Lecture 7: Triage & emergency services Flashcards
The process of sorting injured people based on their need for immediate medical treatment as compared to 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 & 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 (as possible later re-triage). Their condition is stable for the moment and, they are not in immediate danger of death. These victims will still need hospital care and would still 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 patients, BUT you DO need to perform “_____” to determine their condition & treatment needs
Needs/desires; type of triage
It would be ideal to have every patient in your practice pursuing a strict & planned:
comprehensive dental program
1 Priority:
systemic problmes
How can you help a person?
- you must start with a ____
- you must start with a thorough & 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 and 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 options?
- is the tooth STRATEGIC & FUNCTIONAL?
- is the tooth REASONABLY RESTORABLE?
- is their a PERIODONTAL SITUATION which is compromising?
- are there other QUESTIONABLE INVOLVEMENTS?
- is the treatment REASONABLY AVAILABLE?
List the moral, ethical & professional obligations required of a dental 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 by a federally protected group
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 & efficiently in an emergency?
- patient is having SYMPTOMATIC IRREVERSIBLE PULPITIS but no PA sensitivity no PARL and no swelling or fever
Yes
Can you help this patient effectively & efficiently in an emergency?
- patient comes in with PULP EXPOSURE
Yes
Can you help this patient effectively & efficiently in an emergency?
- patient comes in with 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 an instant trust you
-helps YOU feel better about yourself
Helping patient escape from pain
Any tooth with irreversible pulpitis or PA pathology of endodontic origin is best treated by:
Total pulpectomy & RCT
What are some constraints with emergency treatment of total pulpectomy & RCT?
- Time constraints
- $ contstraints
- other constraints
In simple terms, what does emergency treatment mean?
Do the BEST WE CAN to stop the pain at the time - until we have 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 & 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 & avoid liability
A patient presents with:
-symptomatic irreversible pulpitis
- no PA involvement
-no PARL
-no swelling
-NOT sensitive to percussion
The best emergency treatment:
Vital coronal pulpotomy
What is the expected outcome of emergency treatment of 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
- should remain comfortable for a short period of time until canals become necrotic
- patient will need appointment with endo prn
- will require RCT & crown at a later date
How should you provide emergency treatment to a patient with:
- asymptomatic vital pulp exposure without pain
- Do all the 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 temporary restoration such as paracore or IRM
- After restoration take 2 radiographs (1 straight on & 1 shift shot at 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
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 chance of pulp exposure, you should fill out endo diagnosis form before
True
If a patient presents with asymptomatic vital pulp exposure (without pain), you should _____ the tooth in question with ____
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 asymptomatic vital pulp exposure (without pain), what should you disinfectant agent be after removing the 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 a temporary restoration
What do we pulp cap a tooth with if the 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 place with asymptomatic vital pulp exposures without pain
False- paracore may also be placed
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
