ABSTRACT
BACKGROUND: An examination of invasive procedure cancellations found that the lack of pre-procedural oral screening was a preventable cause, for children with congenital heart disease. The purpose of this study was to implement an oral screening tool within the paediatric cardiology clinic, with referral to paediatric dental providers for positive screens. The target population were children aged ≥6 months to <18 years old, being referred for cardiac procedures. METHODS: The quality implementation framework method was used for this study design. The multi-modal intervention included education, audit and feedback, screening guidelines, environmental support, and interdisciplinary collaboration. Baseline rates for oral screenings were determined by retrospective chart audit from January 2018 to January 2019 (n = 211). Provider adherence to the oral screening tool was the outcome measure. Positive oral screens, resulting in referral to the paediatric dental clinic, were measured as a secondary outcome. Provider adherence rates were used as a process measure. RESULTS: Data collected over 14 weeks showed a 29% increase in documentation of oral screenings prior to referral, as compared to the retrospective chart audit. During the study period, 13% of completed screenings were positive (n = 5). Provider compliance for the period was averaged at 70% adherence. CONCLUSION: A substantial increase in pre-procedural oral screenings by paediatric cardiologists was achieved using the quality implementation framework and targeted interventions.
Subject(s)
Cardiologists , Heart Defects, Congenital , Child , Heart Defects, Congenital/diagnosis , Humans , Infant , Pediatricians , Referral and Consultation , Retrospective StudiesABSTRACT
BACKGROUND: Subcutaneous emphysema is a rare occurrence in the dental setting. When it does occur, the entity may be mistaken for an anaphylactic reaction to a local anaesthetic agent or other medications used in dental surgery. CASE REPORT: During restorative treatment of a left second primary molar air was introduced under an operculum. Communication with submandibular and sublingual spaces to the mediastinum was established. CONCLUSION: Therapy for subcutaneous emphysema involves, correct diagnosis and antibiotic coverage. Subcutaneous air will resolve over time so observation is indicated.
Subject(s)
Dental Restoration, Permanent/adverse effects , Face , Neck/pathology , Subcutaneous Emphysema/etiology , Child, Preschool , Dental Caries/therapy , Dental Restoration, Permanent/instrumentation , Female , Humans , Mediastinal Emphysema/etiology , Molar/pathology , Tooth, Deciduous/pathologyABSTRACT
OBJECTIVE: To optimize CO2 removal in a child with a single ventricle. DESIGN: Case report. SETTING: A ten-bed pediatric intensive care unit in a university-affiliated hospital. PATIENT: A 6-yr-old boy with a single ventricle who underwent a Fontan procedure. INTERVENTIONS: Addition of a membrane oxygenator to a venovenous hemodialysis circuit. MEASUREMENTS: Patient respiratory variables were measured. MAIN RESULTS: A clinically significant improvement in CO2 removal was achieved. CONCLUSIONS: Addition of a membrane oxygenator to a dialysis circuit facilitates CO2 removal.
