Prevention & management of extraction complications_part 2 Flashcards
1
Q
PREVENTION OF COMPLICATIONS
* Thorough preoperative assessment
(2)
A
- MEDICAL HISTORY REVIEW!!
- Adequate and up to date images
2
Q
- Comprehensive treatment plan
(3)
A
- Detailed surgical plan
- Needed instrumentation
- Pain/anxiety management
3
Q
- Careful execution of surgical procedure
(3)
A
- Clear visualization and access to surgical field
- Use of controlled force → finesse
- Asepsis, atraumatic handling of tissue, hemostasis, debridement (as needed)
4
Q
- Complications can STILL occur; however,
A
the complications begin to become more predictable and will become routinely
managed
5
Q
PREVENTION OF COMPLICATIONS
(3)
A
- Perform procedures that are within the limits of their capabilities
- Be cautious of unwarranted optimism
- Referral is ALWAYS an options
6
Q
- Be cautious of unwarranted optimism
(1)
A
- Clouds judgment leading to increased post-op complications
7
Q
- Referral is ALWAYS an options
(2)
A
- Is a moral obligation to practitioners → primum non nocere
- Will provide peace of mind
8
Q
ORAL HEMOSTATIC MECHANISM CHALLENGES
(5)
A
- Tissues in the mouth are highly vascular
- Extractions leave an open wound
- Impossible to apply dressing with enough pressure and sealing to prevent additional
bleeding - Patients tend to explore areas of surgery with their tongues, occasionally dislodging clots,
which initiates secondary bleeding - Salivary enzymes may lyse blood clots prior to maturation/organization
9
Q
PREVENTION
(4)
A
- Obtain a history of bleeding
- Use atraumatic surgical technique
- Obtain good hemostasis at surgery
- Provide excellent patient instructions
10
Q
MEDICAL HISTORY REVIEW
(7)
A
- Has the patient ever had any prolonged bleeding after surgery?
- Does the patient bruise easily?
- Is there a family member with a history of prolonged bleeding/easy
bruising/systemic disease? - Medication review looking for anticoagulants/antiplatelets/chemotherapy
- Social history of alcoholism/liver disease?
- Systemic diseases related to prolonged bleeding?
- Is there a history of uncontrolled hypertension?
11
Q
LABORATORY TESTING
(3)
A
- Helps determine stability of the disorder
- Platelets defects → platelet number and bleeding time
- Coagulation cascade defects → INR
12
Q
Platelets defects → platelet number and bleeding time
(3)
A
- Bleeding time is an archaic test:
- Razor blade cuts arm and the bleeding observed until stopping
- Normal bleeding time 3-10 min
13
Q
- Coagulation cascade defects → INR
(4)
A
- International Normalized Ration: is a record of prothrombin time and a standardized control
(due to laboratory differences across nation) - Normal INR 1
- Normal anticoagulated patient INR 2-3
- If above 3, physician needs consultation prior to treatment
14
Q
INITIAL CONTROL OF BLEEDING
A
- Gaining control of all factors that prolong bleeding
- Atraumatic surgery
- Clean incisions
- Gentle management of soft tissues
- Removal of all granulation tissue
- Increased vascularity noted in granulation tissue
- Smooth sharp bony projections
- Inspect socket for bleeding nutrient canals
- Can crush bone into canal to stop bleeding
15
Q
NITIAL CONTROL OF BLEEDING
* Direct pressure of socket with moistened gauze, folded to fit over socket
* Pressure for at least —
* Only dismiss patient if bleeding is controlled with gauze
A
30 – 45 min