Lecture 7- Triage & Emergency Services Flashcards
The process of sorting injured people based on their need for immediate medical treatment as compared to their chance of benefiting from such care:
triage
Triage is done in ___, ___ & ___ when limited medical resources must be allocated to maximize the number of survivors
Emergency rooms, disasters, and wars
(wait) are reserved for the “walking wounded” who will need medical care at some point, after more critical injuries have been treated:
green tags
(observation) for those who require observation (and possible later re-triage). Their condition is stable for the moment and, they are not in immediate danger of death. These victims still need hospital care and will be treated immediately under normal circumstances
yellow tags
(immediate) are used to label those who cannot survive without immediate treatment but who have a chance of survival
red tags
T/F: Dentists in the military or disaster control are often used to triage thus freeing medics to work critical care. Additionally, dentists are used to identify burned or other unidentifiable bodies for identification/legal purposes
True
You cannot control the ____ of patient, BUT, you DO need to perform a ____ to determine their condition and treatment needs
Needs/desires; type of triage
It would be ideal to have every patient in your practice pursuing a strict and planned:
comprehensive dental program
1 priority:
systemic problems
How can you help a person?
- You must start with a ____
- You must start with a thorough and appropriate ____
- You must perform appropriate ____
- You must develop an accurate ____
- You must come up with an appropriate ____.
- Health history
- examination/studies
- clinical testing/radiographs
- diagnosis
- treatment plan
What options should you present to the patient? How should you do this?
ALL options in a clearly understandable language
Your treatment options should present the ___ & ___ in simple terms
risks & benefits
What are some of the patients responsibilities that must be presented to them:
- cost for each option
- time required for each option
- maintenance required for each option
- expected prognosis & longevity of each option
The patient must understand ___ or no permission for treatment exists
potential complications
The professional must be ___ to avoid untoward/unreasonable options in presenting to the patient
responsible
What are some questions that need to be considered by the provider when deciding treatment option?
- is the tooth STRATEGIC & FUNCTIONAL?
- is the tooth REASONABLY RESTORABLE?
- is there a PERIODONTAL SITUATION which is compromising?
- are their other QUESTIONABLE INVOLVEMENTS?
- is the treatment REASONABLY AVAILABLE?
List the moral, ethical, and professional obligations required of a provider:
- We may NOT begin treatment then fail to complete same day
- We may NOT propose to offer any treatment for which we are not qualified
- We may NOT refer the patient to someone whom is not qualified
- We may NOT refuse to provide treatment to the patient for any reason covered federally
T/F: We MAY refuse treatment to any patient for any reason NOT covered as a federally “protected group” as long as we have not begun any treatment
True
T/F: We may refuse to provide treatment to the patient for any reason covered by a federally “protected group”
False- we may NOT refuse
How CAN we help the patient effectively & efficiently in an emergency?
- patient having SYMPTOMATIC IRREVERSIBLE PULPITIS but no PA sensitivity, no PARL, and no swelling or fever
- PULP EXPOSURES
- Patient having SYMPTOMATIC IRREVERSIBLE PULPITIS (or AIP or necrotic pulp) with PA sensitivity, PARL and swelling or fever
Can you help this patient effectively and efficiently in an emergency?
- patient having SYMPTOMATIC IRREVERSIBLE PULPITIS but no PA sensitivity, no PARL, and no swelling or fever
Yes
Can you help this patient effectively and efficiently in an emergency?
- PULP EXPOSURES
Yes
Can you help this patient effectively and efficiently in an emergency?
- Patient having SYMPTOMATIC IRREVERSIBLE PULPITIS (or AIP or necrotic pulp) with PA sensitivity, PARL and swelling or fever
Yes
What is the
- best practice builder
- gives patient instant trust in you
- helps YOU feel better about yourself
helping a person escape from pain
Any tooth with IRREVERSIBLE PULPITIS or PA pathology of endodontic origin is best treated by:
total pulpectomy and RCT
What are some constraints with emergency treatment of total pulpectomy & RCT?
- time
- money
- other
Emergency treatment means: (simple terms)
Do the BEST WE CAN to stop the pain at the time - until we have the TIME to do the complete RCT (if we accept the case)
If we BEGIN any treatment:
we are required to COMPLETE the treatment
If you BEGIN treatment and DON’T COMPLETE the treatment, we can be charged with:
abandonment
If you do NOT BEGIN the treatment in the first place, we can:
Refer and avoid liability
A patient presents with:
- symptomatic irreversible pulpitis
- no PA involvement
- no PARL
- no swelling
- NOT sensitive to percussion
The best emergency treatment is:
vital coronal pulpotomy
What is the expected outcome of emergency treatment for symptomatic irreversible pulpitis, with no PA involvement, no PARL, no swelling, no sensitivity to percussion AFTER doing a vital coronal pulpotomy?
- absence of presenting pulpal pain
- pt should remain comfortable for a SHORT period of time until the canals become necrotic
- pt will need appointment in endo prn
- will require RCT & crown at later date
How should you provide emergency treatment to a patient with:
- Asymptomatic vital pulp exposure without pain:
- Do all clinical testing (test atleast 3 baseline teeth) and record
- Fill out endo diagnosis form (before O&R if pulp exposure may occur)
- Isolate tooth in question with dental dam
- Remove all caries and unsupported enamel (if pulp is exposed)
- Disinfect with NaOCl and arrest hemorrhage
- Pulpcap exposure with dycal
- Place temp restoration such as paracore or IRM
- After restoration take 2 radiographs (1 straight on & 1 shift shot 20 degrees)
- Contact endo faculty with subject of email “pulp exposure” including patient name, and chart #, involved tooth and brief history
If a patient presents with an asymptomatic vital pulp exposure (without pain), prior to working on the exposure, you should do all:
clinical testing & record results (test atleast 3 teeth as baseline)
If a patient presents with an asymptomatic vital pulp exposure (without pain), when clinical testing of the tooth, how many teeth should be tested for baseline?
3 (at least)
T/F: If a patient presents with an asymptomatic vital pulp exposure (without pain), after clinically testing you should fill out endo diagnosis form - prior to temp restoration
True
T/F: If you are doing an O&R and think there may be a pulp exposure you should fill out endo diagnosis form before
True
If a patient presents with an asymptomatic vital pulp exposure (without pain), you should _____ the tooth in question with a ____
isolate; dental dam
If a patient presents with an asymptomatic vital pulp exposure (without pain), you should remove all:
caries & unsupported enamel (if pulp is exposed)
If a patient presents with an asymptomatic vital pulp exposure (without pain), what should your disinfectant agent be after removing caries and unsupported enamel?
8.3% NaOCl
If a patient presents with an asymptomatic vital pulp exposure (without pain), after disinfecting with 8.3% NaOCl, you should:
- Arrest hemorrhage
- Pulp cap with dycal
- Place temporary restoration
What do we pulp cap a tooth with if If a patient presents with an asymptomatic vital pulp exposure (without pain)?
dycal
If a patient presents with an asymptomatic vital pulp exposure (without pain), after dycal placement, a ____ should be placed such as ____ or ___
temporary restoration; Paracore or IRM
T/F: An IRM is the only option of temporary restorations that should be placed with asymptomatic vital pulp exposures without pain
False- paracore may be placed as well
If a patient presents with an asymptomatic vital pulp exposure (without pain), and you have completed the temporary restoration, what radiographs need to be taken?
2 radiographs:
- straight on
- 20 degree shift shot
If a patient presents with an asymptomatic vital pulp exposure (without pain), and you have completed the temporary restoration & radiographs, you should contact endo faculty on exchange email including:
- Subject: Pulp Exposure
- Patient name
- Patient chart #
- Tooth #
- Brief history
If a patients presents with symptomatic vital or non-vital pulps exposure (with pain), you should refer to:
E-chair or endo as indicated by symptoms for treatment
List the steps involved with emergency treatment of If a patient presents with symptomatic vital or non-vital pulps exposure (with pain):
- remove all caries & unsupported enamel
- disinfect & arrest any hemorrhage with NaOCl
- possible pulpotomy or pulpectomy in E-chair (restoration as required)
- make an appointment in endo as indicated by faculty in e-chair or team
What are two potential immediate treatment options for a patient who presents with symptomatic vital or non-vital pulps exposure (with pain),
pulpotomy or pulpectomy
With a patient treated emergently for symptomatic vital or non-vital pulps exposure (with pain), you should refer them to undergrad or advanced endo as indicated by:
faculty in e-chair or team
If a patient presents with symptomatic apical periodontitis (with or without symptomatic irreversible pulpitis), if you identify ________ especially with ______ you may have ________ from “normal” through inflamed and infected to necrotic (may have PARL ornate yet visible)
apical periodontitis of endodontic origin especially in multi canal teeth
