54th FELLOWSHIP EXAMINATION 16 th October 2014 Written Exam 2 SAQs and 5 MCQs Clinical Exam 2 OSCEs Duration 30 minutes 3 teams SAQ 1 Case Stem This is Logan He ID: 779925
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Slide1
AUSTRALASIAN COLLEGE FOR EMERGENCY MEDICINE 54th FELLOWSHIP EXAMINATION 16th October 2014
Slide2Written Exam:
2 SAQs and 5 MCQsClinical Exam2 OSCEsDuration: 30 minutes, 3 teams
Slide3SAQ 1Case
Stem: This is Logan. He is from Logan.He drives a Holden. On weekends he also sells…
Slide4SAQ 1Case
Stem: This is Logan. He is from Logan.He drives a Holden. On weekends he also sells… vitamins and supplements.
Slide5SAQ 1
Sat night watching TV on couch4 guys bashed him up for no reason
Slide6SAQ 1. Describe the dental injuries in this photo. (2 minutes)
Slide7Dental Trauma3 take home points
Two groups of dental trauma: Fractures & Luxations2. Dental Box with 2 types of cement: Calcium & GIC“Fractures = Calcium to put a Cap”“Luxations = GIC to close the Gap”
3. Avulsions:
<1hr, Saliva/Milk, Splint
Slide8Dental Trauma2 groups of dental trauma: 1. Hard Dental
tissue injury = FRACTURES
Clinical significance:
Class 2 and 3 need emergency capping to reduce risk of pulp infection
What Ellis class is the fracture of tooth 11?
What Ellis class is the fracture of tooth 21?
Slide9Dental TraumaTwo groups of dental trauma: 2. Periodontal tissue injury
= LUXATIONS
4
types
of luxation
SUBLUX = loose
but no
displacement
LATERAL = Sideways displacement
INTRUSIVE = into socket
EXTRUSIVE = partially out
of
socket
Avulsion
=
tooth completely out
of socket
Slide10SAQ 1. Describe Logan’s dental injuries.
Vocab:
Luxation – lateral, extrusive, intrusive
Avulsion
Complex dental injury involving teeth 22 and 23 and surrounding gingiva, lip and adjacent alveolar bone. Complete avulsion of tooth 23 with exposed
peri-odontal
ligament cells and possible Ellis 4 root fracture. Anterior displacement of tooth 22 with intrusive luxation.
Slide11SAQ 2a. Describe and interpret Logan’s OPG. (1 minute)
Slide12SAQ 2a. Describe and interpret Logan’s OPG.
REPORT:
Oblique
fracture is seen extending through the left
maxilla.
Movement
artefact obscuring the apices of the upper jaw teeth.
Previous
dental work noted.
No
mandibular fracture is identified.
The
temporomandibular joints are normally opposed.
No
air-fluid level within the right maxillary
antra.
Slide13Different Case Stem = but same location of pain.37yr aboriginal woman, No trauma, left toothache 4 days, left upper gingival swelling, and fevers.
SAQ 2b. Describe and interpret this OPG (1 minute)
Slide14REPORT:Multiple missing teeth. Multiple dental fillings. Multiple dental caries. Lucency surrounding root of tooth 23 concerning for dental abscess.
Slide15Dental TraumaMCQ 1In
avulsion dental injuries, how soon should the tooth be re-inserted to maximize the viability of the peri-odontal ligament cells? 1hr, 2hrs, 3hrs, 4hrs
Slide16Dental TraumaMCQ 1In
avulsion dental injuries, how soon should the tooth be re-inserted to maximize the viability of the peri-odontal ligament cells? 1hr, 2hrs, 3hrs, 4hrsAnswer: Aim to reinsert tooth with intact viable
peri-odontal
cells within 1 hr.
Timing
– 85-97% tooth survival if
reimplanted
within 5
mins
, <1% survival if >60mins coz
periodontoid
ligament cells dead and apex socket closes over. If place tooth in isotonic solution = increase viability time to 4-6 hrs.
Slide17Dental TraumaMCQ 2All of the following are an appropriate transportation medium for an avulsed tooth, EXCEPT
Salivamilkcontact lens solution chocolate yoghurt
Slide18Dental TraumaMCQ 2All of the following are an appropriate transportation medium for an avulsed tooth, EXCEPT
Saliva, milk, contact lens solution, chocolate yoghurt
Answer
: Maintain periodontal cells via saliva, milk (isotonic, mg and ca), sterile saline, contact lens solution. NOT soy, choc milk, juice. Prolongs viability of cells to 4-6hrs.
Slide19Dental TraumaMCQ 3When handling an avulsed tooth you should always:
Scrub the root clean, hold only the crown, boil the tooth for sterilization, Lick your fingers first
Slide20Dental TraumaMCQ 3When handling an avulsed tooth you should always:
Scrub the root clean, hold only the crown, boil the tooth for sterilization, Lick your fingers first
Answer
: do not scrub root, only handle crown, thus avoid disruption of periodontal ligament cells
Slide21Dental TraumaMCQ 4An infra-orbital nerve block in dental trauma results in local
anaesthesia to which teeth:Front 2 incisors 11 and 21, Maxillary Incisors / Canine / Molars, Mandibular teeth 31 to 35, Maxillary teeth 21 to 25
Slide22Dental TraumaMCQ 4An infra-orbital nerve block in dental trauma results in local
anaesthesia to which teeth:Front 2 incisors 11 and 21, Maxillary Incisors / Canine / Molars, Mandibular teeth 31 to 35, Maxillary teeth 21 to 25
Answer
: infra-orbital nerve block (maxillary teeth 1-5), individual maxillary teeth local block, inferior-alveolar block (all mandibular teeth)
Slide23Dental TraumaMCQ 5To splint an avulsed tooth to an adjacent tooth, all of the following methods are acceptable EXCEPT
:Blutac and tinfoil, Using Glass Ionomer Cement, Using Calcium hydroxide cement, Mouth guard
Slide24Dental TraumaMCQ 5To splint an avulsed tooth to an adjacent tooth, all of the following methods are acceptable EXCEPT
:Blutac and tinfoil, Glass Ionomer Cement, Calcium hydroxide, Mouth guard
2 types of
cement in Dental Box
Calcium Hydroxide = FRACTURES
Glass
Ionomer
Cement
=
LUXATIONS
Remember:
“Calcium = CAP”
“
GIC =
GAP”
Calcium hydroxide for “capping” a tooth with an Ellis 2 or 3 dental fracture
.
GIC to splint
an avulsed tooth that has left a “gap
”
Slide25Dental TraumaMCQ 5To splint an avulsed tooth to an adjacent tooth, all of the following methods are acceptable EXCEPT
:Blutac and tinfoil, Glass Ionomer Cement, Calcium hydroxide, Mouth guard
2 types of
cement in Dental Box
Calcium Hydroxide = FRACTURES
Fractures only = Ellis
2 or 3
only with pulp exposed
Calcium Hydroxide for pulp capping only
4
benefits: antibacterial, localized buffer to neutralize acid,
binds strongly to dentin, alters the physical
matrix of dentin to decrease
demineralisation
Remember:
“Calcium = CAP”
“
GIC =
GAP”
Calcium hydroxide for “capping” a tooth with an Ellis 2 or 3 dental fracture
.
GIC to splint
an avulsed tooth that has left a “gap
”
Slide26Dental TraumaMCQ 5To splint an avulsed tooth to an adjacent tooth, all of the following methods are acceptable EXCEPT
:Blutac and tinfoil, Glass Ionomer Cement, Calcium hydroxide, Mouth guard
2 types of
cement in Dental Box
Glass
Ionomer
Cement
= LUXATIONS
Splinting of
Luxations
& Avulsions, NOT fracture pulp capping
polymer of silicon, fluoride and aluminum.
3 benefits: tooth
coloured
, binds to
strongly to enamel,
releases fluoride.
Cons: lower compressible strength thus mainly for outside of tooth fillings or splinting, not mastication surface of tooth, thus not for capping
Remember:
“Calcium = CAP”
“
GIC =
GAP”
Calcium hydroxide for “capping” a tooth with an Ellis 2 or 3 dental fracture
.GIC to splint an avulsed tooth that has left a “gap”
Slide27Dental TraumaOSCE 1CLINICAL SCENARIO STEM:
You are an emergency physician working in a rural district hospital.A 34yr old man called Logan has been assaulted in his home and presents with a dental avulsion of his left tooth. You have a dental trauma box and no other assistance. INSTRUCTIONS:You are required to use the contents of the dental box to reinsert and splint his tooth into anatomical position.
You have 4 minutes.
Slide28Dental TraumaOSCE 2CLINICAL SCENARIO STEM:
You are an emergency physician working in a rural district hospital.A 34yr old man called Logan has been assaulted in his home and presents with a dental fracture of his left tooth with exposed pulp. You have a dental trauma box and no other assistance. INSTRUCTIONS:You are required to use the contents of the dental box to apply a dental cap to prevent a pulp infection.
You have 4 minutes.
Slide29References and Resources: Dental Trauma Box. Dr Tony
Skapetis. Clinical Senior Lecturer in the Faculty of Dentistry at Sydney University, BDS, MEd, PhD, Dentistry/Medical EducationEmergency Dental, Handbook for Medical practitioners. 2010.
Dr
Tony
Skapetis
.
Classification
of Dental Trauma & Management of dental avulsions:
Powerpoint
slides by Tony
Skapetis
Paul Lawless @
Annerley
Meats for the teeth
Slide30Dental Trauma3 take home points
Two groups of dental trauma: _____ & _____2. Dental Box with 2 types of cement: ____ & ____“Fractures = ______ to put a Cap”“Luxations = GIC to close the ______”3. Avulsions: ____, milk/saliva, _____
Slide31Dental Trauma3 take home points
Two groups of dental trauma: Fractures & Luxations2. Dental Box with 2 types of cement: Calcium & GIC“Fractures = Calcium to put a Cap”“Luxations = GIC to close the Gap”
3. Avulsions:
<1hr, Saliva/Milk, Splint
Slide32Dental TraumaTHE END
BEFORE
AFTER
Slide33AUSTRALASIAN COLLEGE FOR EMERGENCY MEDICINE 54th FELLOWSHIP EXAMINATION 16th October 2014
END OF THE EXAM.
EVERYONE PASSED !