Triage Emergency Services Flashcards
what is triage
the process of sorting injured people based on their need for immediate medical treatment as compared to their chance
where is triage done
an emergency room, disasters and wars, when limited medical resources must be allocated to maximize the number of survivors
what are white tags for
- dismiss
- given to those with minor injuries for whom a doctors care is not required
what are red tags for
- immediate
- used to label those who cannot survive without immediate treatment but who have a chance of survival
what are green tags for
- wait
- reserved for the walking wounded who will need medical care at some point after more injuries have been treated
what are yellow tags for
- 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
what are black tags used for
- expectant
- used for the deceased and for those whos injuries are so extensive that they will not be able to survive given the care that is available
what are dentists used in the military for
- triage to free medics to work critical care
- identify burned or other unidentifiable bodies for identification/legal purposed
what is the #1 priority
systemic problems
if you are in pain: you want:
action right now
you want ____ with an unplanned complication
help
how can you help a triage person
- start with health history
- start with thorough and appropriate examination/studies
- you must perform appropriate clinical testing/radiographs
- you must develop an accurate diagnosis and treatment plan
how do you present the options that exist
- present all options in a clearly understandable language
- present the risks and benefits in simple terms
- dont forget to appraise the patient of their responsibilities: costs required for each option, time required for each option, maintenance required for each option, expected prognosis and longevity for each option
when can you ask the patient to become involved in their treatment
when you present the options
how do you make the patient aware of complications
- the patient must understand
- 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
the professional must be responsible to avoid:
untoward or unreasonable options in presenting to the patient
if we dont complete tx we can be charged with:
abandonment
what is the expected outcome for a patient with SIP but no PA invovlement no swelling or fever
-vital coronal pulpotomy
- absence fo presenting pulpal pain
- should remain comfortable for a short period of time until canals become necrotic
- make appointment in endo
- will require RCT and crown at a later date
what do you do for a patient with asymptomatic vital pulp exposure without pain
- do all clinical testing and record at least 3 teeth as baseline
- fill out endo dx form before or if pulp exposure may occur
- isolate tooth in question with dental dam
- remove all caries and unsupported enamel if pulp is exposed
- disinfect with 8.3%NaOCl and arrest hemorrhage, pulpcap exposure with dycal and place temporary restoration such as paracore or IRM
- after restoration take 2 radiographs - 1 straight on and 1 at 20 degrees
- contact any endo faculty on exchange email
what do you do with an asymptomatic non-vital pulp exposure
same as vital pulp exposure
what do you do with a patient with symptomatic vital or non vital pulp exposure with pain
- remove all caries and unsupported enamel
- disinfect and arrest any hemorrhage with NaOCl
- possible pulpotomoy or pulpectomy in e-chair- restoration as required
- make appointment in endo as indicated by faculty in E chair or team
if you identify apical periodontitis of endodontic origin espeically in multi canal teeth you may have any combination of pulpal activity from:
- normal through infected to necrotic
- may or may not have PARL visible
you can be certain when we have periapical inflammation 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
what is the expected outcome for symptomatic apical periodontitis with or without SIP
- immediate cessation of pulpal pain
- tooth will remain sensitive to percussion and biting for up to 3 days
- make appointment in endo prm
- will require RCT and crown
what is the emergency pulpectomy technique
- gain adequate anesthesia and 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 CaOH2 in all canals, cotton, and IRM
- help patient obtain appointment in pre-doc endo or advanced endo is indicated
what are the benefits of emergency pulpectomy technqiue
- removal or irritants, toxins, and substrate
- path to patency obtained and retained
- allows NaOCl to work
what do you do with a patient you do IND on
- place pt on 600mg of IBU q4-6h for 1-3 days
- call patient that evening to see how well they are doing
- tx them the next day if fluid from the tooth was copious and difficultt to dry
if you open the pulp you may be greeted with:
a fountain of pus followed by blood and finally serous fluid. following pulpectomy and shaping you should dry the canals and close with CaOH, cotton and temp filling
any tooth with irreverisble pulpitis or PA pathology of endo origin best treated by:
total pulpectomy and RCT
if the swelling is fluctuant what do you do and why
incise the most dependent portion of the swelling because it will often gain immediate relief from the severe pain
what do you do if the patient comes in with extreme extra oral swelling, cellulitis and spiking fever and pain
- call OS or ER and get patient admitted ASAP
what does Ludwigs angina involve
-submandibular space
- sublingual space
- submental space
why should you be especially vigilant with infections of mandibular molars
often located with their root apices located inferior to the mylohyoid therefore, allowing ready access for infection to enter the submandibular space encouraging cellulitis to occur in that space and also in associated fascial spaces
is CAA an emergency
rarely
how are patients with CAA identified
- DST
- patient is generally comfortable and pain medication and antibiotics are NOT indicated for the healthy patient
when would you proceed with RCT with a DST
the DST is open and actively draining and prescribe warm intraoral rinses
what do you do if the DST is closed and casuing swelling and discomfort
simple I and D before RCT
what is the tx if the CAA appears on the surface of the face
same treatment- RCT
do you need a plastic surgeon to treat a DST on the face
no
what do you do with reversible or irreversible pulpitis with deep caries
- sensibility testing to determine if RP, IP or necrosis
- RP tx: symptomatic treatment
- IP tx: RCT or extract
