FINALS Flashcards
Healthy non smoking
ASA I
Current smoker, pregnant and obesity
ASA II
Severe systemic disease, active hepatitis and implanted pacemaker
ASA III
constant threat to life, ongoing cardiac ischemia or severe valve dysfunction
ASA IV
not expected to survive without operation, multiple organ failure
ASA V
brain dead
ASA V
consequence of stable angina
chest discomfort and arrythmia
con of heart failure
pulmonary edema
asthma
acute respiratory distress
con of epilepsy
seizure
determine the patient’s ability to physically tolerate the stresses
physical evaluation or psychological
types of sphygmomanometer
mercury
aneroid
automatic BP monitors
Temperature that has infection
38-38.8 degrees
pulse rate that has infection
100 bpm- mild
>100- severe
repisratory rate that has infection
18-20 bpm and has airway obstruction
normal pulse rate
60-80 bpm
normal respiratory rate
14-16 cpm
techniques in psychosedation during therapy
nondrug techniques
pharmacosedation
GA
short duration LA
mepivaccaine
intermediate duration
lidocaine and articaine
long duration
bupivaccaine with epinephrine
complications that are easier to prevent
local complications
more complicated to manage
systemic complications
form of neurogenic shock
syncope
management of fainting
discontinue any procedure
extremely rare complication because of small gauge
needle breakage
weakest point of the needle
hub
careless injection, dull needle and rapid depostion
pain on injection
pH of solution, rapid injection and contaminated LA
burning on injection
prolonged numbness because of direct contact with the nerve and hemorrhage around neural sheath
parasthesia
how many weeks or year for the LA resolution during parathesia
8 weeks, 2 months or 1 year
spasm of the masticatory muscle
trismus
what is the cure for trismus
analgesic, diazepam 10 mg in 12 hrs
common technique where hematoma occurs
PSAN block
extremely rare occurence using contaminated needle
infection
swelling of the tissue can caused by angioedema
edema
epithelial desquamation because of the application of topical anesthetic
sloughing of the tissue
caused by the use of the long acting local anesthetic in patients undergoing shorter procedures
trauma to lips and tongue
management to trauma to lips
analgesic for pain and antibiotic when infected
for the sensory nerve
parasthesia
for the motor nerve
paralysis
this nerve is affected when doing IAN block and injected too posteriorly
facial nerve analysis
drug produces elevated levels of the agent in the blood
toxicity
it undergoes hydrolysis
ester
metabolized by enzyme cholinesterase
plasma
if the px has liver disease you can administered?
small dose of ester because there is no alternative
3 sympotms of toxicity
excitation
drowsiness
myocradial depression
sign of epinephrine overdose
elevated BP
elevated heart rate
possible cardiac arrythmias
hypersensitive state and it is not dose related
allergy
management for allergy
administer diphenhydramine hydrochloride
dermatologic reaction in allergy
urticaria and angioedema
place the patient semi erect, give oxygen and administer 0.3 ml of epinephrine
bronchial asthma
the px is positioned supine and possible of cricothyrotomy
laryngeal edema
drug reaction that cannot be explain
idiosyncrasy
test if any intravascular was hit
aspiration
most common dental syringe in dentistry
breech loading,metallic, catridge, aspirating
aka intraligamentary injection or PDL injection
pressure syringe
needle less injection and calibrated to deliver 0.05 to 0-.2 ml solution
jet injector
prevents oxidation of the vasipressor by oxygen
sodium bisulfate
makes the solution isotonic
sodium chloride
possesses bateriostatic, fungiastic and antioxidanr properties
methylparaben
transmits the sensation of pain
sensory neuron
respond to simulation
dendritic zone
distribute the sensory impulses form interpretation
axon
provides metabolic support
cell body
impulses are in the form of electrical action potential
peripheral nerves
slow forward creeping process
unmyelinated nerve
means of current leaps from node to node
myelinated nerve
physio anatomical process of pain
pain perception
psychophysiological process of pain
pain reaction
hyporeactive
high pain threshold
hyperractive
low pain threshold
unpleasant sensation
psychogenic pain
some distance from the site of the injury
referred pain
sharp, burning and instense
neurogenic pain
difuse and difficult to localized
vascular pain
movement of the part intensifies the discomfort
muscle pain
speed the onset of its action
sodium bicarbonate or CO2
pH of LA w/o epi
6.5
effectively stops nerve impulses propagation
minimal blocking concentration
3 succesive nodes or ranvier must be blocked
myelinated nerves
diamter oft he nerve and span 3 nodes that must be blocked by LA
critical blocking length
covers each nerve fiber
endoneurium
covers the fasciculi
perineuruim
carrying nutrient vessels
epineurium
outer layer of epineurium
epineural sheath
anesthesize the proximal structures
mantle fibers
anesthesize the distal structures
core fibers
what fibers lose LA earlier
mantle fiber
it is seen in LA with vasoconstrictor
sodium bisulfite
seen in vial
methyl paraben
what LA use if the px is allergic both to sodium bisulfite and methyl paraben
3% mepivaccaine and 2% prilocaine
what nerve block increased risk of nerve parasthesia
IAN and lingual nerve block
what LA is not used for children because of prolonged duration of action
bupivaccaine
careful weighing the risk of using it to its potential benefit
relative contraindication
no circumstances should the druig be administered to the patient
absolute contraindication
all upper molars except MB root is 1st molar
posterior superior alveolar nerve block
PSAN
from MB root of first molar to 2ND PM
middle superior alveolar nerve block
MSAN
anterior teeth and supporting structures bucally
anterior superior nerve block
ASAN
branches of dental plexus of maxilla
PSAN, MSAN , ASAN
supply the lower eyelid
Inferior palpebral nerve
supply the lateral of the nose
nasal nerve
supply the upper lip and its purely sensory
superior labial nerve
does not have pulpal innervation from canine to canine and exits the incisive foramen
nasoplatine nerve
mucosa and gingiva and bony structures, distal to canine up to posterior part of the hard palata
greater palatine nerve or anterior palatine nerve
pulp and root of the root up to buccal mucosa (lips)
insertion in height of mucobuccal fold
0.5-10.5 ml
supraperiostial injection or local infiltration
maxillary incisors to MB root of 1st molar
1ml of the solution
infraorbital nerve block
maxillary PM to MB root of first molar
height of mucobuccal fold of the 2nd PM
0.9-1.2ml
MSAN middle superior nerve block
all maxillary molars except the MB root of 1st molar
height of the mucobuccal fold of maxillary 2nd M
0.9-1.8ml
posterior superior nerve block
PSAN
complications of the PSAN
hematoma and mandibular anesthesia
approach the incisive papilla and has blotching
0.2-0.3ml
nasopalatine nerve block
greater palatine foramen opposite the 2nd M
0.45ml- 0.6ml
greater palatine nerve block
complications in greater palatine nerve block
ischemia of the soft palate
anesthesia of the soft palate
reported by friedman and hochman
provides pulpal anesthesia from maxillary incisors to premolars from single injection on the PALATAL area
1.4-1.8ml
contact point between first and 2nd PM
anterior middle superior alveolar nerve block
AMSAN
penetrates more deeply
1.4-1.8ml
anterior uperior alveolar nerve block-palatal
most frustrating, can anesthesize the IAN, mental,incisive and lingual nerve
Inferior alveolar nerve block
landmark of IANB
coronoid notch, 6-10mm above the occlusal plane
didn’t change the position then deposit 1.5ml while contact the bone then another 0.1-0.2 ml for the lingual nerve
direct contact
deposit 1.5ml of solution while contact in bone, withdraw then swing it on the other side
indirect technique
very shallow technique, it will contact the bone
long buccal nerve block
large foramen the bifurcates
type1 bifid IAN
bifurcates then fused again
type 2 bifid IAN
most difficult and has two mandibular foramen
type 4 bifid IAN
purely soft tissue, no pulpal and lips only
0.6 of solution
mental nerve block
pulpal anesthesia to the premolars,canine and incisors. it needs to massage to anesthesize the incisive nerve
incisive nerve block
insert the needle in the sulcus of the tooth
intraligamentary injection
pulpal exposure only
intrapulpal
infiltrate the bone through and through
intraosseous injection
causative microorganism of infective endocarditis
streptococcal,staphylococcal and candidal endocarditis
common cause of IE in normal oral flora
viridans streptococci
not normal oral flora associated with IV abuse
staphylococcus
drug of choice in IE
penincillin
no infection but the patient is prone to infection
prophylactic
antibiotic given because there is an existing infection
therapeutic
in 1990, it is the alternatice that has GI upset effect
erythromycin
alternative to penincilliin allergy in 1997
clindamycin
it is not recommended for patients with history of anaphylaxis, angioedema or uticaria
cephalosphorins
140 or less/ 90 or greater, uncommon
isolated diastolic HPN
140 or higher/ 90 or less, risk factor for CVD
isolated systolic HPN
BP is more or equal to 180/110
uncontrolled HPN (ASA III)
avoid using erythromycin and clarithromycin
controlled HPN
precordial pain radiating to the left arm, neck and jaw
angina pectoris
