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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

WORLD EMERGENCY MEDICINE SOCIETIES

My Heart is Racing! Select Cardiac Arrhythmias and Practice Updates

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martes, 1 de diciembre de 2015

Lujación ATM

Brown Emergency Medicine - Posted on November 26, 2015 - By Chana L Rich
REDUCTION TECHNIQUES
Consider trying these methods first:
  • Gag technique: Elicit the gag reflex using a tongue blade or cotton swab. During the reflex, inhibition of the muscles of mouth closure permits the mandible to descend, which may free the condyle in some patients. Have suction handy in case of vomiting.
  • Syringe technique: Place a 5 or 10 mL syringe between the posterior upper and lower molars or gums on one of the affected sides. Have the patient gently bite down on the syringe while rolling it back and forth between the teeth until the dislocation on that side is reduced. The opposite side tends to reduce spontaneously. If this does not occur, place the syringe on the opposite side and try the same technique.
    • Note: this requires a high level of participation of the patient (i.e.: will not work in very young children)
If those fail…
“Classic Technique”/Intraoral reduction:
  • Have the patient sitting up, facing you, head against the back of the bed
  • Have your arms at the level of the mandible
  • Grasp the mandible with both hands
  • Rest your thumbs on the inside the mouth on the ridge of the mandible adjacent to the molars
  • Wrap thumbs in gauze (leave a trail of gauze outside of the mouth so that it can be easily removed)
  • Wrap your fingers around the outside of the jaw. You may place the thumbs on the occlusal surfaces of the teeth. If you do, keep your thumbs safe from being bitten by wrapping them in gauze
  • Have an assistant hold the head of the patient still.
  • Apply downward pressure to the mandible to free the condyles from the anterior aspect of the eminence, then guide the mandible posteriorly and superiorly back into the temporal fossae.
http://blogs.brown.edu/emergency-medicine-residency/procedural-blog-extra-reduction-of-tmj-dislocation/