Chapter 20 (Excessive bleeding following an extraction)

Question 1

excessive bleeding

Answer 1

• complications can occur from extraction
• At risk patients:
  1. hemophiliac
  2. patients taking anticoagulants
  3. patients experiencing a hematoma

Question 2

what is hemophilia?

Answer 2

• group of hereditary disorders with deficiency of clotting factor
• can be mild to severe

Question 3

what are the special care for extraction on people with excessive bleeding?

Answer 3

• recombinant factor injections or IV prior to surgery
• use of glue, gelatin packing, and absorbable sutures
• vasoconstrictors in the LA
• compression for 3 days following surgery

Question 4

what are some anticoagulants for excessive bleeding?

Answer 4

• aspirin
• warfarin
• heparin

Question 5

Warfarin

Answer 5

- 3 types; low, moderate, and high risk
low- no medication change
moderate- withdrawal 48 hours prior to extraction
high- consultation with physician- needs to determine risk of bleeding verses clotting
- INR- international normalized ratio
 a. determines clotting time
b. used during warfarin therapy
c. 2.0-3.0 target range

Question 6

Heparin

Answer 6

• used for thrombogenic episodes in hospitalized patients undergoing complicated surgery
• reduces blood clotting immediately
• short acting
• no need to discontinue for simple procedures, e.i extraction

Question 7

Aspirin

Answer 7

• used to treat ischemic heart disease, TIA, CVA
• minor oral surgery on patients with low dose aspirin regimen
• used for follow-up procedures yields minimal post extraction bleeding

Question 8

hematoma

Answer 8

• collection of blood trapped beneath skin
• caused by truma including LA injection
• careful and knowledgeable injection is best prevention

Question 9

what if hematoma occurs?

Answer 9

• apply firm pressure with gauze until no longer expanding, place cold pack, and possibly use antibiotics
• if expansion continues- EMS

Question 10

signs and symptoms of excessive bleeding

Answer 10

• easily recognized
• heavy bleeding unaffected by compression lasting up to 2 hours
• also look for fever, hypertension, altered mental capacity, and hematoma

Question 11

treatment and prevention of excessive bleeding (POST SURGERY)

Answer 11

• no exercise 12-24 hours
• lie down with head elevated for several hours
• place gauze over socket and apply pressure for 2 hours