Nishtha Singhal presented on the complications of local anesthesia. Some potential complications include soft tissue injury, sloughing of tissues from drugs/chemicals used; needle breakage, hematoma, or failure to obtain anesthesia from injection techniques; and pain, burning, trismus, or neurological symptoms that can arise from both drugs/techniques. Prevention methods and management strategies were discussed for each complication.
Local aneasthesia techniques which are to be performed extraorally when the conventional intraoral approches for local anaesthesia cant be performed.
Very useful for dental Practioners
In this lecture I explain the basic concept of root canal filling or what called obturation. The lectures discuss different techniques used in that matter in step-by-step fashion and explanatory pictures.
It is directed to the level of undergraduate mind.
We in Chinthamani Laser Dental Clinic & Implant Centre ,cover every speciality and subspeciality in dentistry so that all kind of your dental problems can be treated efficiently and effectively.
Contact us:
Chinthamani Laser Dental Clinic & Implant Centre
1/464,Mount Poonamallee High Road,
Iyyapanthangal,
Chennai-56
Phone no.044-43800059 , 92 83 786776
Email:
chinthamanidental@gmail.com,
dr_mrgvl@gmail.com
Website:
www.chinthamanilaserdentalclinic.com
Local aneasthesia techniques which are to be performed extraorally when the conventional intraoral approches for local anaesthesia cant be performed.
Very useful for dental Practioners
In this lecture I explain the basic concept of root canal filling or what called obturation. The lectures discuss different techniques used in that matter in step-by-step fashion and explanatory pictures.
It is directed to the level of undergraduate mind.
We in Chinthamani Laser Dental Clinic & Implant Centre ,cover every speciality and subspeciality in dentistry so that all kind of your dental problems can be treated efficiently and effectively.
Contact us:
Chinthamani Laser Dental Clinic & Implant Centre
1/464,Mount Poonamallee High Road,
Iyyapanthangal,
Chennai-56
Phone no.044-43800059 , 92 83 786776
Email:
chinthamanidental@gmail.com,
dr_mrgvl@gmail.com
Website:
www.chinthamanilaserdentalclinic.com
We in Chinthamani Laser Dental Clinic & Implant Centre ,cover every speciality and subspeciality in dentistry so that all kind of your dental problems can be treated efficiently and effectively.
Contact us:
Chinthamani Laser Dental Clinic & Implant Centre
1/464,Mount Poonamallee High Road,
Iyyapanthangal,
Chennai-56
Phone no.044-43800059 , 92 83 786776
Email:
chinthamanidental@gmail.com,
dr_mrgvl@gmail.com
Website:
www.chinthamanilaserdentalclinic.com
An oroantral communication is an unnatural perforation between oral cavity and maxillary sinus.
Oroantral fistula is an epithelized, pathological, communication between these two cavities. A fistulous tract present more than 14 days should be considered as chronic fistula.
This short presentation discuss very important subject in endodontic field, which is the complications that most commonly occur during root canal treatment, like sodium hypochlorite accident and air emphysema and others. management of these complications is also discussed.
Endodontic emergencies include Pre-treatment emergency of which hot tooth is a commonly encountered situation.
This ppt is contains concise pickup notes on Hot tooth.
In this lecture I explain in step-by-step fashion the basics of Indirect Pulp Capping Procedure. a photo guide is attached to the guide to aid in better understanding of the topic
We in Chinthamani Laser Dental Clinic & Implant Centre ,cover every speciality and subspeciality in dentistry so that all kind of your dental problems can be treated efficiently and effectively.
Contact us:
Chinthamani Laser Dental Clinic & Implant Centre
1/464,Mount Poonamallee High Road,
Iyyapanthangal,
Chennai-56
Phone no.044-43800059 , 92 83 786776
Email:
chinthamanidental@gmail.com,
dr_mrgvl@gmail.com
Website:
www.chinthamanilaserdentalclinic.com
An oroantral communication is an unnatural perforation between oral cavity and maxillary sinus.
Oroantral fistula is an epithelized, pathological, communication between these two cavities. A fistulous tract present more than 14 days should be considered as chronic fistula.
This short presentation discuss very important subject in endodontic field, which is the complications that most commonly occur during root canal treatment, like sodium hypochlorite accident and air emphysema and others. management of these complications is also discussed.
Endodontic emergencies include Pre-treatment emergency of which hot tooth is a commonly encountered situation.
This ppt is contains concise pickup notes on Hot tooth.
In this lecture I explain in step-by-step fashion the basics of Indirect Pulp Capping Procedure. a photo guide is attached to the guide to aid in better understanding of the topic
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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2. LOCAL COMPLICATIONS OF ANAESTHETICS
A)COMPLICATIONS ARISING FROM DRUGS OR CHEMICAL USED
1.SOFT TISSUE INJURY
2.SLOUGHING OF TISSUES
B)COMPLICATIONS ARISING FROM INJECTION TECHNIQUES
1)NEEDLE BREAKAGE
2)HEMATOMA
3)FAILURE TO OBTAIN LOCAL ANESTHESIA
4)POST-INJECTION HERPETIC LESIONS
C)COMPLICATIONS ARISING FROM BOTH
1)PAIN ON INJECTION
2)BURNING ON INJECTION
3)TRISMUS
4)BLANCHING OF SKIN
5)EDEMA
6)PERSISTENT PARATHESIA OR ANESTHESIA
7)INFECTION
8)PERSISTENT PAIN
9)NEUROLOGICAL SYMPTOMS
FACIAL N. PARALYSIS
VISUAL DISTURBANCES
3. 1)SOFT TISSUE
INJURY
CAUSES PREVENTION MANAGEMENT
-SELF INFLICTED -APPROPRIATE -ANALGESICS FOR PAIN
TRAUMA TO LIPS DURATION LA -ANTIBIOTICS
,TONGUE WHILE STILL -COTTON ROLLS -LUKEWARM SALINE
NUMB BETWEEN LIPS AND RINSES TO AID IN
-SEEN IN CHILDREN TEETH DECREASE ANY
AND MENTALLY AND -WARN THE PATIENT SWELLING THAT MAY
PHYSICALLY AND GUARDIAN BE PRESENT
DISABLED AGAINST -PETROLEUM JELLY AS
-SOFT TISSUE EATING,DRINKING HOT LUBRICANT
ANESTHESIA LASTS FLUIDS AND BITING ON
LONGER THEN PULPAL LIPS OR TONGUE TO
TEST FOR ANESTHESIA
2)SLOUGHING
OF TISSUES
i)EPITHELIAL -DO NOT USE HIGH DEPEND ON INJURY
DEQUAMATION CONC. LA WITH -SYMPTOMATIC-
-TOPICAL ANESTHETIC VASOCONSTRICTOR ANALGESICS,ORABASE
FOR PROLONGED (NOREPINEPHRINE -RESOLVES WITHIN 1-2
PERIOD 1:30,000 NOT WEEKS
-HIGHTENED PRESCRIBED) -AN ESTABLISH LESION
SENSTIVITY OF TISSUE MAY REQUIRE
TO LA REACTION IN INCISION AND
AREA OF TOPICAL DRAINAGE
ANESTHETICS
ii)STERILE ABSCESS
-PROLONGED
--ISCHEMIA DUE TO
VASOCONSTRICTOR
-DEVELOPS ON HARD
PALATE
4. B)COMPLICATIONS ARISING FROM
INJECTION TECHNIQUES
1)NEEDLE BREAKAGE
CAUSES
PRIMARY CAUSE-
UNEXPECTED MOVEMENT OF PATIENT
SECONDARY CAUSE-
INAAPROPRIATE THICKNESS OF NEEDLE
PREVIOUSLY BENT
REDIRECTION OF NEEDLES ONCE INSERTED INSIDE TISSUE
MANUFACTURE DEFECT(RARE)
FORCING NEEDLE AGAINST RESISTENCE
NEEDLE ENGAING THE PERIOSTEUM
PREVENTION
INFORM THE PATIENT
USE PROPER GAUZE NEEDLE(FOR N. BLOCK-25 GAUZE,FOR
INFILTRATION-27,25,30 GAUZE
USE PRESTERLIZED DISPOSABLE NEEDLES
ENTIRE LENGTH SHOULD NOT BE INSERTED(FEW MM AWAY FROM HUB)
DO NOT REDIRECT IF EMBEDDED
USE GOOD QUALITY NEEDLE
GENTLE MANIPULATION-NO EXCESSIVE FORCE
DO NOT PERMIT THE NEEDLE TO ENGAGE THE PERIOSTEUM
STABILISATION OF JAW
NEEDLE SHOULD ALWAYS BE KEPT DURING INSERTION
AVOID MULTIPLE PENETRATIONS
MANAGEMENT
CALM,DO NOT PANIC
INFORM PATIENT
IF VISIBLE-USE HEMOSTAT OR MAC GILLS TUBE
IF NOT-FLOUROSCOPE,FOLLOW UP,SURGERY
5. 2)HEMATOMA
THE EFFUSION OF BLOOD INTO EXTRAVASCULAR SPACES CAN RESULT
FROM INADVERTENTLY NICKING A BLOOD VESEL(ARTERY OR
VEIN)DURING THE INJECTION OF LA
NICKING OF ARTERY-HEMATOMA INCRESE RAPIDLY IN SIZE
NICKING OF VEIN-MAY OR MAY NOT RESULT IN FORMATION
CAUSE
NICK→BLOOD EFFUSES FROM VESSELS UNTIL EXTRAVASCULAR
PRESURRE EXCEEDS INTRAVASCULAR→CLOTTING OCCURS
PREVENTION
MODIFY INJECTION TECHNIQUE AS DICTATED BY PATIENT
USE SHORT NEEDLE(APPROPRIATE LENGTH)
MINIMIZE NO. OF PENETRATION
NEVER USE NEEDLE AS A PROBE ON TISSUE
MANAGEMENT
IMMEDIATE-DIRECT PRESSURE AT SITE OF BLEEDING FOR NOT LESS
THAN 2 MINS
BLOCK PRESSURE SITE CLINICAL
MANIFESTATION
IANB MEDIAL ASPECT OF INTRAORAL
MANDIBULAR RAMUS DISCOLORATION AND
PROBABLE TISSUE
SWELLING ON MEDIAL
ASPECT OF
MANDIBULAR RAMUS
INFRAORBITAL INFRAORBITAL DISCOLORATION OF
FORAMEN SKIN BELOW THE
LOWER EYELID
MENTAL N. BLOCK MENTAL FORAMEN DISCOLORATION OF
SKIN OVER THE
MENTAL FORAMEN OR
SWELLING IN THE
MUCOBUCCAL FOLD IN
REGION OF MENTAL
6. FORAMEN
PSA N BLOCK SOFT TISSUE IN COLORLESS SWELLING
MUCOBUCCAL FOLD APPEAR ON SIDE OF
AS FAR AS POSSIBLE AS FACE (USUALLY A FEW
DISTALLY AS CAN BE MINUTES AFTER THE
TOLERATED BY INJEVTION IS
PATIENT COMPLETED)→DAYS
INFERIOR AND
ANTERIOR TOWARD
THE LOWER ANT.
REGION OF CHEEK
IN PSA HEMATOMA EARLIER IN PTERYGOID VENOUS PLEXUS
ACCORDING TO SICHER –PSA ARTERY
OF SORENESS DEVELOPS –ADVISE THE PATIENT TO TAKE ANALGESIC
DO ON APPLY HEAT OVER FOR AT LEAST 4-6 HOUR(VASODILATION-
INCREASES IN SIZE)
HEAT APPLIED ON NEXT DAY-ACTS AS A)ANALGESIC AND B)
VASODILATOR↑RATE AT WHICH BLOOD ELEMENTS ARE RESORBED
IN FORM OF WARM MOIST TOWELS TO THE AFFECTED AREA FOR 20 MIN
EVERY HOUR
RESOLVE S WITHIN 7-14 DAYS.
5)FAILURE TO OBTAIN ANESTHESIA
CAUSES
A)OPERATOR DEPENDENT
i)LA AGENT(TYPE,DOSE)
ii)IMPROPER SURGICAL TECH.
iii)INJ OF WRONG SOLN.
iv)I.V
v_I.M
B)PATIENT DEPENDENT
i)ANATOMICAL-ADDITIONAL INNERVATION
ii)PSYCHOLOGICAL –UNCOOPRATIVE,MOVEMENT
iii)PATHOLOGICAL-INFECTION
ADDITIONAL INNERVATION
‘CUTANEOUS COLLI NERVE’ (CERVICAL CUTANEOUS NERVE)-(A
BRANCH OF 3RD CERVICAL NERVE)-ENTERS A SMALL FORAMEN ON
7. LINGUAL ASPECT OD RAMUS AND SUPPLIES INNERVATION TO
MANDIBULAR TEETH.
IN CASE OF FAILURE IN OBTAINING OPERATIVE ANESTHESIA AFTER A
MANDIBULAR INJ. ,A SUPPLEMENTAL INJ.CAN BE GIVEN TO CERVICAL
CUTANEOUS NERVE.THIS IS DONE BY INSERTING THE NEEDLE LINGUALLY
BETWEEN 2 BICUSPID TEETH,AT THE REFLECTION OF MUCOUS
MEMBRANE AND DIRECTING IT POSTERIORLY,ABOUT HALF OF THE
NEEDLE IS INSERTED AND ABOUT 0.5ML OF SOLN. IS INJECTED.
4)POST INJECTION HERPETIC LESIONS
CAUSE
REACTIVATION OF DORMANT HERPES VIRUS
H/O RECUURENT HERPES LABIALIS
IN TERMINAL BRANCHES OF TRIGERMINAL NERVE
PREVENTION-DELAY SURGICAL INTERVENTION IN THE ACTIVE STAGE
MANAGEMENT-ANTIVIRAL DRUGS
C)COMPLICATIONS ARISING FROM BOTH
CAUSES PREVENTION MANAGEMENT
1)PAIN ON -PROPER TECH. NOT REQUIRED
INSERTION -SHARP NEEDLE-
-CARELESS TECH. INSERT LA SLOWLY
-BLUNT NEEDLE -USE STERILE LA SOLN.
-RAPID INSERTION OF -USE TOPICAL LA B4
LA SOLN. CAN CAUSE -SOLN. AT ROOM TEMP.
TISUE DAMAGE
-HIGH TEMP. OF SOLN.
2)BURNING -SLOW INJ. NOT REQUIRED
SENSATION -SOLN. AT ROOM TEMP.
-RAPID INJ.
-CONTAMINATED
NEEDLE CARTRIDGE
-HIGH TEMP. LA SOLN.
ALTERED PH OF SOLN.
(PH PLAIN-5 APP,WITH
8. VASOCONSTRICTOR-3
APP)
3)INFECTION -PROPER PREP. OF SITE -ANALGESICS
-CONTAMINATION OF PRIOR TO -ANTIBIOTICS
NEEDLE PENETRATION -PHYSIOTHERAPY
-IMPROPER PREP. OF -CAREFUL HANDLING -MUSCLE RELAXANTS
SITE OF NEEDLES (AVOID
-NEEDLE PASSING TOUCHING NON-
THROUGH AN AREA OF STERILE SURFACE)
INFECTION
-LA SOLN DEPOSITED
UNDER PRESSURE ,AS
IN PDL
INJ.→TRANSPORT
BACTERIA
4)EDEMA -PREOP ASSESMENT -FIND OUT CAUSE
-TRUAMA -CAREFUL HANDLING -ALLERGY-(A,B,C,D)
-INFECTION OF LA
-ALLERGY ARMAMENTARIUM
-HEMORRHAGE -ATRAUMATIC TECH.
-INJ OF IRRITATING
SOLN.
5)TISSUE -USE ASPIRATION -TRANSIENT
BLANCHING TECH. PHENOMENON
-TRAUMA TO BLOOD -AVOID -NO T/T REQUIRED
VESSEL BY NEEDLE INTRAARTERIAL
-I.V. ADMINISTRATION ADMINISTRATION
6)TRISMUS
CAUSES
PRIMARY CAUSE-TRAUMA TO MUSCLE ,BLOOD VESSELS IN
INFRATEMPORAL FOSSA
SECONDARY CAUSES-
#INJECTION OF LA CONTAINING IRRITATING SOLN.(ALCOHOL,COLD
STERILISING SOLN.)
#LA HAVE MILD MYOTOXIC PROPERTIES
(AIDS TO PROGRESSIVE NECROSIS OF EXPOSED MUSCLE FIBRES)
# HEMATOMA –(LEADS TO IRITATION OF MUSCLE FIBRES
# LOW GRADE INFECTION
9. # EXCESSIVE DEPOSITION OF LA-DISTENSION OF TISSUES-POST INJ
TRISMUS
#THE BARB OCCURRED WHEN THE NEEDLE COME INTO CONTACT WITH
THE MEDIAL ASPECT OF THR MANDIBULAR RAMUS,WITHDRAWL OF THE
NEEDLE FROM TISSUE INCREASED THE LIKELIHOOD OF INVOLVEMENT OF
THE LINGUAL OR IANB AND DEVELOPMENT OF TRISMUS
PROBLEMS
AVG. INTERINCISAL OPENING IN ACSES OF TRISMUS IS 13.7MM
IN CHRONIC HYPOMOBILTY-
• IF T/T NOT GIVEN
• SECONDARY TO ORGANISATION OF HEMATOMA WITH SUBSEQUENT
FIBROSIS AND SCAR CONTRACTURE
• INFECTION –INCRESED PAIN-INCRASED TISSUE
REACTION(IRRITATION AND SCARRING).
PREVENTION
USE SHARP,STERILE,DISPOSABLE NEEDLE
USE ASEPTIC TECH.
ATRAUMATIC TECH.
AVOID MULTIPLE PENETRATION
USE MINM EFFECTIVE VOL. OF LA
MANAGEMENT
1)HEAT THERAPY-HOT MOIST TOWELS TO AFFECTED AREA FOR 20 MINS
EVERY HOUR
2)WARM SALINE RINSE-HELD IN THE MOUTH ON THE INVOLVED SITE AND
SPIT OUT
3)ANALGESICS ASPIRIN(325MG)
4)MUSCLE RELAXANTS-
CHLOROXAZONE (250 mg IN 2 TO 3 DIVIDED DOSE)
OR DIAZEPAM (5-10 mg BID)
OR MEMEPROBAMATE(1.2g IN 3-4 DIVIDED DOSES)
5)PHYSIOTHERAPY-OPENING AND CLOSING THE MOUTH ,AS WELL AS
LATERAL EXCURSIONS OF THE MANDIBLE FOR 5 MINS EVERY 3 TO 4
HOURS.
10. 6)CHEWING GUMS (SUGARLESS)-TO PROVIDE LATERAL MOVEMENT OF
TMJ
7)ANTIBIOTICS
AVOID FURTHER DENTAL T/T IN INVOLVED REGION UNTIL SYMPTOMS
RESOLVE AND PATIENT IS COMFORTABLE.
IF DENTAL CARE HAS TO BE CONTINUED –THAN ALTERNATE METHOD OR
TECH. FOR ACHIEVING LA MAY BE EMPLOYED.
THE AKINSI MANDIBULAR N. BLOCK PROVIDES RELIEF FORM THA MOLAR
DYSFUNCTION AND ALLOWS THE PATIENT TO OPNE THE MOUTH AND
PERMITS ADMINSTARTION OF APPROPRIATE ADDITIONAL INJ. IF
REQUIRED.
COMPELTE RESOLUTION OD POST INJ. TRISMUS TAKES APPROXIMATELT 6
WEKS ,WITH A RANGE OF 4 TO 20 WEEKS.
7)NEUROLOGICAL SYMPTOMS
A)VISUAL DISTURBANCES
i)SQUINT
ii)DIPLOPIA
iii)TRANSIENT AMAUROSIS
iv)PERAMNENT BLINDNESS
i)DIPOPIA OR DOUBLE VISION
LA SOLN. INFILTRATING INTO THE ORBIT TO ANESTHETIC THE
EXTRINSIC OCULAR MUSLCES OF THE YES.
INTAARTERIAL INJ.-UNCOMMON VASCULAR PATTERNS-(ORBIT IS
SUPPLIED EITHER WHOLLY OR PARTLY BY MIDDLE MENINGEAL
ARTERY.)
NO MANAGEMENT REQUIRED (RESOLVES WITHIN 3 HOURS,OR
WHEN EFECT ENDS)
ii)TRANSIENT SQUINT AND DOUBLE VISION
PARALYSIS OF EXTRINSIC MUSCLES
LA DIFFUSED INTO ORBIT FROM PTERYPALATINE GANGLION AND
INFRATEMPORAL FOSSA VIA INFRAORBTAL FISSURE,EFFECTING
OCCULOMOTOR,TROCHLEAR,ABDUCENS NERVE.
NO TREATMENT REQUIRED
11. CAUSES PREVENTION MANAGEMENT
FACIAL NERVE FOLLOW STANDARD EXPLAIN, REASSURE
PARALYSIS PROTOCOL PATIENT
-UNILATERAL LOSS OF
MOTOR FUNCTION-
DIRECTLY LA TRANSIENT
DEPOSITION IN -EYE DRESSING GIVEN
VICINITY OF 7TH -CONTACT LENSES SHOULD
CRANIAL NERVE BE REMOVED
1)INFRAORBITAL N.
BLOCK
2)PARAPERIOSTEAL
OF MAXILLARY
CANINE
INDIRECTLY-INTO
DEEP LOBE OF
PAROTID GLAND IN
IANB
8)PERSISTENT -FOLLOW STANDARD -REASSURE THE PATIENT
PARATHESIA OR PROTOCAL - VIT B1,B6,B12
-CAREFUL SURGICAL -IF DOES NOT RESOLVE
ANAESTHESIA TECH. THAN REFER FOR SURGERY
-INJECTING -PROPER HANDLING OF
CONTAMINATED CARTRIDGE
LA SOLUNTION
-TRAUMA TO N.
SHEATH
-HEMORRAHGE
AROUND N.
9)PERSISTENT -GOOD SURGICAL TECH. -SYMPTOMATIC
PROLONGED PAIN -AVOID NEEDLE WITH
-POOR SURGICAL BARBS
TECH.(IN -USE
SUPRAPERIOSTEAL VASOCONSTRICTORS
TEARING VOL.) WITH MAXIMUN
-NEEDLE TIP BARBS DILUTION
-ISCHEMIC -AVOID MULTIPLE
NECROSIS PENETRATION
-MULTIPLE
PENETRATIONS
12. SYSTEMIC COMPLICATIONS OF LA
CAUSES OF ADVERS EDRUG REACTION
TOXICITY CAUSED BY DIRECT EXTENSION OF THE
USUAL PHARMACOLOGICAL EFFECTS OF DRUGS-
1.SIDE EFFECTS
2.OVERDOSE
3.LOCAL TOXIC EFFECTS
TOXICITY CAUSED BY ALTERATION IN RECIPIENT OF
THE DRUG
1.A DISEASE PROCESS(HEPATIC DYSFUNCTION,CHF,RENAL DYSFUNCTION)
2.EMOTIONAL DISTURBANCES
3.GENETIC ABBERATIONS(ATYPICAL PLASMA
CHOLINESTERASE,MALIGNANT HYPERTHERMIA)
TOXICITY CAUSED BY ALLERGIC RESPONSES TO THE
DRUGS
13. OVERDOSE
A DRUG OVERDOSE REACTIONS HAS BEEN DEFINED AS THOSE CLINICAL
SIGNS AND SYMPTOMS THAT RESULT FROM AN OVERLY HIGH BLOOD
LEVEL OF A DRUG IN VARIOUS TARGET ORGANS AND TISSUES
PREDISPOSING FACTOR
PATIENT FACTORS,DRUG FACTORS
PATIENT FACTOR DRUG FACTOR
AGE VASOACTIVITY
WEIGHT CONC.
OTHER DRUGS DOSE
SEX ROUTE OF ADMINISTRATION
PRESENCE OF DISEASE RATE OF INJ.
GENETICS VASCULARITY OF INJ SITE
MENTAL ATTITUDE AND PRESENCE OF VASOCONSTRICTOR
ENVIRONMENT
CLINICAL MANIFESTAIOTNS OF OVERDOSE
MINIMAL TO MODERATE OVERDOSE LEVELS
SIGNS SYMPTOMS
TALKATIVENESS LIGHTHEADENESS AND DIZZINESS
APPREHENSION RESTLESSNESS
EXCITABILITY NERVOUSNESS
SLURRRED SPEECH NUMBNESS
EUPHORIA SENSATION
DYSARTHIA METALLIC TASTE
NYSTAGMUS VISUAL DISTURBANCES
VOMITTING AUDITORY DISTURBANCES
DISORIENTATION LOSS OF CONSCIOUNESS
LOSS OF RESPONSE TO PAINFUL DROWSINESS AND
STIMULI DISORIENTATION
↑BP
↑HR
↑RR
14. MODERATE TO HIGH OVERDOSE LEVELS
SEIZURE
CNS DEPRESSION
↓BP
↓HR
↓RR
LIDOCAINE LEVEL CVS
1.8-5.0 ug/ML ANTIDYSRRTHMIC ACTIONS
5.0-10.0 MYOCARDIAL DEPRESSION
10.0PLUS MASSIVE PERIPHERAL
VASODILATION,MYOCARDIAL
DEPRESSION
CARDIAC ARREST
CNS
0.5-4 ANTICONVULSANT ACTION
4.5-7 CNS DEPRESSION,EXCITATION
7.5-10.0 CNS DEPRESSION ,SEIZURE
10.0 PLUS GENERALIZED CNS DEPRESSION
CVS EFFECTS
LA (VASODILATOR)
↓
PERIPHERAL RESISTANCE
↓
↓BP(BP=PR*CO)
FURTHER IN LA CONC.
AFFECT N. CONDUCTION OF HEART
↓
MYOCARDIAL CONTRACTILITY
↓
C.O.(CO=HR*SV)
HEART’S NEURONAL CONDUCTION SYS. IS INHIBITED OR COMPLETELY
BLOCKED BY LA.
AT TOXIC LEVELS,DEPRESSION OF INTRACARDIAC N. CONDUCTION CAN
RESULT IN ATRIOVENTRCULAR DISSOCIATION,VENTRICULAR RHYTHM
,VENTRICULAR FIBRILLATION AND ULTIMATELY CARDIAC ARREST.
15. CNS EFFECTS
THE CONDUCTION OF INHIBITORY NEURONS ID USUALLY BLOCKED BY LA
AGENTS AS THEY REACH TOXIC LEVELS-RESULTING IN UNMODIFIED
ACTION OF FACILITATORY NEURONS(IE,CONVULSIVE-LIKE MOVT.)AS THE
DOSE INCREASES,FACILITATORY NEURONS ARE ALSO BLOCKED
RESULTING IN CESSATION OF FUNCTION.
CERTAIN AMIDE TYPE AGENTS(IE LIDOCAINE)-EFFECT PRIMARILY
FACILATORY NEURONS,HENCE DEPRESSION IS SEEN RATHER THAN
EXCITATION.
MANAGEMENT
1)MILD OVERDOSE
RETENTION OF CONCIOUSNESS,TALKATIVENESS,AGITATION,
↑HR,↑BP. ↑RR(5-10 MIN)→←
P→A→B→C→D
DEFINITIVE CARE
i)REASSURE THE PATIENT
ii)ADMINISTER OXYGEN VIA NASAL CANULA TO PREVENT ACIDOSIS
iii)MONITOR AND RECORD VITAL SIGNS
iv)ESTABLISH i.v. INFUSION
v)USE OF ANTICONVULSANTS –NOT USUALLY INDICATED
DIAZEPAM-5mg.MIN i.v.
MIDAZOLAM-1mg/MIN
2)SEVERE OVERDOSE
UNCONSCIOUSNESS WITH OR W/O CONVULSIONS
RAPID ONSET(WITHIN 1 MINUTE)
i)PROTECT PATIENTS ARMS,LEGS AND HEAD
LOOSEN TIGHT CLOTHES
ii)IMMEDIATELY SUMMON EMERGENCY MEDICAL ASSISTENCE.
iii)CONTINUE BLS
iv)ADMINISTER ANTICONVULSANT
DIAZEPAM –i.v -5mg/min
IF VENEPUNCTURE NOT FEASIBLE
MIDAZOLAM-im -1mg
IF HYPOTENSION PERSISTS(30 MINS)-VASOPRESSOR
(PHENYNEPHRINE OR METHAOXAMINE)IM
17. ALLERGY
ALLERGY IS A HYPERSINSITIVE STATE,ACQUIRED THROUGH EXPOSURE
TO A PARTICULAR ALLERGEN,REEXPOSURE TO WHICH PRODUCE
HEIGHTENED CAPACITY OT REACTION.
PREDISPOSING FACTORS
METHLYPARABEN
SODIUM BISULPHITE ALLERGY
EPINEHRINE
LATEX ALLERGY
TOPICAL ANESTHETIC ALLERGY
PREVENTION-PROPER HISTORY
ALLERGY TESTING
0.1ML OF EACH(INTRAVENOUS)
0.9%NACL
1% OR 2% LIODCAINE,
3%MEPIVACAINE
4%PRILOCAINE(W/O METHYL
PARABEN,BISULPHITE,VASOPRESSORS.
INTRAORAL CHALLENGE TEST
0.9 ML OF LA SOLN. SUPRAPERIOSTEAL INFILTRATION ATRAUMATIC(BUT
W/O TOPICAL LA)ABOVE A MAXILLARY RIGHT OR LEFT PREMOLAR OR
ANT. TOOTH.
DENTAL MANAGEMENT IN CASE OF PRESENCE OF LA ALLERGY:
NO T/T OF AN INVASIVE NATURE CARRIED OUT
IF EMERGENCY –THEN UNDER GENERAL ANESTHESIA
IF GA NOT AVAILABLE –HISTAMINE BLOCKER
DIPPHENHYDRAMINE HCL IN 1 % SOLN. WITH 1:100,000
EPINEPHRINE(30 MIN OF PULPAL ANESTHESIA)
NITORUS OXIDE
ALTERNATIVES-ELECRONIC DENTAL ANESTHESIA
18. CLINICAL MANIFESTATIONS OF ALLERGY
DERMATOLOGICAL REACTIONS-
URTICARIA-WHEAL
ANGIOEDEMA-LOCALISED SWELLING INVOLVING
FACE,HANDS,FEET,GENITILIA,LIPS,TONGUE.
RESPIRATORY REACTIONS-
BRONNCHOSPASM
RESP. DISTRESS
DYSPNOEA,WHEEZING,FLUSHING,CYANOSIS,PERSPIRATION,TACHYCARDI
A,INCREASED ANXIETY,LARYNGEAL EDEMA
GENERALISED ANAPHYLAXIS
SKIN REACTION-
PRURITIS,ERYTHEMA,URTICARIA,CONJUCTIVITIS,RHINITIS
GIT DISTURBANCE
RESP STMPTOMS-WHEEZING,DYSPNOEA
CVS-PALLOR,TACHYCARDIA,HYPOTENSION,CARDIAC
DYSARRTHYMIA,UNCONCIOUSNESS,CARDIAC ARREST
MANAGEMENT
P→A→B→C→D
i)ADMINISTER EPINEPHRINE 0.3mg IM/SC OR
HISTAMINE BLOCKER-50mg DIPHENHYDRAMINE OR
10 mg CHLORPHENIRAMINE
ii)MEDICAL CONSULTATION FROM PHYSICIAN
iii)OBSERVE THE PATIENT (60MIN)
iv)PRESCRIBE ORAL HISTAMINE BLOCKER
50 mg CAP-TDS FOR 3-4 DAYS
BRONCHSPASM
P→A→B→C→D
i)TERMINATE T/T
ii)ADMINISTER OXYGEN (5-6 L/MIN)
iii)ADMINISTER EPINEPHRINE 0.3 mg IM/SC
iv)ADMINISTER HISTAMINE BLOCKER TO MINIMIZE RELAPSE
HISTAMINE BLOCKER-50mg DIPHENHYDRAMINE OR
10 mg CHLORPHENIRAMINE
19. v)MEDICAL CONSULTATION
LARYNGEAL ODEMA
P→A→B→C→D
i)ADMINISTER EPINEPHRINE 0.3 mg IM/SC
ii)EMERGENCY MEDICAL SERVICE
iii)MAINTAIN AIRWAY
iv)ADDITIONAL DRUGS
HISTAMINE BLOCKER
-50mg DIPHENHYDRAMINE OR
10 mg CHLORPHENIRAMINE
CORTICOSTEROID-
100mg HYDROCORTICOSONE IM/IV
GENERALIZED ANAPHYLAXIS
P→A→B→C→D
i) EMERGENCY MEDICAL SERVICE
ii) EPINEPHRINE (0.3ML OF 1:1000) IM/IV
iii) OXYGEN AND VITAL SIGNS
iv) IF DOES NOT IMPROVE SECOND DOSE OF EPINEPHRINE IN 10 MIN
v) ADDITIONAL DRUGS
HISTAMINE BLOCKER
-50mg DIPHENHYDRAMINE OR
10 mg CHLORPHENIRAMINE
CORTICOSTEROID-
100mg HYDROCORTICOSONE IM/IV
vi)CPR
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