Trauma!

Leforte Fractures


Intraoral electrical burn
Department of Pediatric Dentistry
Resident’s Name: Murphy Program:Lutheran Medical Center - Providence

Article title: Trauma, Chapter 9
Author(s): numerous
Journal: The Handbook of Pediatric Dentistry
Year. Volume (number). Page #’s:
Major topic: Trauma
Minor topic(s): Trauma assessment from beginning to end
Main Purpose: List all the necessary/recommended steps in the process of working up a child who has had a traumatic injury
Overview of method of research: Review

Findings:
This ‘article’ was simply Chapter 9 out of “The Handbook”. It’s already been broken down, so it’s kind of hard to summarize. I will attempt it anyway. First triage the situation.
Is the patient conscious? Are they vomiting, nauseas, seizing, etc.
Is the patient responsive? Can they tell you what happened?
Who else was there at the time of the incident
Use the Glasgow coma scale for eval. Of head trauma.

A thorough exam should include a thorough medical/dental history, notes on what/when/where/how the incident happened, extra/intra oral exam, and any necessary x-rays should be taken. After all of the necessary information has been gathered, a diagnosis should be given with a proposed treatment, and then treatment should be initiated. Once completed, any necessary meds should be prescribed, and there should be a follow up plan.
Possible trauma situations include but are not limited to fractured, displaced, or missing teeth, pulp exposures, bone fractures, lacerations, degloving, electrical burns, etc.
The Handbook has a great 5 page flow chart that is included in your residence manual. Definitely a great idea to bring it with you to your ED calls.
Remember we do NOT reimplant primary teeth due to ankylosis, infections risk, and possibly injuring the perm. Tooth bud.

Possible complications
Color changes (gray). Tx may not be indicated, sometimes the tooth changes back. Monitor it routinely.
Pulpal obliteration(calcification), necrosis, internal/external resorption.
Damage to developing tooth bud
ankylosis


Key points/Summary:
The second years last year said there was a lot of questions on the boards with regards to lacerations and electrical burns.

Soft Tissue Injuries
Tongue Lac-suture if bleeding is not controllable
Through and through punctures-suture both sides after adequate debridement
Vermillion border lacs-suture starting EXTRA orally
Ensure proper debridement!


Electrical Burns
Deep burns 2000 C- usually painless
eschar sloughs 7-10 days/bleeding from facial artery possible
use an appliance to stop contraction of the wound, worn for 6-12 months, usually with topical antibiotics
Plastic surgery usually necessary

Assessment of Article: Sort of tough to summarize a summary. We all should know The Handbook backwards and forwards…. So check it out!