Lecture 7: Triage & emergency services

Question 1

The process of sorting injured people based on their need for immediate medical treatment as compared to benefiting from such care:

Answer 1

Triage

Question 2

Triage is done in ____, ____ & ___ when limited medical resources must be allocated to maximize the number of survivors

Answer 2

emergency rooms, disasters & wars

Question 3

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

Answer 3

Green tags

Question 4

(Observation) for those who require observation (as 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 still be treated immediately under normal circumstances:

Answer 4

Yellow tags

Question 5

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

Answer 5

Red tags

Question 6

T/F: Dentists in the military or disaster control are often used to triage thus freeing medics to work critical care. Additionally, dentists are used to identify burned or other unidentifiable bodies for identification/legal purposes

Answer 6

True

Question 7

You cannot control the _____ of patients, BUT you DO need to perform “_____” to determine their condition & treatment needs

Answer 7

Needs/desires; type of triage

Question 8

It would be ideal to have every patient in your practice pursuing a strict & planned:

Answer 8

comprehensive dental program

Question 9

1 Priority:

Answer 9

systemic problmes

Question 10

How can you help a person?

1. you must start with a ____
2. you must start with a thorough & appropriate ____
3. you must perform appropriate ____
4. you must develop an accurate ____
5. you must come up with an appropriate ___

Answer 10

1. health history
2. examination/studies
3. clinical testing/radiographs
4. diagnosis
5. treatment plan

Question 11

What options should you present to the patient and how should you do this?

Answer 11

ALL options in a clearly understandable language

Question 12

Your treatment options should present the ____ & ____ in simple terms

Answer 12

risks & benefits

Question 13

What are some of the patients responsibilities that must be presented to them?

Answer 13

1. cost for each option
2. time required for each option
3. maintenance required for each option
4. expected prognosis & longevity of each option

Question 14

The patient must understand _____ or no permission for treatment exists

Answer 14

potential complications

Question 15

The professional must be _____ to avoid untoward/unreasonable options in presenting to the patient

Answer 15

responsible

Question 16

What are some questions that need to be considered by the provider when deciding treatment options?

Answer 16

1. is the tooth STRATEGIC & FUNCTIONAL?
2. is the tooth REASONABLY RESTORABLE?
3. is their a PERIODONTAL SITUATION which is compromising?
4. are there other QUESTIONABLE INVOLVEMENTS?
5. is the treatment REASONABLY AVAILABLE?

Question 17

List the moral, ethical & professional obligations required of a dental provider:

Answer 17

1. we may NOT begin treatment & then fail to complete same day
2. we may NOT propose to offer any treatment for which we are not qualified
3. we may NOT refer the patient to someone whom is not qualified
4. we may NOT refuse to provide treatment to the patient for any reason covered by a federally protected group

Question 18

T/F: 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

Answer 18

True

Question 19

T/F: We may refuse to provide treatment to the patient for any reason covered by a federally “protected group”

Answer 19

False- we may NOT refuse

Question 20

How CAN we help the patient effectively & efficiently in an emergency?

Answer 20

1. Patient having SYMPTOMATIC IRREVERSIBLE PULPITIS but no PA sensitivity no PARL and no swelling or fever
2. PULP EXPOSURES
3. Patient having SYMPTOMATIC IRREVERSIBLE PULPITIS (or AIP or NECROTIC PULP) with PA sensitivity, PARL and swelling or fever

Question 21

Can you help this patient effectively & efficiently in an emergency?

• patient is having SYMPTOMATIC IRREVERSIBLE PULPITIS but no PA sensitivity no PARL and no swelling or fever

Answer 21

Yes

Question 22

Can you help this patient effectively & efficiently in an emergency?

• patient comes in with PULP EXPOSURE

Answer 22

Yes

Question 23

Can you help this patient effectively & efficiently in an emergency?

• patient comes in with SYMPTOMATIC IRREVERSIBLE PULPITIS (or AIP or NECROTIC PULP) with PA sensitivity, PARL and swelling or fever

Answer 23

Yes

Question 24

What is the:
-best practice builder
-gives patient an instant trust you
-helps YOU feel better about yourself

Answer 24

Helping patient escape from pain

Question 25

Any tooth with irreversible pulpitis or PA pathology of endodontic origin is best treated by:

Answer 25

Total pulpectomy & RCT

Question 26

What are some constraints with emergency treatment of total pulpectomy & RCT?

Answer 26

1. Time constraints
2. $ contstraints
3. other constraints

Question 27

In simple terms, what does emergency treatment mean?

Answer 27

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)

Question 28

If we BEGIN any treatment:

Answer 28

we are required to COMPLETE the treatment

Question 29

If you BEGIN treatment & DON’T COMPLETE the treatment, we can be charged with:

Answer 29

abandonment

Question 30

If you do NOT BEGIN the treatment in the first place we can:

Answer 30

refer & avoid liability

Question 31

A patient presents with:
-symptomatic irreversible pulpitis
- no PA involvement
-no PARL
-no swelling
-NOT sensitive to percussion

The best emergency treatment:

Answer 31

Vital coronal pulpotomy

Question 32

What is the expected outcome of emergency treatment of symptomatic irreversible pulpitis, with no PA involvement, no PARL, no swelling, no sensitivity to percussion AFTER doing a vital coronal pulpotomy?

Answer 32

1. absence of presenting pulpal pain
2. should remain comfortable for a short period of time until canals become necrotic
3. patient will need appointment with endo prn
4. will require RCT & crown at a later date

Question 33

How should you provide emergency treatment to a patient with:

• asymptomatic vital pulp exposure without pain

Answer 33

1. Do all the clinical testing (test atleast 3 baseline teeth) and record
2. Fill out endo diagnosis form ( before O&R if pulp exposure may occur)
3. Isolate tooth in question with dental dam
4. Remove all caries and unsupported enamel (if pulp is exposed)
5. Disinfect with NaOCl and arrest hemorrhage
6. Pulpcap exposure with dycal
7. Place temporary restoration such as paracore or IRM
8. After restoration take 2 radiographs (1 straight on & 1 shift shot at 20 degrees)
9. contact endo faculty with subject of email “pulp exposure” including patient name, and chart #, involved tooth and brief history

Question 34

If a patient presents with an asymptomatic vital pulp exposure (without pain), prior to working on the exposure, you should do all:

Answer 34

clinical testing & record results (test atleast 3 teeth as baseline)

Question 35

If a patient presents with an asymptomatic vital pulp exposure (without pain), when clinical testing of the tooth, how many teeth should be tested for baseline?

Answer 35

3

Question 36

T/F: If a patient presents with an asymptomatic vital pulp exposure (without pain), after clinically testing you should fill out endo diagnosis form - prior to temp restoration

Answer 36

True

Question 37

T/F: If you are doing an O&R and think there may be a chance of pulp exposure, you should fill out endo diagnosis form before

Answer 37

True

Question 38

If a patient presents with asymptomatic vital pulp exposure (without pain), you should _____ the tooth in question with ____

Answer 38

isolate; dental dam

Question 39

If a patient presents with an asymptomatic vital pulp exposure (without pain), you should remove all:

Answer 39

caries & unsupported enamel (if pulp is exposed)

Question 40

If a patient presents with asymptomatic vital pulp exposure (without pain), what should you disinfectant agent be after removing the caries and unsupported enamel?

Answer 40

8.3% NaOCl

Question 41

If a patient presents with an asymptomatic vital pulp exposure (without pain), after disinfecting with 8.3% NaOCl, you should:

Answer 41

1. arrest hemorrhage
2. pulp cap with dycal
3. place a temporary restoration

Question 42

What do we pulp cap a tooth with if the patient presents with an asymptomatic vital pulp exposure (without pain)?

Answer 42

Dycal

Question 43

If a patient presents with an asymptomatic vital pulp exposure (without pain), after dycal placement, a ____ should be placed such as ____ or ____

Answer 43

temporary restoration; Paracore or IRM

Question 44

T/F: An IRM is the only option of temporary restorations that should be place with asymptomatic vital pulp exposures without pain

Answer 44

False- paracore may also be placed

Question 45

If a patient presents with an asymptomatic vital pulp exposure (without pain), and you have completed the temporary restoration, what radiographs need to be taken?

Answer 45

2 radiographs
-straight on
-20 degree shift shot

Question 46

If a patient presents with an asymptomatic vital pulp exposure (without pain), and you have completed the temporary restoration & radiographs, you should contact endo faculty on exchange email including:

Answer 46

• subject: pulp exposure
• patient name
• patient chart #
• tooth #
• brief history