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Medicine

Are You Concerned About Mandibular Blocks In Patients Taking Anticoagulants?

This question was submitted to us by a general dentist: Are you concerned about mandibular blocks and possible injury to blood vessels (Inferior Alveolar Artery/Vein) in patients continuing anti-coagulant therapy (Warfarin)? Potential Hematomas? Management? Dr. Jason Goodchild provided this quick initial response: For patients on anticoagulant therapy, a careful review of the medical history including consultation with the patient’s physician is warranted.  This consultation should include information on the patient’s INR (International Normalized Ratio).  Ideally, a recent INR (with 24-48 hrs) is needed in order to ascertain the patient’s bleeding risk during surgery.   The literature is consistent on this issue: If the patient’s ...

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How Do I Manage A Patient Who Is On Anticoagulants?

We are very pleased to present this series of videos by Dr. Mark Donaldson, Director of Pharmacy Services at the Kalispell Regional Medical Center and faculty member at the University of Montana and the Oregon Health & Sciences University There is no such thing as medical clearance. In fact, the dentist retains the primary responsibility for the procedures carried out for the immediate management of many untoward complications. While it is always prudent to get a consult with a medical practitioner, such as the patient’s primary prescriber or cardiologist, at the end of the day, the onus is on the dentist ...

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Do You Know Your Ibuprofen?

 This Prescription Drug Consult is presented by the JCDA Oasis Team. It is also available in JCDA Oasis Mobile Ibuprofen  Addaprin [OTC]; Advil® [OTC]; Caldolor®; I-Prin [OTC]; Ibu®; Midol® Cramps & Body Aches [OTC]; Motrin® Infants’ [OTC]; NeoProfen Presentation Ibuprofen is a Non-Steroidal Anti-Inflammatory Drug (NSAID) which could be administered orally and through I.V. Ibuprofen is prescribed for inflammatory diseases, analgesia, dysmenorrhea, and as an antipyretic. Dosage Analgesic Children: < 4-10 mg/kg/dose every 6-8 hrs. Adults: 200-400 mg/dose every 4-6 hrs (maximum daily dose: 1.2 g, unless directed by physician). Analgesic, antipyretic: (Consult physician if treatment for > 10 days is required) Children 6 months to 11 years: Use of weight to select ...

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How Can I Treat A Patient With Previous Myocardial Infarction (MI)?

This medical Condition Consult is presented by the JCDA Oasis Team. The consult is also available through the JCDA Oasis Mobile Myocardial infarction (MI) is a consequence of obstruction in the coronary artery blood supply to the heart, resulting in death of the myocardium. Predisposing risk factors include atherosclerosis (thickening of arterial wall caused by the accumulation of lipid plaques), obesity, smoking, hyperlipidemia, family history of MI, and undue stress.   LA/Vasoconstrictors Drug Interactions Use vasoconstrictors with caution, due to increased risk for adverse outcomes1. Increased risk of cardiac arrhythmias in patients taking digitalis (e.g., digoxin).2. Increased risk of a ...

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Do Automated External Defibrillators (AEDs) have an impact on outcomes in health-care settings?

This question was submitted by a practising dentist: AEDs have become somewhat of a comfort object in a number of our offices emergency kit. Recently, a physician colleague commented on the generally unfavourable morbidity/mortality outcomes despite the use of AEDs to re-establish cardiac activity. Is this true?? Dr. Alan Lane, anaesthesiologist at the Ottawa General Hospital provided this initial response: I would say the literature supports that view. Reports indicate that the rate of successful hospital discharge for out-of-hospital cardiac arrests (OOHCA) is around 5%. Sudden OOHCA survival depends on adequate bystander CPR, on successful early defibrillation of a shockable ...

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Which medications are most effective for moderate to severe post-operative dental pain?

The following question was posted by a practising dentist: There is quite a bit of variation in the office with respect to drugs dentists like to prescribe for post-operative pain. Which pain medications are the most effective for moderate to severe pain and have the least number of side effects? Dr. Mark Donaldson from the University of Montana and the Oregon Health & Sciences University provided this initial response: The goal should be: “the most effective dose for the shortest period of time.”  We want to get our patients out of pain as quickly as possible. Two good recent articles come to ...

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What is the QT-Prolonging effect of Epinephrine on Patients Taking SSRIs?

The following question was submitted by a practicing dentist: What may happen with patients who have a prolonged QT due to their SSRI or Prozac medication when they are administered a local anesthetics-containing epinephrine? The following response is provided by Dr. Joonyoung Ji, resident in the Department of Dental Anesthesia at the University of Toronto Main take-away message Epinephrine, stress, and using more than one psychotropic increases the QT interval. The majority of patients have significant medical co-morbidities in reported cases of arrhythmia associated with psychotropics. Therefore, limiting the use of epinephrine to under 40 mcg or no more than 2 cartridges of ...

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Can you visualize the medical data explosion?

With the explosion of cone beam CT the amount of data being generated is staggering. Anders Ynnerman gives a TED talk about how data is being stored and re-processed to help us better understand the human body. He covers the size of the data explosion, virtual autopsy, functional MRI and more. A very interesting lecture.

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