Complications - bleeding Flashcards
Coagulation defect?
e.g. warfarin, haemophilia, von Willebrands
Vessel wall defect?
surgical trauma, lupus, scurvy
Platelet disorder?
thrombocytopenia, aspirin, clopidogrel
Management of bleeding sockets?
- Clean the area
- PACK CORRECTLY
- (Leave undisturbed for 15 mins. Sit patient up)
- Check history
- (Predisposing pathology, family history, previous extractions, nature of surgery- timing etc.)
- Examine
- (signs of underlying cause. Blood pressure and pulse - signs of shock)
In practice - LA, pack, suture
Haemostatic agent?
surgicel
If packing and suturing in practice doesn’t work, what does the hospital do?
What is a prothrombin agent to promote clot formation?
Tranexamic acid
Local haemostatic agents?
Gauzepacks
* Sutures
* Vesselligation
* Diathermy
* Oxidisedcellulose(Surgicel)l
Bonewax
* Adrenaline/Epinephrine
* Astringents(Tannicacid,FeCl3, ZnCl2)
* Tranexamicmouthwash
Iatrogenic damage?
Broken instruments
- Burns
- Lacerations/abrasions
Dry socket aka?
localised alveolitis
What is dry socket?
describes the empty appearance of a non- bleeding post-extraction socket due to loss of the blood clot.
What encouraged dry socket?
more extreme surgery encourages dry socket
Pt find dry socket more painful?
nerve endings
What to do with dry socket?
Clean
Albrogel
eugenol - calms nerves down
- Reassurance
- Radiograph - ? Retained root fragments/ foreign body
- Debride & wash sterile saline / Chlorhexidine (may need regional block LA –avoid infiltrations)
- Dress with resorbable obtundant antiseptic dressing eg Alvogyl (Iodoform/Eugenol/Butamben)
- Analgesics
Risk factors for dry socket?
- Smoking >20 cigarettes per day
- Increased bone density (Pagets, osteoporosis)
- Previous history of dry sockets
- Oral contraceptive pill - more proteases and breakdown clot
- Complex surgical procedures
