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3RD yr- CCD1- Clinical > Paediatric emergencies > Flashcards

Paediatric emergencies Flashcards

1
Q

How do recognised paediatric emergencies

A

Good history and exam

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2
Q

What do we need to include in a history taking

A
  1. Complaint
  2. History of complaint
    3, Dental history
  3. Social history
  4. Medical history
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3
Q

What does SOCRATES stand for

A 
Site
Onset
Characteristics 
Radiation
Assocation
Time
Exacerbating and relieving factors
Severity
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4
Q

Give some special tests we can carry out to come to a diagnosis

A
  1. Palpation
  2. Mobility
  3. Percussion
  4. Radiographs
  5. Childs temperature
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5
Q

List soem diagnosis we can come to

A
  1. reversible Pulpitis
  2. Irreversible pulpitis
  3. Acute apical abscess
  4. Pericoronitis
  5. Teething
  6. Natal and neonatal teeth
  7. Eruption cysts
  8. Oral ulcerations
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6
Q

List some characteristics of reversible pulpitis

A
  1. Precipitated by sweet, hot, cold
  2. Pain stops when stimulus removed
  3. Short duration
  4. Mainly occurs when eating
  5. Early carious lesions
  6. Caries into dentine
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7
Q

List some characteristics of irreversible pulpitis

A
  1. Constant toothache
  2. Relieved only by analgesics
  3. Kept awake at night
  4. Lymphadenopathy
  5. Pyrexia
  6. Extensive marginal ridge breakdown
  7. Sinus/ intra oral swelling
  8. Caries close to pulp
  9. Evidence of periodical pathology
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8
Q

What can happen if reversible pulpitis is left untreated

A

Will Progress to irreversible pulpitis

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9
Q

What initial/ temporary pain relief treatment would you give to a patient with reversible pulpits

A

Gently excavate the caries and debris then dress with GIC

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10
Q

What initial/ temporary pain relief treatment would you give to a patient with irreversible pulpits

A

Gently excavate the caries and debris then dress with ledermic on a cotton wool pledget and zinc oxide eugenol paste

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11
Q

What things do we need to consider for post emergency care

A
  1. Is the child at increased risk of caries or high priority
  2. Prevention ?
  3. Is the child compliant
  4. Should we save the tooth or extract?
  5. Are parents regular attenders
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12
Q

When carrying out an extraction on a child what do we need to remember

A

Remember to balance and compensate extractions eg if you are removing a C from one side extract the opposite C as well

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13
Q

What definitive care can we give to a child

A
  1. Extraction
  2. Restoration
  3. Pulp therapy plus stainless steel crown
  4. First stages of a pulpectomy
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14
Q

When would we carry out a pulpectomy

A

If the tooth is non vital

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15
Q

What is acute apical abscess

A

Acute inflammation of the tooth and surrounding tissues often caused by tooth decay and pulpal necrosis

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16
Q

What are some other terms for acute apical abscess

A

Acute peri radically abscess
Acute dental alveolar abscess
Acute Peri apical abscess

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17
Q

If we have a co operative child with an acute apical abscess how would we treat them

A

Extract the teeth under LA

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18
Q

If we have a NON co operative child with an acute apical abscess how would we treat them

A
  1. Drain through tooth
  2. Sedative dressing
  3. Offer analgesia
  4. Arrange to complete treatment with GA or inhalation sedation
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19
Q

What is very important you obtain before carrying gout treatment on a child

A

CONSENT

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20
Q

Who can give consent for a child

A
  1. Childs birth mother
  2. Childs birth father
  3. Legally appointed guardian
    4 Person with a residence order for the child
  4. A local authority who holds a protection order fro the child
  5. Child who is Gillick competent
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21
Q

What do we do if a child comes in with a large extra oral swelling without fever

A
  1. If the infection is spreading give antibiotics, analgesics and monitor
  2. Most Riley will need to extract/ restore tooth later
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22
Q

When should we be really concerned about a large extra oral swelling

A 
If the patient is systemically unwell:
1. High temp 
2. Dehydrated
3. Lethargic 
REFER TO HOSPITAL
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23
Q

What do we do if a child comes in with a large extra oral swelling WITH fever

A
  1. Refer to hospital for intra venous antibiotics and further treatmetn
  2. Call A+E and warn them the child is on the way and needs to be hospitalised immediately
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24
Q

What is pericoronitis

A

inflammation of the soft tissues surrounding the crown of a partially erupted tooth, including the gingiva and the dental follicl

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25
Q

Which tooth is pericoronitis usually associated with

A

Erupting teeth

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26
Q

List some signs and symptoms of pericoronitis

A
  1. Pain
  2. Swelling of operculum (gingiva surrounding teeth)
  3. Discomfort when swallowing
  4. Unpleasant taste/ odour
  5. Limited mouth opening
  6. Pyrexia
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27
Q

How do we manage pericoronitis

A
  1. Exclude airway risk
  2. Advice optimal analgesia
  3. Encourage oral hygiene
  4. Advise to rinse mouth after food
  5. Consider irrigation with 0.2% chlorohexidine gluconate under LA
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28
Q

What do we need to aware of before prescribing chlorohexidine mouth wash

A

Not suitable for children under 7

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29
Q

List some signs of a teething baby

A
  1. Cheeks may look rosy
  2. Baby wants to bite or avoid a particular area
  3. Drooling or dribbling
  4. Gums may look red
  5. Disturbed sleep
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30
Q

What tips can we give to guardians of a teething baby

A
  1. Cool teething rings
  2. Sugar free teething gels
  3. Massage gums with clean fingers
  4. Try cooling fingers of cucumber. carrots. breadsticks if baby is weening
  5. Sugar free Calpol
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31
Q

What are natal teeth

A

Teeth erupted at birth

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32
Q

What are neonatal teeth

A

Teeth erupted in the first 30 days of post natal life

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33
Q

How many babies are born with natal or neonatal teeth

A

1 in 2000 to 1 in 3500 (more common in females)

34
Q

How do we treat neonatal and natal teeth

A

Extract them

35
Q

Why do we extract neonatal and natal teeth

A
  1. Danger of inhalation
  2. Difficulties with breast feeding and bottle feeding
  3. Causing trauma to the ventral surface of the tongue
36
Q

Before extracting a neonatal or natal teeth what to we need to do

A
  1. gain CONSENT

2. Remember to protect the airways

37
Q

What are eruption cysts

A

They precede the eruption of primary and permanent teeth

They are fluid filled blisters the form on the gums

38
Q

Describe the shape and location of an eruption cyst

A

They occur where a tooth should be erupting

They are well circumscribed, dome shaped fluctuant enlargements that are usually asymptomatic

39
Q

When can eruption cysts form

A

They precede the eruption of primary and permanent teeth

40
Q

How do we treat eruption cysts

A

No treatment as they usually drain on their own when the tooth erupts

41
Q

Name a common oral ulcerations you may encounter in children

A

Recurrent aphthous stomatitis

42
Q

What might ulcers form in the oral cavity

A
  1. Ill fitting dentures
  2. From adjacent teeth
  3. From orthodontic appliance
  4. Due to anaesthetised tissue
  5. Underlying medical conditions
43
Q

How do we treat an ulcer that may have formed due to ill fitting dentures

A

Tell the patient to rinse with chlorophyll hexidene (if over 7 years) and avoid wearing the denture till it is fixed

44
Q

How do we treat an ulcer that may have formed due to trauma from a sharp adjacent tooth

A

Smooth the adjacent tooth that is sharp and hopefully the ulcer should heal in a few days

45
Q

How do we treat an ulcer caused by an orthodontic appliance

A

Add wax to any sharp wires coming off the orthodontic appliance and refer the patient to their orthodontist to get the appliance fixed

46
Q

How do we treat an ulcer that may have formed due to anaesthetised tissue

A

Advice the patient to avoid hot food/drinks till the anaesthesia has worn off

47
Q

What diseases/infectiosn can lead to oral ulceration

A
  1. Viral infections
  2. Bacterial infections
  3. Mucocutaneous diseases
  4. Haematological diseases
  5. Gastrointestinal diseases
48
Q

Give examples fo some viral infections that can lead to oral ulcerations

A
  1. Herpatic stomatitis
  2. Chicken pox
  3. Hand foot and mouth disease
  4. HIV
  5. Herpangina
49
Q

Give examples fo some Bacterial infections that can lead to oral ulcerations

A
  1. Syphilis

2. TB

50
Q

Give examples fo some Mucocutaneous diseases that can lead to oral ulcerations

A
  1. Lichen planus
  2. Behcet’s syndrome
  3. Pemphigus vulgaris
  4. Erythema multiform
  5. Pemphigoid and variants
  6. Chronic ulcerative stomatitis
51
Q

Give examples fo some Haematological diseases that can lead to oral ulcerations

A
  1. Anaemia
  2. Leukaemia
  3. Haemantinic deficiencies
  4. Neutropenia
52
Q

Give examples fo some Gastrointestinal diseases that can lead to oral ulcerations

A
  1. Coeliac disease
  2. Ulcerative colitis
  3. Crohn’s disease
53
Q

What is primary herpetic gingivostomatitis caused by

A

Herpes simplex virus

54
Q

In whom is primary herpetic gingivostomatitis common in

A

Common amongst 2-5 year olds

55
Q

What is the incubation period for primary herpetic gingivostomatitis

A

7 days

56
Q

How many patients are systemically affected by primary herpetic gingivostomatitis

A

5%

57
Q

What symptoms may a patient with primary herpetic gingivostomatitis present with

A

Febrille illness: Headache, malaise, oral pain, mild dysphagia and cervical lymphadenopathy

58
Q

How long is the clinical course for patients with primary herpetic gingivostomatitis

A

14 days

59
Q

What do we need to be careful of when treating a patient with primary herpetic gingivostomatitis

A

It is very contagious so wear PPE

60
Q

How would we manage primary herpetic gingivostomatitis

A 
Advise the patient to:
1. Bed rest 
2. Soft diet 
3. Fluids 
4 Paracetamol
61
Q

What antibiotics can we prescribe to children

A

Amoxicillin
Erythromycin
Metronidazole

62
Q

How much Amoxicillin can we prescribe to a 1 month- 1 year old child

A

125mg TDS for 5 days

63
Q

How much Amoxicillin can we prescribe to a 1-5 year old child

A

250mg TDS for 5days

64
Q

How much Amoxicillin can we prescribe to a 5-12 year old child

A

500mg TDS for 5 days (can increase to 30mg/kg)

65
Q

How much Amoxicillin can we prescribe to a 12-18 year old child

A

500mg TDS for 5 days (if severe increase to 1g TDS)

66
Q

How much Erythromycin can we prescribe to a 1 month- 2 year old child

A

125mg QDS 5 days

67
Q

How much Erythromycin can we prescribe to a 2-8 year old child

A

250mg QDS

68
Q

How much Erythromycin can we prescribe to a 8-18 old year child

A

250mg-500mg QDS

69
Q

What are the side effects of Erythromycin

A

Nausea

70
Q

What are the contra indications for Erythromycin

A

Patients who are taking warfarin

71
Q

How much Metronidazole can we prescribe to a 1-3 year old child

A

50mg every 8 hours

72
Q

How much Metronidazole can we prescribe to a 3-7 year old child

A

100mg every 12 hours

73
Q

How much Metronidazole can we prescribe to a 7-10 year old child

A

100mg every 8 hours

74
Q

How much Metronidazole can we prescribe to a 10-18 year old child

A

200-250 mg every 8 hours

75
Q

What are the contra indications for Metronidazole

A

Patients who are taking warfarin

76
Q

Name the most common analgesics we recommend

A

Paracetamol
ibuprofen
Aspirin

77
Q

What is a key problem of paracetamol

A

It is hepatotoxic

78
Q

How much paracetamol wood we recommend a parent to give a 1month -12 year old

A

15-20mg/ kg every 406 hours

79
Q

How much paracetamol wood we recommend a parent to give a 12 -18 year old

A

1g every 4-6 hours

80
Q

Who do we avoid giving ibuprofen

A

Patients with coagulation defects and asthmatics

81
Q

In whom do we avoid recommending aspirin

A

Pateitns under the age of 16

3RD yr- CCD1- Clinical (7 decks)

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