Management of hospitalised Patients Dr Hazem Al-Ahmad BDS, MSc (Lon), F.D.S. R.C.S.(Eng) Associate Professor Maxillofacial surgeon Dental School University Of Jordan

A dentist in a hospital: Give consultations Give consultations Emergency room consultation Emergency room consultation Inpatient consultation Inpatient consultation Does procedures best done in hospitals Does procedures best done in hospitals

Hospitalising patients for dental care: Behavioural management Behavioural management Children Children Mental retardation Mental retardation Medical problems Medical problems Needs sedation or G.A Needs sedation or G.A Day surgery Day surgery

Preoperative patient evaluation: Preoperative medical examination and medical history Preoperative medical examination and medical history Contact operating room staff Contact operating room staff Instruments Instruments Operating time and list Operating time and list

Preparation of the PatientPreparation of the Patient Admit 24 hours before the operation Admit 24 hours before the operation general health and fitness general health and fitness investigations investigations informed consent informed consent anxiety anxiety Food and drink Food and drink Premedication Premedication

Operating rooms protocols Get an assistant Get an assistant Anesthesiologist Anesthesiologist Scrub nurse- gowned & gloved Scrub nurse- gowned & gloved Circulating nurse Circulating nurse

Local / sedation Local / sedation Day-case surgery Day-case surgery G.A / admission G.A / admission

Operating rooms protocols Route of intubation Route of intubation Length of procedures: > 4 hours Foley ’ s catheter Length of procedures: > 4 hours Foley ’ s catheter Eyes protected Eyes protected Scrubbing, painting, drapping Scrubbing, painting, drapping Moist throat pack Moist throat pack

Operating rooms protocols Surgeons: Surgeons: Surgical scrub uniform Shoe cover Cap Surgical hand and arm scrub Surgical hand and arm scrub Pressure gauze with tail Pressure gauze with tail

-Instruments

Preparation and isolation of Operation Area :

Postoperative Care: Potoperative orders Potoperative orders recovery ward or intensive care unit recovery ward or intensive care unit general care of the patient and local care of the operation site. general care of the patient and local care of the operation site. intermaxillary fixation intermaxillary fixation postoperative pain control and sedation. postoperative pain control and sedation. The Operation Record

discharge Oral hygiene Oral hygiene Wound care Wound care Diet instructions Diet instructions Activity levels Activity levels Follow up visits Follow up visits prescription prescription

Postoperative complications: Airway obstruction or laryngeal oedema Airway obstruction or laryngeal oedema Throat discomfort Throat discomfort Nausea and vomtting – antiemetic drugs- IMF and wire cutters Nausea and vomtting – antiemetic drugs- IMF and wire cutters Fever oral > 37.2, rectal >38 Fever oral > 37.2, rectal >38

Fluids and electrolytes Daily intake L Daily intake L Dextrose 5% Dextrose 5% Normal saline Normal saline Lactate ringer ’ s solution Lactate ringer ’ s solution

Blood transfusion Hypotensive anesthesia Hypotensive anesthesia Low blood loss in oral surgery Low blood loss in oral surgery Autogenous blood transfusion Autogenous blood transfusion

Thank you Thank you Thank you