Paediatric emergency Flashcards
Give examples of special test we can carry out on children to come to a diagnosis
- Palpations
- Mobility
- Percussion
- Radiographs
- Childs temperature
List some paediatric diagnosis we can come to
- reversible Pulpitis
- Irreversible pulpitis
- Acute apical abscess
- Pericoronitis
- Teething
- Natal and neonatal teeth
- Eruption cysts
- Oral ulcerations
List some characteristics of pulpits with reversible symptoms
- Precipitated by sweet, hot, cold
- Pain stops when stimulus removed
- Short duration
- Mainly occurs when eating
- Early carious lesions
- Caries into dentine
List some characteristics of pulpits with irreversible symptoms
- Constant toothache
- Relieved only by analgesics
- Kept awake at night
- Lymphadenopathy
- Pyrexia
- Extensive marginal ridge breakdown
- Sinus/ intra oral swelling
- Caries close to pulp
- Evidence of periodical pathology
What can happen if reversible pulpits is left untreated
Will progress to irreversible pulpit its
What initial temporary pain relief treatment would you give to a patient with reversible pulpits
Gently excavate the caries and debris then dress with GIC
What initial/ temporary pain relief treatment would you give to a patient with irreversible pulpits
Gently excavate the caries and debris then dress with ledermix on a cotton roll pledget and zinc oxide eugenol paste
What things do we need to consider for post emergency care
- Is the child at increased risk of caries or high priority
- Prevention?
- Is the child compliant
- Should we save the tooth or extract
5/ Are parents regular attenders
What definite care can we give to a child
- Extraction
2/ Restoration - Pulp therapy with stainless steel crown
- First stages of pulpectomy
When would we carry out a pulpectomy
Non vital tooth
What is an acute apical abscess
Acute inflammation of the tooth and surrounding tissues often caused by tooth decay and pulpal necrosis
What are some other terms for cute apical abscess
Acute peri radicular abscess
Acute dental avower abscess
Acute peri apical abscess
If we have a co operative child with an acute apical abscess how woudl we treat them
Extract the teeth under LA
If we have a NON co operative child with an acute apical abscess how would we treat them
- Drain through tooth
- Sedative dressing
- Offer analgesia
- Arrange to complete treatment with GA or inhalation sedation
Who can give consent for a child
- Childs birth mother and father
- Legally appointed guardian
- Person with a residence order for the child
- Local authority who holds protection order for the child
- Child who is gillick competent
What do we do if a child comes in with a large extra oral swellign without fever
- If the infection is spreading give antibiotics, analgesics and monitor
- Most likely will need to extract/ restore tooth later
What do we do if a child comes in with a large extra oral swelling without fever
- If the infection is spreading give antibiotics, analgesics and monitor
- Most likely will need to extract/ restore tooth later
When should we be really concerned about a large extra oral swelling
If the patient is systemically unwell with:
1. high temp
2. Dehydrated
3. Lethargic
Refer to the hospital
What do we do if a child comes in with a large extra oral swelling WITH fever
- Refer to hospital for intra venous antibiotics and further treatmetn
- Call A+E and warn them the child is on the way and needs to be hospitalised immediately
What is pericoronitits
inflammation of the soft tissues surrounding the crown of a partially erupted tooth, including the gingiva and the dental follicl
Which tooth is pericoronitis usually associated with
Erupting teeth
List some signs and symptoms of pericoronitis
- Pain
- Swelling of operculum (gingiva surrounding teeth)
- Discomfort when swallowing
- Unpleasant taste/ odour
- Limited mouth opening
- Pyrexia
How do we manage pericoronitis
- Exclude airway risk
- Advice optimal analgesia
- Encourage oral hygiene
- Advise to rinse mouth after food
- Consider irrigation with 0.2% chlorohexidine gluconate under LA
What do we need to aware of before prescribing chlorohexidine mouth wash
Not suitabel for childern under 7
List some signs of a teething babay
- Cheeks may look rosy
- Baby wants to bite or avoid particular area
3/ Drooling or dribbling - Gums may look red
- Disturbed sleep
What tips can we give to guardians of a teething baby
- Cool teething rings
- Sugar free teething gels
- Massage gums with clean fingers
- Try cooling fingers of cucumber. carrots. breadsticks if baby is weening
- Sugar free Calpol
What are natal teeth
Teeth erupted at birth
What are neonatal teeth
Teeth erupted in the first 30 days post natal life
How many babies are born with natal or neonatal teeth
1 in 2000 to 1 in 3500 (more common in females)
How do we treat neonatal and natal teeth
Extract them
Why do we extract neonatal and natal teeth
- Danger of inhalation
- Difficulties with breast feeding and bottle feeding
- Causing trauma to the ventral surface of the tongue
What are eruption cysts
They precede the eruption of primary and permanent teeth
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
How do we treat eruption cysts
No treatment as they usually drain own when the tooth erupt
Name a common oral ulceration you may encounter in children
Recurrent aphthous stomatiitis
Why might ulcers from in the oral cavity
- Ill fitting dentures
- From adjacent teeth
- From orthodontic appliance
- Due to anaesthetised tissue
- Underlying medical conditions
How do we treat an ulcer that may have formed due to ill fitting dentures
Tell the patient to rinse with chlorohexidene (if over 7 years) and avoid wearing the denture till it is fixed
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 shoudl heal in a few days
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§
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
Which disease and infections can lead to oral ulcerations
- Viral infections
- Bacterial infections
- Mucocutaneous diseases
- Haematological diseases
- Gastrointestinal diseases
Give examples fo some viral infections that can lead to oral ulcerations
- Herpatic stomatitis
- Chicken pox
- Hand foot and mouth disease
- HIV
- Herpangina
Give examples fo some Bacterial infections that can lead to oral ulcerations
- Syphillis
- TB
Give examples fo some Mucocutaneous diseases that can lead to oral ulcerations
- Lichen planus
- Behcet’s syndrome
- Pemphigus vulgaris
- Erythema multiform
- Pemphigoid and variants
- Chronic ulcerative stomatitis
Give examples fo some Haematological diseases that can lead to oral ulcerations
- Anaemia
- Leukaemia
- Haemantinic deficiencies
- Neutropenia
Give examples fo some Gastrointestinal diseases that can lead to oral ulcerations
- Coeliac disease
- Ulcerative colitis
- Crohn’s disease
What is primary herpetic gingivostomatitis caused by
Herpres simplex virus
In whom is primary herpatic gingivostomatitis common in
2-5 year olds
What is the incubation period for primary herpetic gingivostomatitis
7 days
How many patients are systemically affected by primary herpetic gingivostomatitis
5%
What symptoms may a patient with primary herpetic gingivostomatitis present with
Febrille illness: Headache, malaise, oral pain, mild dysphagia and cervical lymphadenopathy
What do we need to be careful of when treating a patient with primary herpetic gingivostomatitis
It is very contagious so wear PPE
How would we manage primary herpetic gingivostomatitis
Advise the patient to
1. Bed rest
2. Soft diet
3. Fluids
4. Paracetamol
What antibiotics can we prescribe to children
Amoxicillin
Erythromycin
Metronidazole
How much Amoxicillin can we prescribe to a 1 month- 1 year old child
125mg TDS for 5 days
How much Amoxicillin can we prescribe to a 1-5 year old child
250mg TDS for 5days
How much Amoxicillin can we prescribe to a 5-12 year old child
500mg TDS for 5 days
How much Amoxicillin can we prescribe to a 12-18 year old child
500mg TDS for 5 days (if severe increase to 1g TDS)
List the ages and max doses of amoxicillin we can prescribe to Childs
1mth-1yr: 125mg TDS for 5 days
1-5yrs: 250mg TDS for 5 days
5-12yrs: 500mg TDS for 5 days
12-18yrs: 500 TDS for 5 days
How much Erythromycin can we prescribe to a 1 month- 2 year old child
125mg QDS 5 days
How much Erythromycin can we prescribe to a 2-8 year old child
250qds
How much Erythromycin can we prescribe to a 8-18 old year child
250-500 QDS
What are the side effects of Erythromycin
Nausea
What are the contra indications for Erythromycin
Patients who are taking warfarin
How much Metronidazole can we prescribe to a 1-3 year old child
50mg every 8 hours
How much Metronidazole can we prescribe to a 3-7 year old child
100mg every 12 hours
How much Metronidazole can we prescribe to a 7-10 year old child
100mg every 8 hours
How much Metronidazole can we prescribe to a 10-18 year old child
200-250 mg every 8 hours
List the ages and doses of metronidazole we can prescribe to children
1-3yr olds: 50mg every 8 hours
3-7year olds: 100mg every 12 hours
7-10years olds: 100mg every 8 hours
10-18year olds: 200-250 every 8 hrs
contra indication foe metronidazole
Patients taking warfarin
Name the most common analgesics we recommend
- paracetamol
2., Ibuprofen - Aspirin
What is a key problem of paracetamol
It is hepatotoxic
How much paracetamol would we recommend a parent to give a 1month -12 year old
15-20mg/ kg every 4-6 hrs
How much paracetamol would we recommend a parent to give a 12 -18 year old
1g every 4-6 hours
Who do we avoid giving ibuprofen
Patients with coagulation defects and asthmatics
