Other Flashcards
(24 cards)
Diagnose sepsis syndrome - SIRS
Temp <36 or >38
Respiratory rate >20
Pulse >90bpm
2/3 required for SIRS
- urgent referral if so
Always refer urgently if
- submandibular space or pharyngeal space
- systemic manifestations and immunocompromised
- trouble swallowing or breathing
- rapidly progressing
Formulation and max doses of anaesthetics?
Articaine 4%, 1:100k, 6mg/kg. 88mg per capsule
- 6mg x 80kg = 480mg toxic dose
- 480/88 = 5.45 carpules
Lidocaine 2%, 1:80k, 7mg/kg. 44mg per capsule
- 7mg x 80kg = 560mg toxic dose
- 560/44 = 12.7 carpules
How clean down a pod / station?
Wear appropriate ppe
Sharps removed first
Clinical waste in orange
Non clinical in black
Wipe from top down
Change new tips / spitoon etc
Wipe benches
Difference between type N, B and S steriliser?
What can they each process?
N = non vacuum, passive air removal, unwrapped solid products, non hollow and non lumened
B = vacuum with active air removal. Packaged instruments with lumens, cannulated or porous
S = special and can do hand pieces n shit
Tests for sterilisers?
Daily
- ACT - temp reached for what time
- wipe clean and check components functioning properly e.g. door seals
- Bowie dick / steam penetration test
Weekly ACT
- steam penetration test
- vacuum leak tests
- automatic air detector function test
Quarterly
- validation report
Yearly
- annual report for safety
How identify and deal with an asthma medical emergency
A - difficult to complete sentences
B - increased rate with wheezing
C - increased rate
D - alert
E - tripods
Treatment
- ring ambulance
- salbutamol inhaler - SABA relaxing smooth muscles in bronchi - 100ug per actuation
- 100% oxygen 15L/min flow
How identify and deal with anaphylaxis?
ABCDE signs
- redness and angio-oedema
- tachycardia but weak pulse
- airway constriction
- irregular but fast breathing
Tx
- phone ambulance
- adrenaline 0.1mg injection, Z track technique into thigh, spread skin and insert, aspirate then inject, release tension and pull out
- reassess ABCDE
- 100% oxygen 15L/min
How identify hypoglycaemia and treat?
A - initially talking
B - initially increased rate
C - initially increased
D - initially alert
E - irritable, confused, pale
Treatment
- glucose
- glucagon 1mg IM injection
How identify angina / MI and treat?
A - able to talk
B - increased
C - increased
D - alert
E - pale, clammy, central chest pain
Treatment
- GTN sublingual - 400ug per dose x 2 sprays
- aspirin 300mg chewed if MI
How do bisphosphonates work?
Inhibit osteoclastic activity and so inhibit bone resorption and therefore bone renewal
How do anticoagulants vs antiplatelets work?
Antiplatelets e.g. clopidogrel typically inhibit clot formation through preventing platelet activation
Anticoagulants inhibit a stage in the coagulation cascade preventing fibrin formation for clots.
How go about a medical emergency?
A-airway
- loss of consciousness
- obstruction
- inflammation/swelling/constriction of muscles
B-breathing
- demand for oxygen
- look/listen/feel
- supplemental oxygen
C-circulation
- arrhythmia/arrest
- pulse check
- elevate legs if weak pulse
D-disability
- drugs/brain injury
- hypoglycaemia
- ACVPU level
- optimise ABC first
E-exposure
- clinically relevant information
And treat as you meet
REASSESS
What is fluoride toxicity levels?
How many mgF in a tube of toothpaste?
5mg/kg for a child
1000ppmF is 1mg/g of toothpaste, so a 100g tube would contain 100mg - enough to be toxic to anyone 20kg and under
How would you do a cranial nerve exam?
Olfactory 1 - get pt to smell something
Optic 2 - can you read this text?
Oculomotor 3, trochlear 4, abducens 6 - follow finger in H pattern. Look for ptosis, diplopia or impaired movement
Trigeminal 5 - clench jaw and feel muscles. Touch the face.
Facial 7 - raise eyebrows, close eyes tight and smile and puff out cheeks.
Vestibulocochlear 8 - whisper or click by each ear. Any hearing or balance issues?
Glossopharyngeal 9, vagus 10 - ahhhh - palate should rise. Midline uvula, voice, gag reflex
Accessory 11 - shrug shoulders vs resistance. Turn head vs resistance
Hypoglossal 12 - stick tongue out and wiggle it left and right
Key red flags for referral
- facial asymmetry or weakness
- unilateral parasthesia
- dioplopia or ptosis
- slurred speech or dysphagia
- hoarseness or tongue deviation
Facial Trauma- right orbitozygomatic fracture
Perform an E/O exam (on a mannequin) to assess this patient for the facial fracture.
Suggest further investigations for this fracture type, what you can see on the investigation, and further management if you had this patient present to you in a standard dental surgery.
Look and feel from front, above and below
Check for
- lacerations
- two point mobility
- tenderness
- nasal bleeding / deviation
- asymmetry
- limitation of mandibular movement
Examine
- sensitivity around the area
- eye movement
- cranial nerve exam?
- eye reaction to light
Signs of zygomatic fracture
- peri orbital bleeding
- swelling
- subconunctival haemorrhage
- step deformity
- numb cheek
- occlusal derangement
- anaesthesia or parasthesia of teeth in upper quadrant
Management
- urgent phone to OMFS or A+E
- surgery if symptomatic e.g. CR, ORIF
- conservative if asymptomatic, over 1 month. Old injury or undisplaced
Mandibular fracture how would you go about the appt?
History of injury, and symptoms
- how was it done
- pain, bleeding, bruising, lacerations
- numbness
- loss of consciousness or vomiting
- police involvement
Examination
- normal E/O exam
- asymmetry
- Occlusal derangement
- lacerations / hematoma
- mandibular derivation / limited opening
Classify
- simple, compound, comminuted
- number of features
- direction of fracture line and site
- side
- displacement
Facial Trauma- right orbitozygomatic fracture
State the fracture type most likely from the photo available and clinical history.
Perform an E/O exam (on a mannequin) to assess this patient for the facial fracture.
Suggest further investigations for this fracture type, what you can see on the investigation, and further management if you had this patient present to you in a standard dental surgery.
26 abscess
- how take pus aspirate and fill in pathology form?
Enter pt details onto form
- followed by clinical details / symptoms
- provisional diagnosis
Specimen details
- pus
- site details
Investigations required
- PCR and viral load
- culture and sensitivity testing - bacterial / fungal
- histopathological for tissue biopsies
What are symptoms of MRONJ a pt should look out for?
Exposed bone in OMF region persisting >8wks
Pain or swelling in jaw
Exposed necrotic bone
Non-healing extraction site
Pus discharge
Paraesthesia of IAN
What symptoms might someone with ORN have?
Exposed necrotic bone in irradiated area
Pain and swelling in the jaw
Trismus
Infection
Pathological fracture
Non healing mucosa over area
Features someone might have with infective endocarditis?
Fever and chilll
Fatigue
Night sweats
Weight loss
Muscle and joint pain
Heart murmur and signs of heart failure - short breath and peripheral oedema
Questions to ask someone for bloods in risk assessment>?
Ever diagnosed with HIV, Hep B, Hep C
Ever used IV drugs, or had intercourse with an IV drug user
Ever had sex with another man
Ever had sex with someone outside of Western Europe, North America, Australia and NZ
Ever had an operation in country outside those ^^
Are you from a country outside here?
Ever had transfusion from not one of those countries^
