Special Operations Forces Medical Handbook

5-20

b. Children (<50kg) 100,000-300,000 units/kg/day q 6 hours, not to exceed adult dosage

2. Cefadyl
   a. Adults - 1gm q 6 hours
   b. Children (<50kg) 40-80mg/kg/day q 6 hours, not to exceed adult dosage


3. Clindamycin (Cleocin)
   a. Adults - 300-600 mg q 6 hours
   b. Children (<50kg) 150-300mg q 6 hours

IV. DENTAL PROCEDURES

1. THERMAL TEST FOR CARIES. If hot and cold are used, test a normal tooth as a basis for comparison.
   The application of cold to normal teeth elicits pain in most instances, but the response ceases soon after the
   stimulus is removed. A diseased tooth, compared to a normal tooth, varies in its reaction to the temperature
   test. For example, a reaction to cold could persist after application stops but the tooth responds very little to
   heat, or the reaction to heat persists after application but the tooth appears to respond very little or not at all
   to cold. Perform procedure as follows:
   a. Isolate the teeth to be tested from the saliva with gauze packs.
   b. Cold test: spray a cotton-tipped applicator with ethyl chloride (if available) then place the cold surface
   on the tooth crown (ice may also be used). Note the response and its duration. A vital tooth will give a
   painful response to cold that abates after the cold stimulus is removed.
   c. Heat test: heat an instrument (e.g., a mouth mirror handle) and touch against the tooth. Note the
   response and duration. Similar pattern to cold test.
   d. Test an unsuspected tooth for comparison.


2. DENTAL ANESTHESIA
   a. Anesthetic solutions:


3. 2% lidocaine with 1/100,000 epinephrine (Xylocaine)
   (1) 1.8 ml carpule with red/ black lines
   (2) Duration of 2-4 hours
   (3) Max dose: 8 carpules for healthy 70 kg adult
   (4) Max dose: 2-3 carpules for child under age 12 (<50 kg)


4. .5% bupivacaine with 1/200,000 epinephrine (Marcaine)
   (1) 1.8 ml carpule with blue/black lines
   (2) Duration of 6-8 hours
   (3) Max dose: 10 carpules for healthy 70 kg adult
   (4) Max dose: 2 to 3 carpules for child under age 12 (<50 kg)


5. 3% mepivacaine without epinephrine (Polocaine or Carbocaine)
   (1) 1.8 ml carpule with tan/black lines
   (2) Duration of 1⁄2 to 1 hour
   (3) Max dose: 6 carpules for healthy 70 kg adult
   (4) Max dose: 1 to 2 carpules for child under age 12 (<50 kg)
   NOTE: Anesthetic agents with vasoconstrictors (epinephrine or neocobefrin) should never be used in areas
   with compromised blood supply: fingers, toes, ears, nose and penis.
   b. Anesthesia for maxillary extraction.
   
   
   1. Infiltration of anesthetic will provide adequate analgesia of the maxillary teeth. (Analgesia – block
      pain impulses; Anesthesia – block all nerve impulses.)
   
   
   2. Technique. Both facial and palatal injections must be given.
      (a) Facial injection (see Figure 5-3).
      (1) Insert the needle into the mucobuccal fold directly above the tooth. Shaking the cheek
      and lip during needle insertion can help alleviate injection discomfort.
      (2) Advance the needle upward about three-eighths of an inch until the needle gently
      contacts bone (this should approximate the root end).
      (3) Aspirate to insure that the needle has not entered a blood vessel.
      (4) Slowly deposit three-fourths of the carpule’s contents.