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Case 2
Patient taking Humulin or Glyburidine
Patient is loquacious
Rapid pulse
Slow respiration
Dizzy and nauseated
Goes limp
- Medications are for diabetes
- Signs of hypoglycemia
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Case 3
Benign HH
No meds
Patient's eyes roll back and begin to have abnormal convulsions of the body
- Epilepsy
- Problem is self limiting
- Move everything out of the way
- Turn head to side in case of emesis
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Case 4
Benign HH
Taking oral contraceptives
Anxious
Mouth and fingers are tingly
Rapid respiration
Sweating and nauseated
- Hyperventilation/Anxiety
- Reassure patient
- Have patient hold breath or breath into a bag
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Case 5
History of asthma
Taking albuterol and salmeterol
Patient begins to wheeze and squeak
- Give rescue inhaler (albuterol)
- If no response, call 911
- Give O2 and nitrous for relaxation
- Epi and corticosteroids may want to be given by injection.
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Case 6
History of latex and penicillin allergy
Hx of mitral valve prolapse with regurgitation
Pre-med before appt
20 minutes later, BP is 80/40, pulse is 120 and swollen tonsils
- Anaphylaxis emergency (you have 4 minutes to treat)
- Give epi injection
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Case 7
Acute airway obstruction (aspirated vomit or crown)
- Place in Trendelenburg position on right side
- Perform heimlich
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Case 8
Hx of heart problems
Meds nitroglycerin tab prn
During procedure pain in the chest radiating to the left arm and mandible
- Give nitroglycerin tablet/spray under the tongue (wait 5 minutes up to 3 times and then call 911 if it doesn't work)
- Give patient O2, chew aspirin tablet, opioid analgesic
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Case 9
Cardiac Arrest
- Administer CPR immediately
- Use defibrillator if indicated
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Adrenal Crisis
Nausea
Vomiting
Cardiovascular Collapse
Irreversible shock
Parenteral hydrocortisone and inhalation O2, call 911
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Opioid Overdose
- Shallow and slow respiration
- Pinpoint pupils
- Treat with Naloxone (Narcan)
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Reaction to Local Anesthetic
You give 8 carps of 2% lido 1:100,000 epi to a 100 pound patient
How much should you have given?
- 2mg/lb
- 100x2=200mg- how much you can give the patient
- (8)(18)(2)=288mg, too much!
- Treatment is symptomatic
- Convulsions-diazepam
- Hypotension-pressor agent
- Bradycardia-atropine
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Case 10
You give 8 carps of 2% lido with 1:50,000 to a 200lb patient
Patient becomes nervous, heart begins to beat fast, and shake uncontrollably
- 200ug, heart problems 40ug
- (8)(18)(2)=288- too much!
- Epi is quickly metabolized, do not give anymore!
- Try and calm patient down so they don't release more endogenous epi
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