Complications
What do you want to do immediately if a patient gets a hematoma?
Apply pressure
(also okay: apply ice/cold therapy)
What size and gauge needle is recommended for the IA or inferior alveolar nerve block?
25 gauge long needle
What is the most effective vasoconstrictor for hemostasis?
Epinephrine
How many carpules of 3% Carbocaine is 90 mg if there is 1.8 ml per carpule?
1.6 carpules
3 x 18 = 54 mg per carpule
90mg given/54mg per carpule= 1.6 carpules given
What is the MOST important step before administering local anesthesia?
Updating the patient’s medical history.
Which nerve block can create the most unaesthetically pleasing hematoma?
PSA or Posterior Superior Alveolar Nerve block
What injection anesthetizes the 3rd, 2nd, and 1st molar besides the MB portion of the 1st molar?
PSA or Posterior Superior Alveolar Nerve Block
What is the best patient position to prevent vasodepressor syncope during local anesthetic administration?
Trendelenburg
What is the maximum recommended dose of .5% Bupivicaine per appointment?
90 mg
How often should a medical history be updated?
At least every 6 months.
What is the single most important element of preparation of the dental office for medical emergencies?
Basic Life Support (BLS) training for all staff members
What is nerve block with the greatest percentage of positive aspirations?
The IA (or inferior alveolar) nerve block
What are three reasons the IA block is commonly missed?
Insertion of the needle to low on the medial side of the ramus
Accessory innervations
Anatomical variations
What is the maximum recommended dose in mg for a 100lb healthy pt for 2% lidocaine 1:100,000 epi with 1.8 mL per carpule?
320 mg
3.2 mg/lb x 100 lbs = 320
1:100,000 = .018mg per carp (320/36 mg per carp = 8.8 carps x .018 = .16 which is less than .2 mg for a healthy patient.
Generally, how long should you wait after an MI before performing elective dental treatment?
6 months
Name 3 signs or symptoms of vasoconstrictor overdose.
Fear, anxiety, tachycardia (elevated heart rate), restlessness, perspiration, dizziness, dyspnea (respiratory difficulty), palpitations, cardiac dysrhythmias
Tooth #6 needs to be anesthetized for pulpal anesthesia, which injection would you give?
Right Anterior Superior Alveolar Nerve block
(also: supraperiosteal above #6 would work)
After administering an inferior alveolar nerve block the patient complains of an inability to close or blink their eye on that side. What just occurred?
Local anesthetic was deposited near the facial nerve causing paralysis of the muscles of facial expression
2 carpules.
.04 mg MRD for cardiac pt.
.04/.018 mg epi per carpule = 2.2
200lb x 3.2mg/lb Lido MRD = 640/36 mg per carpule= 17 carpules- way too many, go with smaller #.
A patient claims to be allergic to sulfites, what should you avoid in your anesthetic drug/carpule choice?
Avoid using a vasoconstrictor
Moderate-high local anesthetic overdose symptoms include? (Name 3)
Tonic-clonic seizure activity
CNS depression
Hypotension: decreased BP/pulse/respirations
Pulpal anesthesia for #22-24 can be accomplished by two blocks, which injections are those?
L IA (Inferior alveolar) and L incisive
(FYI- you usually would give one or the other, not both because they both would achieve pulpal anesthesia)
The six vital signs include:
Blood pressure, pulse, respirations, temperature, height, weight
How many mg of anesthetic is given if the patient received 3 carpules of .5% Bupivacaine 1:50,000 epi with 1.8 ml per carpule?
27 mg
.5 x 18 = 9 mg per carpule
9 mg x 3 carpules= 27 mg
A patient's medical history reveals atypical psedocholinesterase. What type of local anesthetic drugs should be avoided?
Ester drugs