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BOARDs > Oral Surgery > Flashcards

Oral Surgery Flashcards

1
Q

Indications for tooth extraction?

A

Caries
Endo:
Perio:
Ortho:
Cracked Teeth
Impacted Teeth
Supernumerary
Pathology:
Questionable Teeth BEFORE Radiation

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2
Q

Contraindications for Tooth Extraction

A

Poorly Controlled Diabetes

Unstable Angia

ESRD: End Stage Renal Disease

Leukemia

Lymphoma

Hemophelia or Platelet disorder

Hx of Head & Neck Radiation
* HYPERBARIC OXYGEN BEFORE & AFTER EXO

IV Bisphosphonatees

Pericornitis:
* treat infection first

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3
Q

Impacted teeth

A

Do not erupt when expected
* primary reason=inadequate arch length

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4
Q

What are the most common teeth likely to be impacted?

A
  1. Mandibular 3rd Molars
  2. Maxillary 3rd Molars
  3. Maxillary Canines
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5
Q

Congenitally missing teeth

A
  • Teeth that don’t form
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6
Q

What are the teeth that are most likely to be congenitally missing?

A
  1. 3rd molars
  2. Mandibular 2nd premolar
  3. Maxillary Laterals
  4. Maxillary 2nd premolars
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7
Q

What are the different classification systems for impacted teeth?

A
  1. Nature of overlying tissue
  2. Winter’s Classification
  3. Pell & Gregory Classification
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8
Q

Nature of Overlying tissue Classification

A

Soft tissue Impaction:
* HOC above bone level
* gingiva is completely or partially covering tooth
* Easiest

Hard tissue impaction:
1. Partial bony: HOC below bone level
2. Complete Bony: Tooth entirely surrounded by bone. Most DIFFICULT

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9
Q

Impacted Teeth Classification: Winter’s Classification

A

3rd molars ONLY
* compare long axis of 3rd molar to 2nd molar

Mandibular: (Mama Has Violet Daises):
Mesioangular: Easiest
Horizontal: 2nd easiest
Vertical: 2nd Hardest
Diatoangular: Most Difficult

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10
Q

Pell and Gregory Classification

A

lower 3rd molars ONLY

Class A: same plane as other molars
Class B: Halfway down other molars
Class C: Below cervical line (CEJ) of 2nd molar
* MOST DIFFICULT

Class I: crown anterior to ramus
Class II: 1/2 crown in ramus
Class III: Entire crown in ramus
* MOST DIFFICULT

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11
Q

Subperiosteal Abscess

A

Extraction Complication
* infection under periosteum layer
* small pieces of bone or tooth left under a flap
* irrigate thoroughly to avoid

Can happen whenever you elevate a flap

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12
Q

Oro-Antral Communication (OAC)

A

Aka Sinus Exposure
* communication b/w oral cavity & antrum (Sinus)

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13
Q

What tooth is most commonly associated with an Oro-antral Communication?

A

Maxillary 1st molar (palatal root)

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14
Q

Oro-Antral Communication: Tx

A

< 2mm : Do nothing, Sinus Precautions

2-6 mm: 4A’s and Figure 8 suture
* Antibiotics
* Analgesics
* Antihistamines
* Afrin Nasal Spray 2x per day

> 6 mm: Flap Surgery

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15
Q

How do you prevent an Oroantral Communication (OAC)

A

Good pre-op radiograph: shows level of sinus
* Avoid excessive apical pressure

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16
Q

Alveolar Osteoitis

A

AKA Dry Socket
* blood clot dislodges or dissolves before wound heals after extraction
* NOT AN INFECTION, NO ANTIBIOTICS REQUIRED

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17
Q

Alveolar Osteitis: Tx

A

Irrigate & Local pain control
* PACK ALVEOGEL
* EUGENOL HELPS W/PAIN

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18
Q

Nerve Injury

A

Most common w/Lower 3rd Molars
* close to IAN Nerve

Tx:
*Medrol Dosepak=Steroid to decrease inflammation
* numbness > 4 weeks, refer for microneurosurgeon eval

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19
Q

Tooth Displacement

A
  • maxillary 1st/2nd molar: Maxillary Sinus
  • Maxillary 3rd molar: Infratemporal fossa
  • Mandibular 3rd molar: Submandibular space
  • Oropharynx=Send to ER for chest & abdominal x-ray
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20
Q

Complications of tooth extraction

A
  • Subperiosteal abscess
  • Oro-antral communication
  • Alveolar Osteitis
  • Nerve Injury
  • Tooth Displacement
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21
Q

Bite Block

A

Better visualization

Stabilizes mandible (good for TMJ)

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22
Q

Suction Tips

A

Yankaur Suction: soft tissue

Frazier Suction: hard and soft tissue
* Cover hole=hard tissue, more suction
* Uncover: Soft tissue, weaker suction

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23
Q

Towel Clip

A

holds drapes placed around patient
* Locking handle w/finger & thumb rings
* be careful not to pinch patient’s skin

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24
Q

Austin Tissue Retractor

A

Austin:
* Right angle
* small flaps

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25
Q

Weider Tissue Retractor

A

AKa Sweet Heart

Broad heart shaped
* protect and retract tongue

Mandibular lingual surgery

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26
Q

Minnesota Tissue Retractor

A

offset curved and broad
* Cheek/flap reflection

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27
Q

Seldin Tissue Retractor

A

Long and flat

elevate down to floor of mouth
* mandibular tori removal

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28
Q

Periosteal Elevators

A

Woodson periosteal: Small & Delicate
#9 Molt periosteal: Larger elevator

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29
Q

Straight Elevator

A

aka #301
* most commonly used

Lever

Blade: concave surface towrads tooth to be elevated

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30
Q

Triangular Elevator

A

aka Cryer
* second most common

Wheel and Axle

Remove broken root left in socket

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31
Q

Pick Elevator

A

remove retained or broken root

Wedge

Crane Pick
* heavy version

Root Tip Pick
* delicate version

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32
Q

150 Forceps

A

Upper universal
* A=premolars
* S=primary teeth

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33
Q

151 Forceps

A

Lower universal

A=premolar

S=primary

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34
Q

23 Forceps

A

Cowhorn
* lower molars
* beak engages bifurcation

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35
Q

88R/L Forceps

A

Upper Cowhorn
* 2 beaks: palatal root
* 1 beak: buccal bifurcation

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36
Q

74 Forceps

A

Ash
* mandibular premolars

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37
Q

65 Forceps

A

Upper Root forceps

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38
Q

15 blade

A

most common for intraoral sx

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39
Q

11 Blade

A

Stab Incisions

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40
Q

10 Blade

A

Large Skin incisions

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41
Q

12 Blade

A

Mucogingival surgery
* curved shape: improved access to sulcus

Curved shape
* easier to access sulcus

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42
Q

Irrigation

A

steady stream of sterile water/water during bone removal
* prevents heat generation (May devitalize bone)
* increases bur efficiency

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43
Q

Curettes

A

Spoon shaped end-scrape away soft tissue
always curette a socket

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44
Q

Rongeurs

A

double spring pliers

Trim interradicular bone

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45
Q

Curuttes promote better

A

Promotes better:
* clotting
* healing
* bony infill of socket

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46
Q

Osteotome

A

Aka Bone Chisel
Flat End
* tapped w/surgical mallet

Monobevel: Remove torus
Bibevel: Section teeth

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47
Q

Bone File

A

Final Smoothing before suturing

Pull stroke

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48
Q

Surgical Handpieces

A

Do NOT use air-driven handpiece
* leads to air emphysema

Straight fissure burs:
* section teeth

Round Burs:
* Remove bone

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49
Q

Hemostat

A

Hemostasis
* clamp blood vessels closed before suturing or cauterizing

Useful for blunt dissection of soft tissue
* I&D

Curved or straight beaks

Serrated End=Grasp Tissue

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50
Q

Needle Holder

A

Short Stout Beak: (compared to hemostat)
* Face of beak=crosshatched-better grasp of needle

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51
Q

Suture

A

Primary purpose: Immobilize flap

Place from movable tissue (Flap) to non-movable tissue

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52
Q

Adson tissue forceps

A

Toothed:
* periosteum
* muscle
* aponeurosis

Non-Toothed:
* fascia
* mucosa
* pathological tissue for biopsy

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53
Q

Utility forceps

A

Pick up items from tray or prepare packing materials
* NOT for soft tissue handling

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54
Q

Dean Scissors

A

Cut Sutures

Blade angles up: easier access to suture thread

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55
Q

Mayo Scissors

A

cut fascia & dissecting soft tissue

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56
Q

What are the preparatory steps for extraction?

A
  1. Remove entire correct tooth
  2. Check tooth condition
  3. Check Radiograph (PAN or PA)
  4. Informed Consent
  5. Comfortable positioning
  6. Profound anesthesia
  7. Throat Screen
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57
Q

Simple vs Surgical Extraction

A

Simple:
* no incisions or sutures

Surgical:
* surgical access w/ mucoperiosteal flap
* use Surgical handpiece
* suture needed

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58
Q

Steps involved in Simple extractioin

A
  1. Sever soft tissue attachment
  2. Luxate tooth with elevator
  3. Deliver tooth w/forceps
  4. Post ext:
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59
Q

Simple Extraction: Sever Soft Tissue Attachment

A

Use periostea Elevator:
* loosen gingival fibers & PDL attached to tooth
* confirms good anesthesia
allows apical placement of forceps

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60
Q

Simple Extraction: Luxate tooth with elevator

A

Face of blade:
* against tooth your extracting
Back of Blade:
* against alveolar crest

Find a purchase point

Lever
* fulcrum=alveolar bone
* not 100% on adjacent tooth
* = EXPANSION OF BONE & TEAR PDL

61
Q

Simple Extractoin: Deliver Tooth with Forceps

A

Slow and deliberate force
* tooth should first be moved then removed

Motions:
Outward (Buccal/Labial):
* initial movement for most permanent teeth

Inward (Lingual/palatal):
* initial movement of most primary teeth

Rotary:
* initial movement in conical-rooted teeth

Apical:
* Always used
* avoid excessive pressure in maxillary molars

UPPER 1st Premolar
CAUTION W?DEEP BIFURCATION
NO Rotation

UPPER Molars:
* Favor buccal pressure (palatal may push palatal root into sinus)

62
Q

Simple Extraction: Post-Ext

A

Bend B-L Plates back in place
* unless ortho and implants are planned in future

CSI:
* Curettage
* Smooth bone w/bone file or rongeur
* Irrigate w/syringe

63
Q

General Rules for Flap Design

A

Wider base

Incisions over intact bone
* NOT bony defects or eminences

Rounded Corners
Vertical Releases at Line angles
Avoid vital structures

Post-op plaque control=most important procedure after perio sx

64
Q

Types of Full Thickness Flaps

A

aka Mucoperiosteal Flaps

envelope:
* 0 vertical releases
* 2 teeth Anterior, 1 Posterior

3-cornered:
* 1 vertical release
* 1 tooth anterior, 1 tooth posterior

Trapezoidal:
* 2 vertical releases
* 1 tooth anterior, 1 tooth Posterior

65
Q

Semilunar Incision

A

Type of flap

Apical to mucogingival junction
* apicoectomy (endo sx)
* NOT on maxilla palate

66
Q

Double Y Incision

A

Type of Flap

Incision down Palatal midline
* 2 vertical releases at each end (Double Y)
* palatal torus removal

67
Q

Factors for Prediciting Difficult Extractions

A
  • Divergent Roots
  • Root Dilacerations
  • Endo treated tooth
  • Root Resorption
  • Long Roots
  • Dense Bone
  • Root Fracture
  • Proximity to floor of sinus/IAN
  • Limited opening
  • Bruxism
  • Exostoses or tori
  • Gross caries
  • Severe crowding
68
Q

What can surgical handpieces be used for?

A

remove buccal bone
* create ditch/trough=purchase point & path for delivery
* Careful if implant is planned

remove interradicular bone
* moves center of resistance apically
* careful if implant is planned

section tooth

1&2 create space for a purchase point

69
Q

Single Interuppted suture

A

Aka simple loop
* easiest
* most common technique

70
Q

Silk Sutures

A
  • wicking property- allows bacteria to invade
  • multifilament
71
Q

Mandibular Fractures

A

Best Eval with PANs

Condylar Fractures> Angle>Symphysis> Body>Alveolus>Ramus>Coronoid

Condylar Fracture: contralateral side of blow
Angle/gonial fracture: Ipsilateral side of blow

Ideal Tx: Open Reduction & Internal Fixation (ORIF)

72
Q

Types of Mandibular Fractures

A

Greenstick: not all the way throgh
Comminuted: Crushed into multiple fragments
Simple: Closed to oral cavity
Compound: Open to oral cavity, bone exposed through mucosa

73
Q

Midface Fractures

A

Best Eval with CBCT

LeFort I: Horizontal across maxilla

LeFort II: Pyramidal
* involves medial Orvit & Nasal Bone

LeFort III: Copmlete cranial fracture dysfunction

Zygomaticomaxillary complex fracture
* caused by direct blow to malar eminence (Cheekbone)
* Bleeding under conjuctiva (eye)

74
Q

Trauma Surgery

A

Reduction: Fracture fragments returned to normal position
* Open Reduction: Dissect tissue to Surgically expose fragments
* Closed Reduction: Manipulate fragments w/o surgical exposure

Fixation: Hold bone together for healing
* Internal Fixatoin: use titanium plates & screws to hold bone together
* Intermaxillary Fixation (IMF): wire the jaws closed; arch bars and elastics

75
Q

How are mandibular fractures ideally treated?

A

Open Reduction and interal fixation (ORIF)
* use occlusion to hold the jaw in place
* occlusal splints: 4-6 weeks

76
Q

Retrognathic Mandible

A

Class II

77
Q

Orthognathic Surgery

A

Correct Severe Skeletal Discrepancies
* require Lateral Cephs
* CBCT is becoming more common

Use: Acrylic Splint intraoperatively
* Occlusion guides surgical outcome

78
Q

Le Fort I Surgery/osteotomoy

A

Move Maxilla

Used for:
* retrusive maxilla
* vertical maxillary excess

79
Q

BSSO

A

Bisagittal Split Osteotomy

Move Mandible

Used for:
* retrusive mandible
* protrusive mandible

Most common post-op complication=nerve damage

80
Q

Distraction Osteogenesis

A

2 bone surfaces are gradually separated by traction
* then deposit bone b/w them
* Bone Lengthening (not width)

Phase 1: osteotomy
* Split bone in 2 pieces

Phase 2: Latency period
* appliance is mounted to bone
* not activated for 1 week

Phase 3: distraction phase
* activate appliance
* gradually separate the 2 pieces as bone fills in gap

81
Q

Biopsychosocial Model of Pain

A

Axis I: Bio
* nociceptive input from somatic tissue
* acute

Axis II: Psychosocial
* influence interaction b/w thalamus, cortex, and limbic
* Chronic (>6 months)

Its not just about the tooth (axis I), but also the person w/the tooth (axis II)

82
Q

Pain Pathway

A

1.Transduction: Pain info tavels from PNS to CNS
2.Transmission: Pain info travels from CNS to thalamus and higher cortical centers
3.Modulation: limit flow of pain info
4.Perception: human experience of pain= 1+ 2 + 3+ psychological factors of higher thought and emotion

83
Q

Somatic Pain

A

Increased Stimulus=Increased Pain
* typical dental pain
* Depends on Magnitude of stimulus

Musculoskeletal:
* TMJ
* Periodontal
* Muscles (Myofascial)

Visceral:
* Salivary glands
* pulpal

84
Q

Neuropathic Pain

A

Pain independent of stimulus intensity

Damaged pain pathway:
* Trigeminal Neuralgia (TN)
* trauma
* stroke

85
Q

Trigeminal Neuralgia

A

Aka Tic Douloureux

Postmenopause women (>50)

Symptoms:
* Trigger Point at specific location
* Electrical, sharp, shooting, and episodic, followed by refractory periods
* Unilateral, affects any of the 3 branches

Tx:
* anticonvulsants (Carbamazepine)
* surgery

86
Q

Atypical Odontalgia (AO)

A

Secondary to deafferentation (remove part of nerve pathway)
* result of endo therapy or ext

Localized Phantom Toothache

87
Q

Postherpectic Neuralgia (PHN)

A

Sequela of herpes zoster infection

Symptoms:
Burning, aching, shock-like

Tx:
* anticonvulsants
* antidepressants
* sympathetic blocks

88
Q

Burning Mouth Syndrome

A

Postmenopause women

associated with:
* type 2 diabetes
* malnutrition
* xerostomia

Characteristics:
* Burning pain
* dryness
* altered taste (maybe)

89
Q

Chronic Headache

A

aka neurovascular pain

Migraine:
* unilateral
* pulsating
* nausea and vomitting
* photophobia and phonophobia (Decreased ability to withstand sound and light)
* Tx: Tripan (Selective Serotonini Receptor agonist)

Tension Type:
* bilateral
* non-puslating
* not aggravated by routine activity

Cluster:
* intense pain near one eye

90
Q

Psychogenic Pain

A

Intrapsychic disturbance
* conversion reaction
* psychotic delusion
* malingering

91
Q

Atypical Pain

A

Facial Pain of unknown cause/diagnosis is pending

92
Q

Indications for tooth extraction?

A

Caries (Severe)

Endo:
* major trauma–> severe internal root resorption

Perio:
* Severe CAL
* questionable perio prognosis

Ortho:
* severe crowding

Cracked Teeth
* can’t be saved by a crown

Impacted Teeth
Supernumerary

Pathology:
* significant pathology related to tooth
* odontogenic cysts or infections

Radiation Therapy
* Extract all Questionable BEFORE
* avoid risk of ORNJ (Osteoradionecrosis of the Jaw)

93
Q

Root tip removal options

A

Root tip pick: Gouge into adjacent bone

Remove facial bone & elevate facially

Make bone windy at apex & push root out

94
Q

Prognathic Mandible

A

Class III

95
Q

Apertognathic

A

Anterior open bite

96
Q

Vertical Maxillary Excess

A

Maxilla too long
* gummy smile

97
Q

Horizontal Transverse Discrepancy

A

Posterior Crossbite

98
Q

Macrogenia

A

chin too big

99
Q

Microgenia

A

chin too small

100
Q

Orthognathic Surgery

A

correct severe skeletal discrepancies

101
Q

Genioplasty

A

Move Chin

102
Q

TMJ Anatomy

A

Conylar Head
Mandibular (Glenoid) Fossa
Articular Eminence
Articular Disc

Lower Joint space (inferior to disc): Rotational Movement
Upper Joint space (Superior to disc): Translation

103
Q

TMJ Muscles:

A

fxn: Move the mandible

Opening:
* Lateral Pterygoid

Closing:
* Masseter
* Temporalis
* Medial Pterygoid

104
Q

TMJ Ligaments

A

fxn: lmit movement of mandible from overextending

Capsular Ligament: Completely covers the TMJ

Discal/Collateral Ligament: Attaches to medial and lateral poles of condyle
* keeps disc attached during movement

Posterior Ligament:
* articular disc to back of condyle
* Prevents anterior disc displacement

Lateral Ligament:
* Disc–>wraps around condyle
* prevents posterior displacement

105
Q

TMJ: Blood Supply

A

MADS

Maxillary Artery
Ascending Pharyngeal
Deep Auricular
Superficial Temporal

106
Q

TMJ: Disc Displacement

A

Aka Internal Derangement

With Reduction:
* Clicking

W/o Reduction:
* Locked
* Condyle stuck behind the disk=decreased ROM w/ipsilateral deviation on opening

107
Q

TMJ Opening Patterns:

A

Deflection:
* Deflects towards the side that is stuck at max opening
* **Condyle only rotates, No translation

Deviation
* Deviates toward 1 side & returns back to midline at max opening

108
Q

Recurrent Dislocation

A

Move Jaw Down and Back to get over the hump of the eminence

Tx: Botox Injection of lateral pterygoid
* If chronic=surgery

109
Q

TMJ Ankylosis

A

Fusion b/w condyle & skull
* severely restricted ROM

Most common cause= TRAUMA

110
Q

Myofascial Pain Syndrome (MPS)

A

Chronic Muscular Pain Disorder:
* Somatic pain
* Diffuse pain in pre auricular area
* most common cause of masticatory pain
* Trigger points in muscles of mastication

Tx: Physical Therapy
* Stress management
* Splint therapy
* Medications

111
Q

TMJ: Non-surgical Tx Options

A

Counseling:
* Address parafunctional habits

Medical Therapy:
* NSAIDs, Steroids, Analgesics, Antidepressants, Muscle relaxants

Physical Therapy:
* Transcutaneous electrical nerve stims, massage, thermal tx, exercise

Occlusion:
* Splint therapy to Decrease intra-articular pressure

Arthocentesis:
* 2 needles flush out superior joint space

112
Q

TMJ: Surgical Tx Options

A

Arthroscopy:
* 2 cannulas + instrumentation w/in superior joint space

Arthroplasty:
* Disc surgically repositioned
* indicated if persistent painful clicking or closed lock

Discectomy:
* Disc/removal if it is severely damaged

Condylotomy:
* Vertical ramus osteotomy: Bone is not fixated
* allows soft tissue to reposition the condyle where they are happiest

Total Joint Replacement:
* only for severe pathologic joints
* Osteoporosis or Rheumatoid Arthritis

Be careful of Facial Nerve For any of these surgeries

113
Q

When is a biopsy indicated?

A

after 2 weeks observation of Red or White Lesion

114
Q

Biopsy Types

A
  1. Cytology (Brush Biopsy)
  2. Fine Needle Aspiration
  3. Incisional
  4. Excisional
115
Q

Cytology

A

Aka Brush Biopsy

Scrape the lesion w/kit brush or tongue depressor
* smear cells on glass slide
* immediately fixed

116
Q

Cytology: Indications

A

Monitoring large tissue areas for dysplastic changes

117
Q

Cytology: Pros vs Cons

A

Many false positives

118
Q

Fine Needle Aspiration

A

Use needle + Syringe to suck up lesion contents
* fluid expelled onto slide & fixed

119
Q

Fine Needle Aspiration: Indications

A

Fluid Filled Lesion

Find out type of fluid
*rule out vascular lesions before cutting into them

Explore intraosseous lesions

120
Q

Fine Need Aspiration: Pros vs Cons

A

Pros:
* Good at differentiating Benign vs Malignant

121
Q

Incisional Biopsy

A

Deep Narrow Wedge Cut

122
Q

Incisional Biopsy: Indications

A

Large Lesions (>1 cm diameter)

Malignant Suspicion

123
Q

Excisional Biopsy

A

Complete excision of lesion
* 2-3 mm margin
* Elliptical incision used (Easier to close)

124
Q

Excisional Biopsy: Indications

A

Small Lesions (**<1 cm diameter)

Benign Suspicion

125
Q

Biopsy Techniques

A
  1. Form a Ddx List: Help determine type of biopsy indicated
  2. Identify lesion margin w/indelible ink marker
  3. use Block Anesthesia when you can– Local Infiltration can distort lesion architecture
  4. Dont handle tissue directly (Crush the cells)– USE TISSUE FORCEPS
  5. Sample stored in 10% Formalin (H&E Staining) or Michaels Medium (direct immunofluorescence if pemphigoid/Pemphigus is suspected)
126
Q

What biopsy technique would you use for:

Large white patch on buccal mucosa that wipes off w/guaze and presumed to be candidiasis.

A

Cytology brush biopsy

127
Q

What biopsy technique would you use for:

Firm rough 2x3 cm whtie lesion on lateral tongue that does not wipe off with glaze.

A

Incisional Biopsy

128
Q

What biopsy technique would you use for:

Denture wearer presents w/red swelling in the buccal vestibule.

A

No Biopsy
* adjust the denture and f/u in 2 weeks

129
Q

Surgical Management of Cysts vs Tumors

A

Cysts:
* Enucleation
* Curettage
* Marsupialization

Tumors:
* Enucleation
* Curettage
* Resection

130
Q

Enucleation

A

Surgical Removal of mass w/o cutting into it or rupturing it

131
Q

Marsupialization:

A

Cut slit into abscess or cyst
* suture Slit edges- keep it open
* drains freely

Used for:
* cyst close to vital structures
* I&D

132
Q

Curettage

A

Removal of tissue by scraping or scooping
* remove granulation/infectious tissue

133
Q

Resection

A

Surgical removal of cyst or tumor + Normal tissue around it

134
Q

Medical Emergencies:

A

SPORT

Stop treatment
Position Patient
Oxygen*
Reassure (Staff and patient)
Take Vitals

135
Q

Syncope

A

Most common emergency in dental chair

Vasovagal syncope:
* Most common form
* related to needle anxiety

Orthostatic hypotension:
* 2nd most common
* BP drops when standing suddenly

Tx: Place in Tredelenburg position (Supine)
* If pregnant: Left lateral decubitus to relieve inferior vena cava

136
Q

Epinephrine Overdose

A

=Rapid intravascular injection
* Always aspirate

Signs & Symptoms:
* Increased BP & HR
* Thumping heart palpations

137
Q

Angina

A

=Chest pain from coronary arteries
* Not enough blood to heart
* ischemia w/o necrosis

Stable:
* Predictable w/activity and stress

Unstable:
* Spontaneous
* no precipitating factors, at rest

Tx: ONA
* Oxygen
* Nitroglycerin (0.4mg)-> 5 mins-> NTG-> 5 mins-> NTG
* Aspirin (w/3rd dose of NTG + Call 911)

138
Q

Myocardial Infarction

A

Aka Heart Attack
=Angina caused by ischemia w/necrosis
* sudden occlusion of major coronary vessel (Offend L Anterior Descending Artery, LAD)

Tx: MONA
* Morphine
* Oxygen
* Nitroglycerin(0.4mg)-> 5 mins-> NTG-> 5 mins-> NTG
* Aspirin (w/3rd dose of NTG + call 911)

139
Q

Hypoglycemic Emergency

A

Ensure patient has eaten, and has had adequate insulin

Tx:
* IF conscious: Glucose tab or orange juice
* If Unconscious: IV Dextrose or IM Glucagon

140
Q

Hyperventilation

A

Increase O2 Decrease CO2 in blood

Do NOT give O2, it will make it worse

Tx:
* Position patient upright
* Get them to create into a paper bag (They rebreathe their CO2)

141
Q

Asthma

A

=Constriction + Inflammation of bronchioles
* wheezing= high pitch on exhale (Cardinal Sign)
* Avoid NSAIDs and Narcotics

Tx:
* 2 puffs of Albutterol:
* relaxes smooth muscle in bronchioles

142
Q

Airway Obstruction

A

Tx:
1. Clear the pharynx of any food, vomit, or foreign object
2. Check for breathing (rise and fall of chest, sounds in mouth/nose)
3. Chin tilt –>protrudes tongue and mandible forward

143
Q

Seizure/Convulsions

A

Do not restrain, just clear hazards to protect from injury

Tx:
* IV/IM Benzos (Diazepam)
* Grand Mal Seizure: Dilantin/Phenytoin
* Status Epilepticus (>5 mins): Valium/Diazepam

144
Q

Stroke

A

TIA: Transient Ischemic Attack
* Mini stroke
* Blood to brain blocked for few mins

CVA: Cerebrovascular accident
* either Thrombotic (Blockage) or Hemorrhagic (Rupture)

Causes:
* Hypoatremia

Signs:
* Facial droop
* arm lift
* slur

Tx: O2 + Call 911 immediately

145
Q

Anaphylactic Shock

A

=Severe Allergic Run

Tx: AEIOU
* Albuterol
* Epinephrine (0.3mg 1:1000)
* IM antihistamine
* Oxygen
* U call 911

146
Q

Anticoagulation: Blood Tests

A

Check Blood Tests:
CBC: Anemia, Leukopenia, Thrombocytopenia

Bleeding Time: Platelet Fxn

PT:
* Anticoagulants, liver damage, Vit K-> Extrinsic Clotting Pathway
* INR->Warfarin/Coumadin, INR=2-3 Ideally

PTT: Heparin, Renal Dialysis, Hemophilia->Intrinsic Clotting Pathway

147
Q

What medication can predispose someone to alveolar osteitis?

A

ORAL CONTRACEPTIVES

148
Q

Supraperiosteal Flap

A

Incision in Buccal mucosa from premolar to premolar
* does not include periostium=partial thickness flap
* Vestibuloplasty

149
Q

Herbal Anticoagulants

A
  • Garlic, Ginger, Ginko, Ginseng

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