Acidente com hipoclorito de sódio durante tratamento endodôntico: análise de prontuário / Accident injection with sodium hypochlorite during endodontic treatment: case report

O sucesso do tratamento endodôntico está diretamente ligado ao processo de limpeza e modelagem dos canais radiculares. E para se conseguir a limpeza e desinfecção são utilizadas substâncias químicas auxiliares como coadjuvantes ao preparo mecânico, pois são essenciais na redução de microrganismos presentes no sistema de canais radiculares. Dentre as principais substâncias químicas auxiliares empregadas, a que apresenta maior destaque é o Hipoclorito de Sódio. O objetivo do presente estudo é mostrar através de uma análise de prontuário, um relato de um acidente com hipoclorito de sódio durante um atendimento odontológico. Para isso, um prontuário foi selecionado, onde a paciente procurou a clínica do Curso de Odontologia do Centro Universitário da Serra Gaúcha para realizar tratamento endodôntico do dente 16. Durante este procedimento, ocorreu um extravasamento do hipoclorito de sódio aos tecidos periapicais, e partir deste fato foi possível relatar maneiras de como prevenir, tratar e evitar esse tipo situação(AU)

The success of endodontic treatment is directly related to the root canal cleaning and modeling process. In order to achieve cleaning and disinfection, auxiliary chemical substances are used as auxiliaries to the mechanical preparation, since they are essential in the reduction of microorganisms present in the root canal system. Among the main auxiliary chemical substances employed, the most prominent is Sodium Hypochlorite. The objective of the present study is to show through an analysis of medical records, an account of an accident with sodium hypochlorite during a dental care. For this, a chart was selected, where the patient sought the clinic of the Dentistry Course of the University Center of Serra Gaúcha to perform endodontic treatment of the tooth 16. During this procedure, an extravasation of the sodium hypochlorite occurred to the periapical tissues, and from this It was possible to report on ways to prevent, treat and avoid this type of situation(AU)

Death After Accidental Injection of Tranexamic Acid During Spinal Anesthesia / 대한법의학회지

Medication errors such as administration of wrong drugs, wrong dosage and erroneous route of administration are not rare among medical misadventures. We present an autopsy case of accidental injection of tranexamic acid instead of bupivacaine during spinal anesthesia, accompanying the quantitative result of the tranexamic acid in the blood, cerebrospinal fluid and each internal organs. We think that warning signs on syringes and ampoules, simple and unified guideline for drug administration, separative documentation of drug administration and interpersonal communication on drug information should be done to prevent this type of medical errors.

A Case Report of Central Nervous System Toxicity following Accidental Injection of Tranexamic acid into Subarachnoid space / 대한마취과학회지

Neurologic Sequelae after spinal anesthesia are extrenely rare, due in part to use of prepackaged and sterile kits and the small doses of local anesthectics employed. We have experienced 42 years old healthy male developed cental nervous system toxicity due to injection of wrong substance into subarachnoid space. And the patient recovered 3 days later with mild pulmonary edema and about 72 hour anterograde amnesia after symptomatic treatment.