Paediatric emergencies Flashcards

(81 cards)

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
Which tooth is pericoronitis usually associated with
Erupting teeth
26
List some signs and symptoms of pericoronitis
1. Pain 2. Swelling of operculum (gingiva surrounding teeth) 3. Discomfort when swallowing 4. Unpleasant taste/ odour 5. Limited mouth opening 6. Pyrexia
27
How do we manage pericoronitis
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
28
What do we need to aware of before prescribing chlorohexidine mouth wash
Not suitable for children under 7
29
List some signs of a teething baby
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
30
What tips can we give to guardians of a teething baby
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
31
What are natal teeth
Teeth erupted at birth
32
What are neonatal teeth
Teeth erupted in the first 30 days of post natal life
33
How many babies are born with natal or neonatal teeth
1 in 2000 to 1 in 3500 (more common in females)
34
How do we treat neonatal and natal teeth
Extract them
35
Why do we extract neonatal and natal teeth
1. Danger of inhalation 2. Difficulties with breast feeding and bottle feeding 3. Causing trauma to the ventral surface of the tongue
36
Before extracting a neonatal or natal teeth what to we need to do
1. gain CONSENT | 2. Remember to protect the airways
37
What are eruption cysts
They precede the eruption of primary and permanent teeth | They are fluid filled blisters the form on the gums
38
Describe the shape and location of an eruption cyst
They occur where a tooth should be erupting | They are well circumscribed, dome shaped fluctuant enlargements that are usually asymptomatic
39
When can eruption cysts form
They precede the eruption of primary and permanent teeth
40
How do we treat eruption cysts
No treatment as they usually drain on their own when the tooth erupts
41
Name a common oral ulcerations you may encounter in children
Recurrent aphthous stomatitis
42
What might ulcers form in the oral cavity
1. Ill fitting dentures 2. From adjacent teeth 3. From orthodontic appliance 4. Due to anaesthetised tissue 5. Underlying medical conditions
43
How do we treat an ulcer that may have formed due to ill fitting dentures
Tell the patient to rinse with chlorophyll hexidene (if over 7 years) and avoid wearing the denture till it is fixed
44
How do we treat an ulcer that may have formed due to trauma from a sharp adjacent tooth
Smooth the adjacent tooth that is sharp and hopefully the ulcer should heal in a few days
45
How do we treat an ulcer caused by an orthodontic appliance
Add wax to any sharp wires coming off the orthodontic appliance and refer the patient to their orthodontist to get the appliance fixed
46
How do we treat an ulcer that may have formed due to anaesthetised tissue
Advice the patient to avoid hot food/drinks till the anaesthesia has worn off
47
What diseases/infectiosn can lead to oral ulceration
1. Viral infections 2. Bacterial infections 3. Mucocutaneous diseases 4. Haematological diseases 5. Gastrointestinal diseases
48
Give examples fo some viral infections that can lead to oral ulcerations
1. Herpatic stomatitis 2. Chicken pox 3. Hand foot and mouth disease 4. HIV 5. Herpangina
49
Give examples fo some Bacterial infections that can lead to oral ulcerations
1. Syphilis | 2. TB
50
Give examples fo some Mucocutaneous diseases that can lead to oral ulcerations
1. Lichen planus 2. Behcet's syndrome 3. Pemphigus vulgaris 4. Erythema multiform 5. Pemphigoid and variants 6. Chronic ulcerative stomatitis
51
Give examples fo some Haematological diseases that can lead to oral ulcerations
1. Anaemia 2. Leukaemia 3. Haemantinic deficiencies 4. Neutropenia
52
Give examples fo some Gastrointestinal diseases that can lead to oral ulcerations
1. Coeliac disease 2. Ulcerative colitis 3. Crohn's disease
53
What is primary herpetic gingivostomatitis caused by
Herpes simplex virus
54
In whom is primary herpetic gingivostomatitis common in
Common amongst 2-5 year olds
55
What is the incubation period for primary herpetic gingivostomatitis
7 days
56
How many patients are systemically affected by primary herpetic gingivostomatitis
5%
57
What symptoms may a patient with primary herpetic gingivostomatitis present with
Febrille illness: Headache, malaise, oral pain, mild dysphagia and cervical lymphadenopathy
58
How long is the clinical course for patients with primary herpetic gingivostomatitis
14 days
59
What do we need to be careful of when treating a patient with primary herpetic gingivostomatitis
It is very contagious so wear PPE
60
How would we manage primary herpetic gingivostomatitis
``` Advise the patient to: 1. Bed rest 2. Soft diet 3. Fluids 4 Paracetamol ```
61
What antibiotics can we prescribe to children
Amoxicillin Erythromycin Metronidazole
62
How much Amoxicillin can we prescribe to a 1 month- 1 year old child
125mg TDS for 5 days
63
How much Amoxicillin can we prescribe to a 1-5 year old child
250mg TDS for 5days
64
How much Amoxicillin can we prescribe to a 5-12 year old child
500mg TDS for 5 days (can increase to 30mg/kg)
65
How much Amoxicillin can we prescribe to a 12-18 year old child
500mg TDS for 5 days (if severe increase to 1g TDS)
66
How much Erythromycin can we prescribe to a 1 month- 2 year old child
125mg QDS 5 days
67
How much Erythromycin can we prescribe to a 2-8 year old child
250mg QDS
68
How much Erythromycin can we prescribe to a 8-18 old year child
250mg-500mg QDS
69
What are the side effects of Erythromycin
Nausea
70
What are the contra indications for Erythromycin
Patients who are taking warfarin
71
How much Metronidazole can we prescribe to a 1-3 year old child
50mg every 8 hours
72
How much Metronidazole can we prescribe to a 3-7 year old child
100mg every 12 hours
73
How much Metronidazole can we prescribe to a 7-10 year old child
100mg every 8 hours
74
How much Metronidazole can we prescribe to a 10-18 year old child
200-250 mg every 8 hours
75
What are the contra indications for Metronidazole
Patients who are taking warfarin
76
Name the most common analgesics we recommend
Paracetamol ibuprofen Aspirin
77
What is a key problem of paracetamol
It is hepatotoxic
78
How much paracetamol wood we recommend a parent to give a 1month -12 year old
15-20mg/ kg every 406 hours
79
How much paracetamol wood we recommend a parent to give a 12 -18 year old
1g every 4-6 hours
80
Who do we avoid giving ibuprofen
Patients with coagulation defects and asthmatics
81
In whom do we avoid recommending aspirin
Pateitns under the age of 16