Oral surgery Flashcards

Question

What are the vital signs to look out for during IV sedation?

Answer 1

* O2 saturation * Blood pressure * Heart rate * Breathing rate

Answer 2

* It is carried out on a separate visit Things done in this appt: 1. SH (drinking , smoking , drugs) 2. MH ( allergies , medications) 3. DH ( dental anxiety , nature of fear , previous experience , previous sedation) 4. Proposed treatment plan 5. take vital signs for baseline

Answer 3

* ASA I - normal heathy patient * ASA II - mild systemic disease * ASA III - severe systemic disease but not a threat to lifr * ASA IV - severe systemic disease that is constantly a threat to life * ASA V - moribund , not expected to live for more than 24 h * ASA VI - patient who is brain dead for organ donation

Answer 4

* Normal oxygen saturation 97-100 , alarms goes off at 90 , hypoxic at 85 * If dropping then ~ Give supplemental oxygen through nasal cannulation - 2L/min ~ Reverse with flumazenil ( 500 micro/5ml ) , 200mcg then 100 mcg increments every one minute

Answer 5

* Intracranial pathology * Severe COPD * Hepatic insuffiency * Pregnancy and lactation * Hypothyroidism * Myasthenia gravis ( autoimmune disease causing muscle weakness)

Answer 6

* Common cold * Tonsilitis / adenoidal enlargement * Nasal lockage * Severe COPD * MS , mysathenia gravis * First trimester of pregnancy * Claustrophobia (fear of the mask)

Answer 7

30% (max N2O = 70%) * Start at 100 O2 then reduce by 10% until 80% then by 5% * Normal is 30% N2O + 70% O2

Answer 8

* Explain procedure ~ have the XX XLA under intravenous sedation ~ You will be conscious but will be sedated using a drug called midazolam which will help reduce you anxiety , it also have an amnesic effect where you will not remember the procedure ~ The drug will be given through the back of your hands intravenously ~ you will then be numbed up as normal * Risks of IV sedation ~ Resp depression ~ Over sedation ~ Failure to sedate * Discuss alternatives such as IS and GA * Benefits of IV sedation ~ relaxation and anxiolysis ~ Amnesia ~ Fast onset and recovery * Obtain full MH - medications and allergies * Ask if taking care of any children, tell them to not fast , they need to bring an escort and avoid doing any important decisions or use machinery on the day of sedation * Explain procedure , then complications (same as XLA) * Give post op instructions

Answer 9

* Teflon cannula for IV sedation * A pulse oximeter to measure oxygen saturation and pulse rate * Stimulate patient to breath and give supplemental oxygen and if it fails then reverse sedation * It is set to alarm at 90% due to the oxygen dissociation curve starting to drop steeply * a nasal cannula, used to deliver supplemental oxygen. It consists of two small prongs that sit in the nostrils and is often used during sedation to maintain adequate oxygenation. *2-4 L per min * Face mask with oxygen (hudson mask 5l/min)

Answer 10

* Patient details * Practice details * Patient complaint * Your concerns ( why are you referring , urgent or routine , patient in pain? swelling) * MH,DH,SH * Summary of OH status and clinical findings * Details of request - for advice or to see pt * Enclosing details - Rx and investigations

Answer 11

* Signs and symptoms ~ Pain 3-4 days after XLA and can take 7-14 days to resolve ~ No blood clot in socket ~ Dull aching pain ~ pain keeps pt up at night which radiate to ear ~ Exposed bone is sensitive ~ bad smell and taste * Predisposing factors ~ molars - increased risk anterior to posterior ~ mandible more common ~ smoking increase risk due to lower blood supply ~ more common in females ~ Oral contraceptive pill ~ Traumatic extraction ~ excessive mouth rinsing post extraction ~ Family or history of dry socket * Diagnosis Dry socket is a very painful dental condition that is a common post operative complication after extraction ~ Inflammation of the bone which occur when the blood clot at the site of the extraction fails to develop or dislodges or dissolved before the would has fully healed ~ Not associated with an infection * Initial management ~ Reassure that it will go away within 2 weeks and is not an infection ~ Analgesia ~ Avoid smoking and maintain good oral hygiene ~ Seek urgent dental care ~ LA to relieve pain * Subsequent care ~ Irrigate socket with saline to flush out debris ~ debridement to encourage new clot formation ~ Pack with alvogyl (antiseptic and LA) or WHVP ~ Abs not required unless there are signs of spreading infection or systemic infection or immunocompromised patients

Answer 12

* Choose correct instruments - kilner needle holder and Gillies toothed forceps * Mount the needle 1/3 from the end * Correct grasp of needle holder * Correct hold of tissue forceps - pen grip * Atraumatic handling of tissue with tissue forceps * Insert the needle at right angles to the wound edge and perpendicular to the surface * Insert needle at appropriate distance from the wound edge (2-5mm) * Pass needle through flap and retrieve it with an instrument * Adequate pronation and supination of hand * Remount needle correctly again without the use of fingers * Insert in second flap and retrieve with forceps * Tie knot (Double throw then 2 single ones ) * Cut suture * know to side of wound * Dispose needle in sharps box

Answer 13

* Patient details * Hospital details * Clinical details ~ Pain ~ lesion characteristics ~ Provisional diagnosis ~ relevant MH * Specimen detauls including site ~ Type of sample (excisional biopsy) ~ left dorsum of tongue * Investigation - histopathology/ culture sensitivity testing , PCR or viral load * Wear appropriate PPE when handling specimen , and place in formalin ( do not touch it) * Seal for transport - cap tightened * Label syringe with details and place in plastic bag attached to request form

Answer 14

Warwick james elevator it mobilises the tooth , creats point of application for forceps , removal of teeth and roots

Answer 15

Howarth's periosteal elevator to raise mucoperiosteal flaps to lift and detach the periosteum from the bone Retract periosteal flaps

Answer 16

Cryer's elevator Remove interadicular bone , mobilise and elevate roots/teeth

Answer 17

Allis forceps (tissue) to hold and grasp soft tissues atraumatically

Answer 18

Bone rongeurs used to trim , contour and remove bone

Answer 19

Mitchell's trimmer curettage of soft tissues Depridement of roots (perio) Cleaning XLa sockets

Answer 20

Ward's buccal retractor Retracting the cheek to facilitate access and vision to surgical field + protection of soft tissues

Answer 21

Laster retractor - retraction of cheek and soft tissues - better visibility and access - protects soft tissues commonly used for third molar XLA

Answer 22

Kilner cheek retractor - retracts cheeks - better visibility - protects soft tissues - keeps mouth open

Answer 23

EO signs * Swelling * flushed appearance * trismus * lymphadenopathy IO signs * swollen and inflamed operculum * suppuration Tx * LA * Subgingival debridement of the operculum * Irrigation of perculum * Operculectomy Post op care * Provide curved syrings with HSMW / CHX rinse for 2 days before brushing under operculum Antibiotics * metronidazole/ amoxicillin for trismus/ systemic symptoms * Follow up with surgical XLA of 48 once infection is done

Answer 24

Signs of adequate sedation * Patient is relaxed but awake * Verbal contact maintained * Delayed response to command * Reduced gag reflex * Mouth open on request Satuation questions * normal range set to 97-100 Alarm at 90% O2 * Stop procedure and tell pt to take a few breaths * Hypoxic at 85% Max NO2 - 70% -Contraindications for inhalation sedation Common cold tonsillar enlargement Severe COPD first trimester of pregnancy Dear of masks or claustrophobia