Exam - Emergencies

Based on the patient’s medical history, here are the potential medical emergencies that could occur in a dental setting and the appropriate responses according to the provided context.

1. Cardiovascular Emergencies (Stroke or Angina/Myocardial Infarction)

• Risk Factors: History of Hypertension, Atrial Fibrillation, TIA, and Hyperlipidaemia.

A. Stroke

Potential Emergency: The patient’s history of a TIA significantly increases their risk of a stroke.

Response:

1. Stop dental treatment.
2. Call 000 immediately. Time is critical.
3. Use the F.A.S.T. test:
   • Face: Check if their mouth has drooped.
   • Arms: Ask them to lift both arms.
   • Speech: Check if their speech is slurred or if they can understand you.
   • Time: Note the time the symptoms started.
4. Maintain the patient’s airway and monitor vital signs (blood pressure, heart rate, oxygen saturation) until help arrives.
5. Do not give aspirin, as the stroke could be haemorrhagic.
6. Start basic life support if the patient loses consciousness.

B. Acute Angina or Myocardial Infarction (MI)

Potential Emergency: Uncontrolled hypertension and hyperlipidaemia are major risk factors for an acute coronary syndrome (ACS).

Response:

1. Stop dental treatment.
2. Call 000, as this should be treated as a new or severe chest pain event.
3. Administer Aspirin 300 mg (chewed or dissolved).
4. Administer Glyceryl Trinitrate (GTN) spray (400 micrograms sublingually) if available and the patient has a known history of angina. This can be repeated every 5 minutes (max 3 doses).
5. Monitor vital signs (BP, heart rate, oxygen saturation).
6. Provide supplemental oxygen if saturation drops below 90%.
7. Reassure the patient and keep them calm.
8. If the patient loses consciousness, begin basic life support and use an AED if available.

2. Endocrine Emergency (Hypoglycemia)

• Risk Factors: Type 2 Diabetes with a high HbA1c (8.9%), indicating poor glycaemic control. A stressful appointment or a missed meal before treatment can trigger this.

Potential Emergency: Hypoglycemia (low blood sugar).

Response (if patient is conscious):

1. Stop dental treatment.
2. Administer 15g of a fast-acting glucose product (e.g., juice box, glucose gel, jelly beans).
3. If there is no improvement after 15 minutes, repeat the glucose dose.
4. Once symptoms improve, provide a longer-acting carbohydrate (e.g., a sandwich).
5. Keep the patient under observation and advise them not to drive home.

Response (if patient is drowsy, uncooperative, or unconscious):

1. Stop dental treatment.
2. Call 000.
3. Start basic life support.

3. Respiratory Emergency (COPD Exacerbation)

• Risk Factors: History of mild COPD. Stress or being in a supine position for too long can trigger an exacerbation.

Potential Emergency: Acute shortness of breath or bronchospasm, similar to an asthma attack.

Response:

1. Stop dental treatment and sit the patient upright.
2. Administer 4 puffs of their salbutamol inhaler via a spacer (one puff at a time, followed by 4 breaths).
3. Wait 4 minutes.
4. If there is little or no improvement, give another 4 puffs.
5. If the attack becomes severe or there is still no improvement, call 000 and continue administering the inhaler as needed while waiting for assistance.