prevention of inhalation of foreign bodies/materials
- All patients must be provided with and be wearing appropriate PPE (safety visor, bib)
- ensure all equipment is in good working order prior to every clinical procedure - HANDPIECE SAFETY, not working report to nurse in charge
- use of rubber dam (if not appropriate consider sponge/throat pack/guaze to protect airway)
- high volume suction available to remove debris
- check mouth/airway after the procedure to look for any debris etc
impressions - upright, roll imp posterior-anterior, don’t overload trays
initial management of inhalation management
- you/pt think inhaled somthing then STOP ALL TX
- keep calm and try not to alarm pt
- initially do not move pt - check mouth and gently remove any debris/foreign object or material with tweezers
- encourage pt to cough
- ASK pt if they are away of swallowing or inhaled or foriegn object - Immediate symptoms of ingestion may present as dysphagia, odynophagia (pain on swallowing), vomiting, retching,
foreign body sensationion, retrosternal pain. Hyper
salivation and an inability to swallow are signs of complete oesophageal obstruction. - choking/not able to response - BLS and 999
pt unsure - SEARCH; if not found consult senior clincian
inhaltion of object less than 5cm
reassure pt and no further action needed
advise to check stool - some may not appear
develpment any abdominal symptoms - get them to go to A&E
inhalation of object larger than 5cm, long, sharp, pointed or inflexible
refer to A&E immediately
pt suffereing from actue respiratory distress i.e.
wheezing, coughing, stridor, dyspnoea (difficulty in breathing), cyanosis (blue skin tone),
send to A&E
NaOCl accident when
comes into direct contact with periradicular tissues and structures
prevention of NaOCl accident
- pt PPE
- obtain consent for endo and what to expect (advise if feel pain or bad taste in mouth or nose during procedure lmk)
- pre op radiographs
- rubber dam
- NaOCl conc range 1-5.25% (3% in GDH)
- side vented Luer Lock needle used
- needle measured 2mm short of EWL
- gentle finger pressure and free from root canal (not binding)
ID high risk situations
examples of high risk endo situations
- Open apices (iatrogenic or anatomic).
- Perforation (including those not previously diagnosed).
- Close proximity to surrounding structures (e.g. maxillary antrum,
- inferior dental canal).
- Teeth with unclear root angulation or prosthetic crowns which may
- disguise this.
- Narrow, curved canal where needle wedging could occur more easily.
signs and symptoms of NaOCl accident
6
- Severe pain of sudden onset (can develop over minutes to hours).
- Large and diffuse swelling (similar to cellulitis).
- Profuse haemorrhaging through the root canal or within the periradicular tissues.
- Irrigant flow from nostrils with burning pain (for accident involving the maxillary antrum.
- Taste of sodium hypochlorite.
- Epistaxis - nose bleed
initial management of NaOCl extrusion
STOP ALL Tx
keep calm and try not alarm pt
mainly protectve and pallative for the affected tissues
advise the pt of what has happened and reassure them regarding immediate management
- pain - give LA via block to affected area (Do not admister LA directly to area of NaOCl extrusion)
- profuse bleeding through RCS - allow to continue till haemostasis achieved
- steroid containing intracanal medicament (Ledermis) placed - ensure no pressure during application
- do not obturate on this visit - seal access cavity
emergency management possibilities for NaOCl
respiratory - A&E
eye pain/blurriing/diplopia - Opthamaology
post op advice NaOCl
advise the pt to use alternative cold and warm compresses at site to minmise swelling
analgesia advice
consider prescription of antimicrobials in cases where there is high risk of tissue/bone necrosis, or involvement of the maxillary antrum or IDC
follow up for NaOCl extrusion
review within 24hrs
late signs and symptoms of NaOCl extrusion
haematoma
mucosal/bone necrosis
suppuration
changes to sensory or motor nerve function
trimus
crepitus
eye pain/ blurred vision/ diplopia
airway obstruction
advise to go to A&E and tell medical staff of prev incident
when to refer to oral and maxillofacial surgery
in NaOCl extrusion
mucosal or bone necrosis
sensory or motor nerve defects
