Oral surgery Flashcards Preview

Dent: Finals > Oral surgery > Flashcards

Flashcards in Oral surgery Deck (151):
1

What are the signs of reversible pulpitis?

Pain on hot and cold, sugary things
Not TTT
Vital (+ve PE)
On stimulus (goes away when removed)
Relieved with analgesia

2

What are the signs of irreversible pulpitis?

Pain on hot (also cold)
Not TTT
Hypersensitive or delayed PE response
Not relieved by analgesics
Keeps patient up at night

3

What are the signs of Acute apical periodontitis?

TTT
Non vital
Can be due to progression from irreversible pulpitis or alone e.g. high spot on restoration, endo filling extruding past apex, bacterial invasion at apex and infection from gingival communication

4

What are the signs of Chronic apical periodontitis?

Sinus
Longer duration
May be painless, non-vital
Large radiographic radiolucency

5

What are the signs of an acute exacerbation of CAP?

TTT
Painful
Longer duration but now painful
Non vital

6

What are the signs of Acute apical abscess?

Infection after RCT/pulpal infection
non vital
Pus
swelling
fever

7

When do you give antibiotics?

If systemic (i.e. fever)

8

What antibiotics do you give for dental infection? (SDCEP)

Amoxicillin 500mg for 5 days (if allergic use metronidazole 400mg)

(double dose for severe infections)

9

When should you send a patient to hospital?

When infection has spread causing cellulitis or submandibular swelling threatening the airways

10

Where does infection spread when apices close to the lingual cortical plate?

Above mylohyoid muscle = can spread to sublingual space = elevated tongue, swelling of floor of mouth, can force tongue upwards and close airway

11

Where does infection from the mandibular molars spread?

Below mylohyoid muscle into the submandibular space

12

What is Ludwigs angina?

When an infection affects submental, submandibular and sublingual spaces bilaterally = DANGEROUS - obstruction risk

13

Where do midface infections spread?

Oedema and pressure can cause blood to back up through cavernous sinus = cavernous sinus thrombosis - a sharp pain behind the eye which gradually gets worse, decreased vision, increased eye movements, dilated pupils = DANGEROUS and life threatening

14

How can infection lead to blindness?

Track through maxillary sinus -> orbital space = orbital cellulitis

15

How can infection get to the posterior mediastinum?

Behind retropharyngeal space (danger zone) = posterior medistinum

16

What is it called when infection gets into the bone?

Osteomyelitis

17

What % of septicaemia cases lead to death?

50

18

What is Eryspilas?

Acute infection of deep dermis by s. pyrogens
Causes blistering rash/orange peeling of skin
Red and raised skin/fever/lymphadenopathy/vomiting and shaking within 48 hours

19

What are the general routes of infection for the upper teeth?

Upper 1s - labial sulcus/nose
Upper 2s- Palate/labial sulcus
Upper 3s -infraorbital/labial sulcus
Upper 4s-8s - Buccal sulcus/buccinator

20

What are the general routes of infection for the lower teeth?

Lower 1s and 2s - submental
Lower 3s and 4s - sublingual space (above mylohyoid)
Lower 5s to 9s - submandibular (below mylohyoid)

21

How does diabetes effect tooth infection?

Increased prevalence of apical infections
Increased complications from dental abscess

22

How does smoking and alcohol effect tooth infection?

Increase risk of infection
Decrease resistance to infection

23

What is the treatment for an abscess:

Incision and drainage and RCT/XLA
Analgesics advised
Antibiotics only if: systemic, cellulitis, trismus, medically compromised

24

If abscess is serious and life threatening what antibiotics do you give?

Amoxicillin and Clauvonic acid/metronidazole

if allergic metronidazole or clindamycin

25

What are the SDCEP guidelines for antibiotics?

Always get rid of infection by extirpation/XLA
May need incision if not all pus removed
Only prescribe antibiotics if: severe (AAA or trismus) or spreading infection (lymphadenopathy, cellulitis, if can't feel lower border of mandible, in ludwig's angina), systemic involvement (fever >38, malaise, loss of appetite, unwell), patient factors (immunocompromised, bleeding risk etc)

26

When should you consider a lower dose of antibitics?

Renal and liver function issues

27

What is the % risk of allergy to penicillins?

1-10% (0.05% risk of anaphylaxis)

28

What is a common side effect of penicillins?

Diarrhoea

29

What dose of amoxicillin is prescribed?

>5 y/o 500mg 3x daily for 5 days
(<1 125mg, 1-5 250mg)

30

What dose of phenoxymethylpenicillin is used?

>12y/o 500mg 4x daily for 5 days
(5-12 250mg, 1-5 125mg, <1 65.5mg)
Poorly absorbed
PENICILLIN ALLERGY

31

What dose of metronidazole is used?

>18 y/o 400mg daily for 5 days
(<10 200mg, <7 100mg 2/day, <3 50mg 2/day)

32

When is metronidazole used?

ANUG
Pericoronitis
Part of perio pill
With amoxicillin in severe infections

33

When should metronidazole not be used?

Pregnancy
Breastfeeding
Warfarin
Alcohol
Chrons

34

When is clindamycin used?

Allergy to penicillin and pregnancy
X Chrons Ulcerative colitis
150mg 4/day 5 days

35

When is clarythromycin used?

Good for patients who have shown resistance or allergy to penicillin
X pregnancy/breastfeeding/warfarin/statins/heart/kidney/liver problems
150mg 2/day for 7 days

36

When is Co-amoxiclav used?

Severe dental infections and spreading cellulitis
X penicillin allergy or liver problems
Side effect: Steven Johnsons syndrome
375mg 3/day for 5 days

37

When is tetracycline (doxycycline) used?

Dip avulsed tooth pre-implanting open apex tooth (1mg: 20 ml saline), perio (20mg 2/day for 3 months)
X pregnancy/breast feeding / under 12 -> staining

38

When is Floxacillin used?

Staph skin infections and cellulitis
(good for patients with resistance)
250mg 4/day for 5 days

39

Why is erythromycin not very useful for dental infections?

Resistance
(also dont use in pregnancy or warfarin)

40

When is chlorhexidine used?

0.2% 10 mg for 1 min 2 x daily for perio
Reduces plaque 50-90%
Safe for pregnancy/breastfeeding
BEWARE OF ANAPHYLAXIS RISK
DOnt use in <12 y/o

41

What are the antibiotic cover guidelines: (NICE and SDCEP)

Cover is:
- not recommended for routine dental appointments (e.g. fillings and dentures)
- if platelets < 50 x 10^9 (n.b. can't give IDB at this level)
- if WBC <1.5 x10^9 (oral 3g amoxicillin or 600mg clindamycin 1 hr before XLA)
- Consult cardiologist if patients need cover for: XLA, RCT, RSD if at high risk of infective endocarditis (congenital heart disease, septal defects, previous episode of IE, prosthetic valves, hypertrophic cardiomyopathy... mid risk: IV drug users)
- Dont give for MRONJ/osteoradionecrosis prophylaxis just warn patients of risk
- cover patients: Haemophiliacs/von willebrand disease, immunocompromised (bone marrow transplant, HIV, chemo) and prosthetics with rheumatoid arthritis/infection

42

What are the steroid cover guidelines (at UH Bristol)?

Group A = addison's disease - see in hospital setting
Group B = long term steroids - Prednisolone >5mg 3 weeks -> double dose on day of XLA or 100mg IV hydrocortisone

43

When do we treat and individual on chemotherapy if required?

Just before/day of chemo
(highest risk of bacteraemia 14days post chemo), recover counts 28 days post chemo (just before next dose)

44

What are the guidelines for warfarin? SDCEP

Check INR within 24 hours
INR <4 proceed with XLA
INR >4 delay XLA and contact GP - ref. to hospital if XLA urgent (IV vit k)
Pack and suture
No NSAIDS - paracetamol only
No metronidazole, erythromycin or clarithromycin
No antifungals

45

What are the guidelines for Heparin (deltaparan, enoxaparin, tinazaparin)? SDCEP

Ref to hospital for XLA
Reverse by protamine sulphate
(Factor 10a inhibitors)

46

What are the NOACs?

Apixiban and rivaroxaban (inhibit factor 10a)
Dabigatran (inhibits thrombin)

47

What are the guidelines for NOACs? SDCEP

Always do XLA in morning in case of complications
Pack and suture
No NSAIDS - paracetamol only

Apixiban and dabigatran (miss morning dose)
Rivaroxaban (if taken in morning delay dose and take 4 hours post haem, if taken in evening take as normal)

48

What are the guidelines for anti platelets (Aspirin, clopidogrel, dipyridamole)? SDCEP

Pack and suture
No NSAIDs

49

What are the guidelines for SSRI + carbamezipine? SDCEP

May increase bleeding risk but no extra measures taken

50

What are the contraindications to ibuprofen?

Pregnancy
Antiplatelet or anticoagulant
Asthma
Elderly (caution)
Peptic ulcers/gastric bypass surgery
Uncontrolled hypertension (if controlled limit to 5 days)
Kidney disease
Chrons/ulcerative colitis
Past TIA/stroke
Any heart conditions/surgery

51

What can cause increased risk of bleeding?

Head and neck chemo and radiotherapy <3 months
Kidney disease
Liver disease
Ehlers danlos syndrome
Scurvy (low vit c)
Thrombocytopenia (platelet cover)
Haemorrhagic telangiectasia (hereditary)
Hameangioma
Sturge Webers (CT before XLA to prevent haemorrhage)

52

What extra tests are needed for kidney disease?

FBC for platelets
Thrombopoietin can be given to make platelets from bone marrow

53

What extra tests are needed for liver disease? SDCEP

INR + FBC + LFT + clotting screen

54

What are the guidelines for all bleeding disorders? SFCEP

Refer to hospital for XLA
Given 1g oral tranexamic acid (stop clot breaking down)

55

How do we treat Haemophilia A extractions?

IV Factor 8 1 hr before, desmopressin and tranexamic acid

56

How do we treat Von Willebrand disease extractions?

IV factor 8 1 hr before, desmopressin and tranexamic acid

57

How do we treat Haemophilia B extractions?

IV factor 9 1 day before and tranexamic acid

58

How do we treat Haemophilia C extractions?

IV factor 11 and tranexamic acid

59

What are the signs of haemorrhage?

Low BP, cold extremities, increased HR

60

What are the guidelines for pregnancy? SDCEP

Dont lie flat
Xrays - avoid in 1st trimester, lead apron if urgent but if non urgent wait until 2nd
Urgent XLA can be done in 2nd trimester, Non urgent wait 6 weeks after birth
Sedation : none
Avoid Felypressin containing LA - induces labour
Avoid: metronidazole, tetracycline, clarithromyicn
Antibiotics: amoxicillin or clindamycin (if allergy)
RCT: No odontopaste or lefermix -> use hypo cal
Analgesia: no NSAIDS or codeine -> use paracetamol
Antifungals: No systemic -> use nystatin
If symphilis/HSV/mumps/rubella = urgent referral (tetrogenic)

61

What are the guidelines for paracetamol? SDCEP

2 x 500 mg 4/day every 4 hours for 5 days
Max dose = 4g (adults)
Overdose = 8 tablets or 75mg/kg in 1 day -> A and E
Contraindication = liver problems and severe renal impairment

62

What are the guidelines for Ibuprofen? SDCEP

400mg tablet 4/day every 4 hours with meals for 5 days
Max dose = 2.4g (adults)
Overdose = 8 tablets or 75mg/kg in 1 day -> A and E
Contraindication = uncontrolled asthma, hypersensitivity ti NSAIDs, GI sensitivity, peptic ulcers

63

What are the guidelines for Diclofenac? SDCEP

50mg 1 x daily for 3 days
Max dose 150mg
NOT recommended in children, ischameic heart disease, cerebrovascular disease, heart failure, hypertension, low dose daily aspirin and use with caution with warfarin and anticoags

64

Who is at high risk of MRONJ?

- previous MRONJ
- taking meds for cancer (breast, prostate, blood or multiple myeloma) > osteoporosis
- + bisphosphonates (>5 years = high risk)
- + steroids
- anti resorptive and anti angiogenic drug risk > anti resorptive > angiogenic
- Denosumab (monoclonal antibody) in past 9 months

65

What should you do when placing a patient on anti-resorpatives?

- Prioritise prevention: OHI/fluoride/diet/smoking/alcohol/regular visits + Bas
-reduce mucosal trauma (denture adjustment/perio)
- avoid future extractions
- extract poor prognosis teeth
- tell patient of risk of developing MRONJ (small risk so not discouraged from taking their medication and dental treatment)
- NO ANTIBIOTIC PROPHYLAXIS

66

Following extraction in high risk MRONJ patient what should you tell them?

Contact practice if:
- unexpected pain, tingling, numbness or swelling post XLA

67

When is it classified as MRONJ?

When its been there for > 8 weeks
= Refer to oral surgery/special care dentistry

68

Define MRONJ?

History of antiresorbative/anti-angiogenic drugs and exposed bone > 8 weeks that can be probed through an IO/EO fistula, in the maxillofacial region where there has been no history of radiation therapy or cancer to the jaw

69

Define osteoradionecrosis?

History of radiotherapy and exposed bone > 8 weeks that can be probed through an IO/EO fistula, in the maxillofacial region, where there has been no history of antiresorbative/anti-angiogenic drugs

70

What are the signs and symptoms of MRONJ?

Delayed healing after XLA, non healing sores, pain/infection/swelling, loose teeth, numbness/parasthesia, exposed bone >8 weeks

71

What can cause MRONJ?

Any dental trauma
Spontaneously

72

Which jaw is MRONJ more common in?

Mandible (less blood supply)

73

What is the risk of developing MRONJ if on antiresorpatives for cancer?

1%

74

What is the risk of developing MRONJ if on antiresorpatives for osteoporosis?

0.1%

75

name the antiresopative drugs:

Bisphosphonates
Denosumab
Alendroate

76

Whats the half life of alendroate?

10 years

77

how long does it take for denosumabs effects to diminish?

9 months

78

name the anti-angiogenic drugs

bevacizumab
aflibercept

79

Can you place implants in a cancer patient?

Generally agreed to avoid (risk currently unknown)

80

Can you place implants in an osteoporosis patient? SDCEP

Not currently contraindicated but BRONJ less frequent if placed before bisphosphonates taken (insufficient evidence on survival or denosumab)

81

Should bisphosphonate have 'drug holidays' for extractions etc,? SDCEP

No evidence to support a reduced risk in temporarily or permanently stopping prior to XLA as persists in bone for years

82

Whats the advice for drug holiday for denosumab? SDCEP

6 monthly IV for osteoporosis - delay non urgent XLA to 1 month before next IV scheduled and resume when socket is healed (liase with GP)

83

Can you extract a tooth in a high risk patient in practice?

Yes - no benefit in referral to secondary care
If suspect MRONJ - refer to oral surgery/special care and report to allow card for bone sequestral removal, antibiotic therapy and topical antiseptic

84

What are the contraindications to IV midazolam conscious sedation?

Hypothyroid
COPD
Liver disease
Pregnancy/lactation
Malignant hyperpyrexia
Prophyria (abnormal metabolism of pigment in Hb)
Renal failure
Heart failure
Very old
Unaccompanied
Under 12
Cant communicate

85

What are the contraindications for NO inhalation sedation?

COPD
Blocked airway/ upper respiratory tract infection
Pregnancy
URTI
Claustrophobia
Cant communicate e.g. deaf
B12/folate deficiency - caution
Eye surgery that has used intraocular gas
Mouth breather
Heart conditions (caution)

86

When can NO inhalation sedation be used?

Adults with psychiatric disorders
Mental retardation
Prolonged procedures
Gag reflexes

87

What are contraindications to GA?

Hypothyroid
Hyperthyroid
Pregnancy
Obesity
Anaemia
Any heart conditions
Respiratory conditions (TB, emphysema, COPD)
Uncontrolled disease

88

Risks of extraction:

pain
swelling
bruising
infection
bleeding
crown or root fracture
scarring
dry socket
tuberosity fracture
OAC (upper 4-7)
surgical required (rare)
root being displaced in adjacent structures
numbness - temp/permanent change or loss of sensation

89

Whats the max dose of lidocaine?

without adrenaline 4.4mg/kg
with adrenaline 7mg/kg

90

What LA should you use with liver problems?

Articaine or Procaine or <300mg lidocaine

91

What LA should you use in pregnancy?

NOT prilocaine with felypressin

92

What LA should you use in recent MI?

Refer to hospital (50% likely to have second MI in first 3 months)
No adrenaline

93

At what platelet level should we not give and IDB?

<50x10^9

94

In open apex or apical root fracture what should you irrigate RCT with?

LA

95

What are the pterygomandibular borders?

Post - parotid
inferior - inferior border of mandible
mesial - mesial pterygoid
lateral - ramus
superior - lateral pterygoid

96

How common is IDB parasthesia?

Temp 1-5%
Permanent 0-1%

97

How common is lingual nerve parasthesia?

Temp 0.4-1.5%
Permanent 0-0.5%

98

What is neuropraxia?

temporary paraesthesia from stretching

99

What is axonotmesis?

Deviation of axon = temp paraesthesia

100

What is neurotmesis?

deviation of nerve = permanent paraesthesia

101

why does LA fail?

Infection/abscess -> increased permeability of blood vessel = wash away LA, prostaglandins = reduced pain threshold for nerve, acidic environment = LA can't diffuse through tissue to nerve

Poor technique (positioning and insufficient LA)
Complex anatomy (accessory nerves)
Wait 5-10 mins!

102

What are the contraindications to XLA?

Uncontrolled diabetes
Recent MI (3 months)
Uncontrolled angina
Pregnancy (best to wait until 2nd trimester)
Bleeding disorders (need prophylaxis)
Trismus (blocking access)
Infection so severe LA won't work

103

At what point should you refer to hospital?

8s that are close to IDN (need CBCT) or >5mm winters line
Airway risk (stride, hot potato voice, can't feel lower border of mandible, can't stick out tongue, can't swallow)
Ludwigs (dont take tooth out if has soft tissue infection because infection could track back to airway)
Medical emergency risk - uncontrolled condition (diabetes, angina)
MI < 3 months ago
Impacted/ectopic teeth
High risk of OAC
Bleeding disorder/risk/INR >4
Need sedation
Tooth is in tumour
Severe trismus blocking access (alkinosi not working)
Infection severe so LA won't work
Dentigerous cyst
Unerupted teeth close to mucosa
Infra-occluded deciduous teeth (most commonly E's)
Impacted 8's -> caries to distal of 7
Ectopic 3's -> resorption of laterals

104

What are the indications for XLA in practice?

Ortho
Caries non restorable (below level of alveolar bone)
Severe perio (grade 2 mobile)
Pt uncompliant or poorly motivated
Immunocompromised
Cant do RCT (8's/roots already resorbed/sclerosed canal/strange morphology)
Trauma (dentoalveolar fracture, bertical root fracture, teeth in line of fracture)
Dental clearance prior to screen (MRONJ, chemo, radiation, bone marrow transplant)
Retained roots
Supernumary

105

What do you do if you have a maxillary tuberosity fracture?

If not infected = stop and splint tooth for 4-6 weeks
If infected = remove it and do buccal flap

106

What increases the risk for a maxillary tuberosity fracture?

lone standing tooth, bulbous roots, increased age, wrong elevator use, ankylosis, sinusitis, osteoporosis or very dense bone and upper 8's

107

What do you do if you have an OAF?

ADAM
Analgesia
Decongestants (xylometazoline, phenyl ephedrine hydrochloride)
Antibiotics (amoxicillin./erythromycin)
Menthol steam inhalation

Buccal flap + vertical mattress suture 10-14 days and ref to ENT if there is pathology in antrum

108

What do you do if fractured root?

Non vital/infectedd = remove
Vital/not infected = leave to resorb if <5mm apical

109

What do you do if tooth is displaced not maxillary antrum?

In practice - if can see XLA
If can't - raise flap and suture? ref to O/S immediately
Hospital/GA: caldwell luc

110

What is the prevention for displacement into maxillary antrum?

Never use forceps on upper PM/M root fractures or RR

111

What do you do if you damage the mandible?

Refer to O/S

112

What do you do if tooth displaced into pterygomandibular space

Refer

113

What do you do if tooth displaced into lingual much?

Airway risk
If can see it - get it out ASAP
If can't - Refer for GA referral = need LSO, lateral oblique and PA

114

What do you do if 8s in pterygomasseteric space/infratemporal fossa?

Refer

115

Wha do you do if inhale tooth?

Refer for chest xray
Heimlich x 5 if needed

116

What do you do if you extract the wrong tooth?

tell patient, contact ortho + defence society
extract right tooth if non vital/infected etc.

117

What do you do if the crown fractures?

Use luxator or go surgical

118

What do you do if LA failure?

AB's for 3-4 days + try again or refer if an emergency

119

What do you do if fails XLA?

Look at X-ray for sclerosis, root morphology, ankylosis (use smaller forceps/luxator or go surgical and divide roots with fissure bur)

120

What do you do if nerve damage?

should have been part of consent
2 week review + second opinion

121

What do you do with post op pain?

Take a history diagnose
If too tight sutures/sutures not dissolved = remove sutures
Hot salt mouth rinse

122

What do you do with dry socket?

take temp, saline rinse, alveogyl, return if not improved in 24 hours
(No chlorhexidine - anaphylaxis risk)

123

How common is a dry socket?

Routine extractions 0.5-5%
Surgical impacted L8s 30%

124

How do you prevent dry socket?

Chlorhexidine but study showed that although it reduced frequency anaphylaxis and antibiotic resistance meant it does more harm than good
Some dentists debride socket to encourage bleeding

125

What are the post op instructions for extraction?

No smoking
No alcohol
No rinsing for 24 hours
After 24 hours hot salt water rinses after eating
No heavy exercise for next 24 hours
Take OTC analgesia within dose
20 mins compression if starts bleeding

126

What are the risk factors for dry socket?

Poor blood supply
Mandible (collects more food debris)
Molar (larger defect)
Smoking (nicotine causes vasoconstriction)
Traumatic/surgical XLA (crushes blood vessels)
Sclerotic bone (pagets, hypoparathyroidism, chronic osteomyelitis, bone cancer, osteopetrosis, cement-osseous dysplasia)
Radiotherapy
Diabetes (damage to blood vessels)
LA (vasoconstrictor)
Loss of clot - mouth rinsing, local trauma (brushing), OCP oestrogen, prexisting perio/anug/pericorinitis less likely to cause dry socket when extracted)
Previous history
Poor OH

127

What are the signs and symptoms of a dry socket?

Not infection (no fever/lymphadenopathy or pus)
Severe dull aching throbbing pain not relieved by analgesia, may radiate to ear/temple/neck
2-4 days post XLA
redness
mild trismus (post. XLA)
empty socket with exposed bone
Halitosis (food debris stagnating in pocket)
Bad taste
n.b. swelling may hide dry socket from clinical exam

128

What is in alveogyl?

Eugenol, iodoform, butamben, peppermint oil

129

What patients should you not use alveogyl on?

Allergy to procaine
Allergy to iodine

130

When are wisdom teeth removed?

Dentigerous cyst
Resorption of 7's
Causing caries on 7
Periodistal to 7 can cause communication to 8 so should extract 8
Denture wearing resorb alveolar ridge exposing and carious 8
Carious 8

131

What do you need to assess 8's?

OPG (depth of impaction shows if surgical, winters line, angulation of tooth and IDB)
PA (root form, length and curve of root, adjacent teeth carious)

132

What are the radiographic signs that 8 is close to IDB?

Loss of tram lines
Diverging tram lines
Constriction
Radiolucency at end of root

133

What is pericoronitis?

inflammation of the operculum due to:: occluding tooth, erupting 8 or stagnation of food under operculum

134

What are the signs of pericoronitis?

Lower 8s and primary teeth
Dull constant pain
Swelling of operculum
Trismus
Facial swelling
Dysphagia
Bad taste/smell

135

What is the treatment for pericoronitis?

1st line: irrigate with mono jet and saline, RSD under LA, salt water rinses, analgesia, soft diet
Pus and systemic involvement: metronidazole 400mg 3/day for 3 days
On 3rd occurence refer for surgical XLA

(consider XLA upper 8s or smooth if opposing tooth is traumatising operculum)
(operculotomy - but usually grows back

136

What are the complications of pericoronitis?

Spread of infection to pterygomandibular, reropharyngeal and submassetric space, tonsillar fossa

137

What is the aetiology of ANUG?

Smoking
Low OH
Stressed
Increased in males
Immunocompromised and HIV patients

138

What is the cause of ANUG?

Spirochetes and fusiform bacteria (anaerobic)

139

Whats the signs of ANUG?

Punched out lesions in interdental papilla, grey sloughing, feeling of tightness around teeth (pain), bleeding gums, metallic taste and halitosis
lymphadenopathy

140

Whats the treatment for ANUG?

1st line: OHI, debridement of calculus (chronic phase as less painful), hydrogen peroxide/ chlorhexidine m/w
If severe: metronidazole 200mg 1x daily for 3 days (SDCEP) or amoxicillin 500mg 3x day for 5 days - adults

141

What do you do if a patient faints?

Lie patient flat, raise legs, give O2

142

What do you do if a patient has an epileptic fit?

Ambulance (more than 5 mins or first fit)
Buccal midzolam ro 10mg diazepam (rectal) immediately, protect head and give O2

143

What do you do if a patient is hypoglycaemic?

n.b. signs aggressive, confused, act drunk, slurred speech, act drunk

Concious - glucose drink, semiconscious - buccal glucose gel, unconscious 1mg Glucagon IM or 50ml IV glucose, give O2

144

What do you do if a patient has a steroid crisis (adrenal insufficiency)?

n.b. long term steroid use, addisons or stress
signs look pale, thready pulse, low BP

Lie them flat
Oxygen
100mg hydrocortisone
Call 999

145

What do you do if a patient goes into anaphylaxis?

Lie flat
Oxygen
Call 999
adrenaline 1ml 1:1000 IM (epipen)
repeat every 5 mins
If doesnt work hydrocortisone 100mg IV, if it doesnt work 5% dextrose IV 1-2L

146

What do you do if a patient has an asthma attack?

Oxygen
Salbutamol 2 puffs (nebuliser if needed)
Status asthmaticus: IV hydrocortisone 100mg, adrenaline IM 0.5-1ml 1:1000 IM

147

What do you do if a patient had an angina attack?

Lie them flat, GTN spray sublingual (500mcg), oxygen

148

What do you do if a patient has a heart attack?

Oxygen, low dose aspirin (300mg) and GTN

149

What do you do if a patient goes into cardiac arrest?

Oxygen
BLS/defibrillator
999

150

What do you do if a patient has a stroke?

Lie them back
Oxygen
999

151

What do you do if a patient is choking?

Back blows x 5, heimleich manoeuvre x 5
Cricothyroidotomy