Trauma 3 - immediate management Flashcards
a patient presents with trauma - what must you assess first?
full assessment ruling out head injury and other body injuries that need prioritised
how do you assess for signs of head trauma?
history of loss of consciousness
was the incident witnessed?
child ‘acting out of character’?
history of vomiting, nausea?
visual disturbances?
what must be assessed extra orally?
abrasions
lacerations
palpate and look for signs of skeletal fractures (asymmetry)
inferior border of mandible
zygomatic arch
battle signs
bilateral periorbital bruising
what are battle signs?
bruising of mastoid process behind ear - sign of a bad hit and potential brain injury
what must be assessed intra orally?
bruising
haematoma
floor of mouth
lacerations
degloving injuries
displacement of soft tissue
steps in occlusion
mandibular deviation on opening
what do steps in occlusion suggest?
mandibular/ maxillary fracture
what investigation may you want to carry out if you suspect a condylar or mandibular fracture?
DPT
list some indicators of non accidental injury (NAI)
repeated injury
bruising of ‘protected areas’
‘quiet watchfulness’
what is known as a protected area of the face?
cheeks
what guidelines should be consulted if NAI suspected?
practice policy
regional health board policy
list some typical types of NAI
both sides of body
soft tissues
particular patterns
injury doesnt fit explanation
delays in presentation
untreated
where is the ‘triangle of safety’?
ears
side of face
neck
top of shoulders
what should you do if a child presents with a tooth/ tooth fragment?
place in saline
trauma assessment
treatment plan
ideally a full oral health assessment
what questions should be included in trauma assessment?
when did it happen?
where did it happen?
was it witnessed?
first time experiencing trauma?
symptoms?
is pain getting worse?
tetanus status?
what must be asked if a tooth is avulsed?
how long dry (extra alveolar dry time - EADT)?
how long in medium?
what medium?
what are you looking for when assessing each tooth and the relationship between teeth?
arch form
emergence profile
occlusion
crown fracture
displacement
mobility
if adjacent teeth move when assessing mobility, what does this suggest?
alveolar fracture
what does a blood clot attached to gingival crevice suggest?
if within 24 hours - subluxation
what must be checked of a bleeding socket?
is it empty - exclude intrusion
correlate with radiographs
what must be assessed in primary teeth root trauma?
relationship/ proximity to permanent successor
root fracture
alveolus fracture
displacement
what must be assessed with permanent teeth root trauma?
root fracture
crown - root fracture
alveolus fracture
root displacement
what radiographs should be taken to rule out possible root fracture?
2 views at different angles i.e., max occlusal and PA
what types of radiographs should be taken to view affected teeth immediately following trauma?
generally - anterior occlusal maxillary plus periapicals
as well as the affected tooth what else should be radiographed?
contralateral tooth - to compare
what are the desirable treatment outcomes for primary and permanent teeth?
eliminate pain/ symptoms
prevent infection/ further issues
preserve and minimise damage to permanent dentition
explain the treatment for an enamel-dentin-pulp fracture in a permanent tooth
LA
gut back to healthy bleeding pulp
ensure 2mm of clean dentine walls above pulp
arrest bleeding with saline soaked cotton pellet
cap with non setting CaOH or MTA
RMGI
Composite
what is the function of calcium hydroxide?
kills pulpal cells it contacts
bactericidal to allow pulpal healing
what type of extra oral laceration would you refer to A+E?
lacerations with loose tissue/ requiring intervention
what is the purpose of a splint?
stabilise teeth that have undergone injuries to the PDL until there is sufficient healing
list the properties of a splint
flexible - allow normal biological movement
passive - apply NO force on teeth
user friendly - easy to shape by clinician
what type of wire should be used for splints?
wire with no shape memory - soft stainless steel
what requires longer splinting - lateral luxation or extrusive luxation?
lateral luxation
list healing outcomes of horizontal root fractures
non healing
hard tissue union
investing of connective tissue
investing of connective tissue and bone
explain non healing of horizontal root fracture?
granulation tissue is present in the horizontal fracture
explain hard tissue union in horizontal root fracture
union of fractures part - like a broken bone
explain investing of connective tissue in horizontal root fractures
PDL can invest the fracture
what placement of root fractures required prolonged splinting?
cervical third - up to 4 months splinting
what is the most common type of tooth trauma to primary dentition?
intrusion
what do you do if a primary tooth has been avulsed and there is no sign of it?
contact A+E
what do you do it a primary tooth is slightly displaced?
leave it - unless interfering with occlusion - if so, xLA
what do you do if a crown has fractured off a primary tooth but roots are retained?
leave roots in situ unless infected in which case xLA
what do you do if a primary tooth has gone dark?
xLA - unless risk of endocarditis
what does an orange colour suggest in a tooth?
pulp canal obliteration
what does pulp canal obliteration mean for the tooth?
it is still alive/ vital
what main signs do we monitor following trauma?
swelling
sinus tract
suppuration
discolouration
what main symptoms do we monitor after trauma?
avoiding brushing
upset
not letting parent/ gaurdian see teeth
not eating
how may an extruded primary tooth be managed if there is no movement after 4 weeks?
orthodontic extrusion
