0071598626.pdf

the possibility of aspiration or entrapment in soft tissues should be consid-
ered. Avulsed permanent teeth require prompt intervention. The best envi-
ronment for an avulsed tooth is its socket. Replantationis most successful
if the tooth is returnedtoits socketwithin 30 minutes of the avulsion.
A 1% chance of successful replantation is lost for every minute that the tooth
is outside of its socket. The tooth should only be handled by the crown, so
as not to disrupt the root. If the patient cannot replant the tooth, then he or
she should keep the tooth under his or her tongue or in the buccal pouch
so that it is bathed in saliva. If that cannot be achieved, then the tooth can
be placed in a cup of milk (e)or in saline. The best transport solution is
Hank solution, which is a buffered chemical solution. However, it is typi-
cally unavailable in this setting.
(a)The worst situation is to transport the tooth in a dry medium.
(bandc)Water and beer are less than ideal. Saliva, milk, or saline are bet-
ter solutions.

132.The answer is c.(Rosen, p 138.)The GCS score, as seen below, may be
used as a tool for classifying head injury and is an objective method for fol-
lowing a patient’s neurologic status. The GCS assesses a person’s eye, verbal,

152 Emergency Medicine

Eye opening Spontaneous 4

To verbal command 3

To pain 2

None 1

Verbal Oriented 5

responsiveness Confused 4

Inappropriate words 3

Incomprehensible sounds 2

None 1

Motor response Obeys 6

Localized 5

Withdraws (pain) 4

Flexion (pain) 3

Extension (pain) 2

None 1

A Glasgow Coma Scale

Total: ________

(Reproduced, with permission, from Stone CK, Humphries RL, eds.The multiply injured patient.
In:Current Diagnosis & Treatment: Emergency Medicine.6th ed. New York, NY:
McGraw-Hill; 2008: Figure 10-2.)