My tooth hurts, and I don't want narcotics!

It's Sunday evening, and a patient with tooth pain signs into triage. This pleasant but teary 44-year-old woman had a root canal two days earlier. Many ED providers would agree that dentists should not schedule root canals on Fridays unless they are truly emergent. But the patient is in the ED asking for your expert dental advice. The good news is you can assist her temporarily until she gets back to her dentist. This quick and effective ED procedure will save you time and heartache. THE BASICS No other medical problems or surgeries. Allergies: ASA, NSAID. The culprit: Tooth #17 Medications tried: Vicodin, Percocet, and Tylenol, all to no avail. PE: Negative except severe pain in the tooth itself, no gum involvement, no signs of infection, or abscess. THE APPROACH Inferior Alveolar Nerve (IAN) Block. THE PROCEDUREThe IAN block provides anesthesia to all the teeth on the side of the mandible of injection. It also numbs the lower lip and chin. Prefill (away from the patient) a 5 mL syringe with bupivacaine Attach 25 g 1.5 inch needle to syringe. Position the patient sitting upright at a 90-degree angle. Lying flat is also an option. Stand on the opposite side of intended injection, and use good light. Have an assistant hold a light source if needed to better visualize the site. Dry the area of injection with gauze. Remove gauze. Spray topical 20% benzocaine (HurriCane spray) to the site. Option: Saturate two cotton tip applicators with benzocaine. Place cotton tips on i...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs