What are the 2 cranial nerve examinations
Trigeminal nerve - 5 (cotton/pin prick)
Facial nerve - 7
(motor functions|)
What do you assess when doing the trigeminal nerve (5) exam
- Sensory functions -> cotton/pinprick sensation
- demonstrate on neck - so they know what it feels like
• forehead - Ophthalmic V1
• cheek - Maxillary V2
• jaw - Mandibular V3 - Motor functions
• pt to clench + feel masseter + temporalis bilaterally
• ask pt open mouth whilst you push jaw up
- Asses reflexes • Jaw jerk? • Corneal reflex ∙ explain procedure + get consent ∙ depress lower eyelid + pt look up ∙ touch edge cornea with cotton ∙ normal = direct blinking
What do you assess when doing the facial nerve (7) exam
- inspect sig facial asymmetry
- inspect motor functions
• Raise eyebrows
▸ raise eyebrows as if surprised
• close eyes
▸ scrunch eyes + don’t let me open them
▸ assess power
• blown out cheeks
▸ blow out cheeks + don’t let me deflate them
• smiling
▸ smile
▸ check asymmetry
• pursed lips
▸ try and whistle
▸ check asymmetry
inspect sensory changes • taste changes ▸ any changes to taste recently (7 supplies taste sensation to anterior 2/3 of tongue) • hearing changes ▸ any noises sound louder than normal
When checking lymph nodes, what do you check lumps for
- size ▸ <2mm - insig ▸ changed size over time - multiple? - consistency ▸ hard/rubbery/soft - tender ▸ non-tender = malignant - mobility ▸ fixed/mobile - erythema on overlying area
If infected or draining an infected organ, node will become….
- firm
- tender
- enlarged
- warm
- mobile
- overlying skin can be inflamed _ red
Lymph node may indicate
malignancy if …
- firm
- non-tender
- matted
- fixed
- progressively enlarging
Gain consent for XLA
- introduce me, pt name + DOB
- review MH, DH
- Explain procedure
I. “Today we will be extracting ___”
II. “You’ll be awake at all times + maintain verbal contact”
III. “You won’t feel any pain during the procedure but will feel pushing +
pressure
IV. Provide patient option of no treatment - Give benefits with continuing with procedure
I. Relief of pain
II. Removal of infection
Risks associated with procedure.. I. Bleeding II. Bruising III. Infection IV. Pain V. Swelling VI. Fracture of tooth VII. Damage to adjacent teeth VIII. Dry socket (if smoker/ contraceptive pills/ NUG) IX. Surgical procedure i. Cut in the gum ii. Bone removal iii. Stiches required
X. Mandible
i. Temporary/ permanent loss of sensation to chin, lip & tongue
XI. Maxilla
i. Fracture of maxillary tuberosity
ii. OAC
- “Do you have any questions?…”
- If patient happy to proceed, sign & date
Post Op instructions for XLA
• For next few hours, until the numbness wears off:
o Avoid eating
o Be careful not to bite tongue, cheek, lip
o Nothing hot or cold.
• For the rest of the day:
o Avoid any physical work or exercise
o NO rinse mouth/spit for rest of day
o Clean your teeth as usual- be careful not interfere with surgical area.
• After 24 hours
o Salt water rinses for 1 week, 4x a day (after meals)
• For 24 hours:
o Avoid alcohol
• For first few days:
o Soft diet for first few days.
o Do not use a straw
• For 48 hours
o Avoid smoking
• Bleeding:
o May get blood in the saliva for 2 days - normal
o if starts bleeding put clean gauze + apply biting pressure for 20
minutes.
o If bleeding is persistent call number
• Pain and swelling is normal.
o For pain relief may take appropriate pain killers normally take
- Take any antibiotics prescribed and finish course
- Don’t drink alcohol with metronidazole.
- May suffer sensitivity of surrounding teeth, clean well.
- If sutures used will dissolve in 3-4 weeks
- May feel sharp fragments around socket- don’t worry, will disappear.
What do you give for angina
Glyceryl trinitrate spray
400 micrograms / dose
sublingual
how does GTN spray work + what are possible side effects of using GTN spray
potent vasodilator for coronary artery
dizziness
headaches
What do you give for MI
+ if unresponsive after that
oral aspirin (anti-platelet) crushed/chewed
300mg
NOT FOR KIDS <18
start BLS
what do you give for asthma
salbutamol blue inhaler / reliever for asthma
inhalation
through large volume spacer?
100 micrograms/actuation or 10 puffs
symptoms of severe asthma
Inability to complete sentences in one breath
○ Respiratory rate >25 per minute
○ Tachycardia (HR >110 per minute)
○ PEFR <50%
symptoms of life threatening asthma
Cyanosis, exhaustion, confusion, decreased level of consciousness
○ Respiratory rate <8 per minute
○ Bradycardia (HR <50 per minute)
○ PEFR <33%
symptoms of anaphylaxis
- Difficulty breathing (stridor & wheezing), rhinitis, urticaria (rash) tachycardia, abdominal pain, vomiting, diarrhoea, sense of impending doom & flushing
how does salbutamol work
B2 agonist
bronchodilator
smooth muscle relaxant
what do you give for anaphylaxis
Adrenaline IM (repeat every 5 minutes if req.) 6 months - 5 years = 0.15ml 6 - 11 years = 0.3ml 12+ years = 0.5ml (0.5ml of 1:1000 solution)
how does adrenaline work
alpha receptor agonist
B1 agonist
B2 agonist
mast cells stabilisation
glucose elevation
