic (grand mal).
- Manage seizure by noting time, protecting patient, placing in recovery position.
- Prolonged seizures may require midazolam.
Hypoglycaemia
- Abnormally low blood glucose levels.
- Most common in diabetics.
- Treat conscious patients with oral glucose.
- Unconscious patients may need glucagon injection followed by oral glucose.
Myocardial Infarction
- Heart attack due to blocked coronary artery.
- Manage by calling ambulance, sitting patient upright, giving oxygen, GTN, aspirin.
Syncope
- Fainting due to insufficient blood flow to brain.
- Manage by laying patient flat, raising legs, giving oxygen.
- Monitor breathing and circulation.