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endo > triage/emergency > Flashcards

triage/emergency Flashcards

1
Q
  • Triage is the process of:
A
  • Triage is the process of sorting injured people based on their need for immediate medical treatment as compared to their chance of benefiting from such care
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2
Q

Triage is done in:

A

Triage is done in emergency rooms, disasters, and wars, when limited medical resources must be allocated to maximize the number of survivors.

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3
Q

triage tags

A

white
green
yellow
red
black

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4
Q

white tag

A

(dismiss) are given to those with minor injuries for whom a doctor’s care is not required.

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5
Q

green tag

A

(wait) are reserved for
the “walking wounded” who will
need medical care at some point,
after more critical injuries have
been treated.

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6
Q

yellow tag

A

(observation) for
those who require observation (and
possible later re-triage). Their condition is
stable for the moment and, they are not in
immediate danger of death. These victims
will still need hospital care and would be
treated immediately under normal
circumstances

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7
Q

red tag

A

(immediate) are used to label
those who cannot survive without
immediate treatment but who have a
chance of survival

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8
Q

black tag

A

(Expectant) are used for the
deceased and for those whose injuries are so
extensive that they will not be able to survive
given the care that is availabl

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9
Q

when would we triage

A

Dentists in the military or disaster control are often used to triage thus freeing the medics to work critical care.
ANY 1st RESPONDER NEEDS AND MUST USE THIS TRAINING.
Additionally, dentists are used to identify burned or other unidentifiable bodies for identification/legal puposes

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10
Q

controlling pt needs/desires?
what can you do?

A

YOU CAN’T CONTROL THE NEEDS/DESIRES OF PATIENTS
BUT: You DO need to perform a “type of TRIAGE” to determine their condition and Tx needs.

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11
Q
  • It would be ideal to have every patient in your practice pursuing:
A
  • It would be ideal to have every patient in your practice pursuing a strict &
    planned comprehensive dental program.
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12
Q

1 priorty of pt health

A

systemic problems

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13
Q

complications of providing care

A

Life may have dealt you a whole bunch of problems which comprise multiple glowing embers any of which
can erupt into a raging emergency at any time. (You may have NO EMERGENCY FUND)
This may be one of those times and the last thing patient wants is advice or counseling:
Don’t Preach: Don’t Educate. . . “JUST STAMP OUT THE CURRENT FIRE”
You COULD refer them to someone less busy; you don’t have to do it all. Just provide a path

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14
Q

how can you help someone in emergency care

A
  • You MUST START with a HEALTH HISTORY.
  • You MUST START with a thorough & appropriate EXAMINATION/STUDIES
  • You MUST PERFORM appropriate CLINICAL TESTING/RADIOGRAPHS
  • You MUST develop an accurate DIAGNOSIS
  • You MUST envision an appropriate TREATMENT PLAN (with OPTIONS)
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15
Q

deciding the care options available and explaining them to pts

A
  • Present ALL OPTIONS in clearly understandable LANGUAGE
  • Present the RISKS & BENEFITS in simple terms
  • Don’t FORGET to appraise the PATIENT of THEIR Responsibilities
  • Costs required for each option
  • Time required for each option (availability of TX and # of visits, etc.)
  • Maintenance required for each option
  • Expected Prognosis and Longevity for each option
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16
Q

after explaining tx options to pts what occurs next

A

ONLY NOW CAN YOU ASK THE PATIENT TO BECOME INVOLVED in his/her treatment as regards their desires and expectations.
The patient drives the bus, and they must be fully informed and then they must make their decision regarding which option they wish for their TREATMENT
(if mentally capable)

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17
Q

BEWARE of some COMPLICATIONS w tx presentation

A
  • The patient MUST UNDERSTAND (or no permission for Tx exists)
  • The patient MUST HAVE reasonable expectations:
  • The treatments must be professionally reasonable: The Professional must be responsible to avoid
    untoward/unreasonable options in presenting to the
    patient.
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18
Q

considerations for tx presentation

A
  • IS THE TOOTH STRATEGIC AND FUNCTIONAL?
  • IS THE TOOTH REASONABLY RESTORABLE?
  • IS THERE A PERIODONTAL SITUATION WHICH IS COMPROMISING?
  • ARE THERE OTHER QUESTIONABLE INVOLVEMENTS?
  • IS THE TREATMENT REASONABLY AVAILABLE?
19
Q

considerations for tx availability

examples

A
20
Q

WHEN THE PATIENT REASONABLY
DECIDES AND THE EMERGENCY TX IS COMPLETED & PATIENT COMFORTABLE then you may:

A

THEN YOU CAN LECTURE TO THEM ABOUT THE BENEFITS OF COMPREHENSIVE DENTAL CARE &
MAYBE THEY WILL CHOOSE TO BECOME YOUR REGULAR PATIENT & MAYBE THEY WILL CHOOSE TO
WAIT FOR THE NEXT EMERGENCY TO OCCUR. OR NOT. YOU CANNOT FORCE THEM.

21
Q

completion of tx and referals

A

We may NOT begin treatment and then fail to complete same & we may NOT propose to offer to provide any treatment for which we are not qualified. Nor may we refer the patient to anyone whom we do not know to be qualified.

22
Q

refusal of tx

A
  • We may NOT refuse to provide treatment to the patient for any reason covered by a federally
    “protected group”.
  • We MAY refuse treatment to any patient for any reason not covered as a federally “protected group”
    as long as we have not begun any treatment
23
Q

ANY Tooth with Irreversible Pulpitis or PA
Pathology of Endodontic Origin is Best
Treated by:

A

TOTAL Pulpectomy and RCT

24
Q
  • “EMERGENCY” TX: MEANS -
A

Do the best we can to stop the pain at the time -until we have time to do the complete RCT. (If we accept
the case)

25
Q

If we BEGIN any Tx, we are?
If we DON’T COMPLETE it?
If we DON’T begin any Tx?

A

If we BEGIN any Tx, we are bound to complete the Tx.
If we DON’T COMPLETE it; we can be charged with “Abandonment”
If we DON’T begin any Tx; we can REFER & avoid the Liability

26
Q

Patient with Symptomatic Irreversible Pulpitis but no PA involvement, no PARL & no swelling nor fever emergency tx and follow up?

A

vital coronal pulpotomy for emergency relief
Expected Outcome:
- Absence of presenting pulpal pain
- Should remain comfortable for a short period of time
until canals become necrotic
- Make appointment in Endo. (Undergrad or Advanced) prn
- Will require RCT & Crown at a later date.

27
Q

Asymptomatic Vital Pulp Exposure (without Pain) emergency tx

A

deep caries with pulp exposure> Next: Cover with resin restoration and restore using Paracore + 2 Radiographs

28
Q

what to do when there is vital pulp exposure in clinic

A
  • DO ALL CLINICAL TESTING & RECORD (TEST AT LEAST 3 TEETH AS “BASELINE”)
  • FILL OUT ENDO. DIAGNOSIS FORM (BEFORE O&R IF PULP EXPOSURE MAY OCCUR)
  • ISOLATE TOOTH IN QUESTION WITH DENTAL DAM
  • REMOVE ALL CARIES & UNSUPPORTED ENAMEL (If pulp is exposed)
  • DISINFECT WITH 8.3 % NaOCl and ARREST HEMORRHAGE, PULPCAP EXPOSURE WITH DYCAL & COTTON & PLACE TEMPORARY RESTORATION SUCH AS PARACORE
  • AFTER RESTORATION, TAKE 2 RADIOGRAPHS ( 1 STRAIGHT-ON AND 1 AT 20 DEGREE SHIFT SHOT)
  • CONTACT ANY ENDO FACULTY ON EXCHANGE E-MAIL (SUBJECT OF E-MAIL IS “PULP EXPOSURE”)
    INCLUDE PATIENT NAME & CHART #, TOOTH INVOLVED AND BRIEF HISTORY.
29
Q

Asymptomatic NON-Vital Pulp Exposure emergency tx

A

same as vital

30
Q

Symptomatic Vital or Non-VITAL Pulp Exposure emergency

A

Place Cotton and Cavit and refer to E-Chair or Endo as indicated by symptoms
email Dr. W
same isolation and disinfection procedure as with vital

31
Q

Symptomatic Apical Periodontitis (with or without Symptomatic Irreversible Pulpitis)

A

If you identify apical periodontitis of endodontic origin especially in multi-canaled teeth, you may have any combination of pulpal activity from “normal” through inflamed & infected to necrotic (may have PARL or not yet visible). However, you can be CERTAIN WHEN WE HAVE PERIAPICAL INFLAMATION of PULPAL ORIGIN that Emergency Tx will only be effective with complete pulpal extirpation (pulpectomy) and that RCT is indicated for this tooth in the near future.

32
Q

Symptomatic Apical Periodontitis (with or without Symptomatic Irreversible Pulpitis) expected emergency tx outcome

A

-Immediate cessation of pulpal pain.
-Tooth will remain sensitive to percussion and biting for up to 3 days
- Make appointment in Endo. (Undergrad or Advanced) prn
- Will require RCT & Crown

33
Q

EMERGENCY PULPECTOMY TECHNIQUE

A

Gain Adequate Analgesia & Isolate tooth
- Access and locate canals
- Use apex locator and #10 file to find patency
- Enlarge 1mm. Short of patency with a #15 file
- Enlarge 2mm. Short of patency with a #20 file
- Enlarge 3mm. Short of patency with a #25 file
- Irrigate copiously between each instrument with 8.3% NaOCl
- Dry with paper points and place CaOH in all canals, cotton and IRM.
- Help patient obtain appointment in Pre-doc endo or Advanced endo as indicated

34
Q

benefits of emergency pulpectomy tx

A
  • removal of irritants, toxins and substrate
  • path to patency obtained & retained
  • allows NaOCl to WORK
  • provides space for CaOH
35
Q

what to do with ludwigs

A

get pt to hospital

36
Q

spaces involved in ludwigs

A

Submandibular space
Sublingual space
Submental space

37
Q

when to be concerned for ludwigs

A

Be especially vigilant with infections of mandibular molars (especially 2nd & 3rd Molars) WHY: 2nd & 3rd
Molars often are located with their root apices located inferior to the mylohyoid M. therefore, allowing ready access for infection to enter the submandibular space encouraging cellulitis to occur in that space and also in associated fascial spaces.

38
Q

CAA emergency?

A

(RARELY AN EMERGENCY)
Identified by DST: Patient is generally comfortable and pain medication and antibiotics are NOT indicated for the healthy patient.

39
Q

open DST tx

A

Actively draining and prescribe warm intraoral rinses. Then you may proceed with RCT/Crown if total situation justifies the procedure.

40
Q

closed DST tx

A

In certain cases, the ostium of the DST may become closed causing localized swelling and discomfort and a simple I&D may be required as emergency Tx before proceeding to RCT

41
Q

facial DSt tx?

A

same, tx cause (RCT) and it will resolve

42
Q

What about Deep Caries - Rev.or Irrev.
Pulpitis?

A

You MUST do your Sensibility Testing to determine if you are dealing with reversible pulpitis, irreversible pulpitis or necrosis

43
Q

rev vs irrev pulpitis tx

A

ACCURATE DIAGNOSIS suggests CORRECT TREATMENT
Rev. Pulpitis: Symptomatic Treatment
IRREV. PULPITIS: RCT or T.E

44
Q

PULP Capping for IRREV. PULPITIS or NECROTIC PULP?

A

PULP Capping is ONLY an INTERIM TREATMENT for
IRREV. PULPITIS or NECROTIC PULP

endo (22 decks)

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