so there i was, with an upset patient in my chair...
pt c/o swelling R face for 7/7:
on 290408 i did a PSA block for cons purposes. after that the patient noted swelling and ecchymosis.
o/e: R lower cheek area presented with ecchymosis, tender on palpation of the bruised region. posterior to the ecchymosis was a region of inflamed skin. pt reported using a muscle ointment on the bruise to cope with the pain. no abnormalities intraorally; buccal sulcus normal. adjacent teeth nttp/pp and vital except for the one with the prior RCT. stetson's duct was patent, with clear fluid expressed.
everything basically pointed towards me having nicked a vessel or something. blood then tracked down the fascia and pooled in the lower end of the buccal space. so what's to be done? AB cover and review, plus some Piriton for the skin irritation that seemed to be connected to usage of an oil of wintergreen-containing ointment. pretty standard stuff, management is basically to make sure that the dead space is taken care of using antibiotics to minimise risk of ending up with a cellulitis.
now at this point the blog will leave didactics and move into full-blown rant mode...
for this patient there is also an incidental finding of acute malignant shit-for-brains. the patient was remarkably ungracious about the whole incident. yes, youre upset because you have a big-ass bruise on your face. yes, you acknowledge it's your bloody fault that when i bent over backwards to give you a fast review you didnt show up because you thought it was getting better, and couldnt be arsed to come down and grace my chair with your presence. but for goodness sake, checking you up one more time costs money too! x-rays don't come free! and medications certainly don't come free either. if you don't want to eat medications and still want to be seen, what do you want me to do? we already bent over backwards to waive all the clinical stuff and x-ray fees, now be a good hippopotamus and eat your medication! no point coming up with stupid excuses about 'i fear medications' (this doesn't translate well from the mandarin) or 'antihistamines make me sleepy'. how do you expect things to happen if you don't eat medications? and when you casually mention the fact that a dentist in your church told you it was just a nicked vessel and not to worry, it identifies you as a person of the book and destroys testimony, not to mention the snide remarks about God blessing you with a haematoma. shit for brains! truly shit for brains...
and i have to review her again on thursday. i am so looking forward to this...
pt c/o swelling R face for 7/7:
on 290408 i did a PSA block for cons purposes. after that the patient noted swelling and ecchymosis.
o/e: R lower cheek area presented with ecchymosis, tender on palpation of the bruised region. posterior to the ecchymosis was a region of inflamed skin. pt reported using a muscle ointment on the bruise to cope with the pain. no abnormalities intraorally; buccal sulcus normal. adjacent teeth nttp/pp and vital except for the one with the prior RCT. stetson's duct was patent, with clear fluid expressed.
everything basically pointed towards me having nicked a vessel or something. blood then tracked down the fascia and pooled in the lower end of the buccal space. so what's to be done? AB cover and review, plus some Piriton for the skin irritation that seemed to be connected to usage of an oil of wintergreen-containing ointment. pretty standard stuff, management is basically to make sure that the dead space is taken care of using antibiotics to minimise risk of ending up with a cellulitis.
now at this point the blog will leave didactics and move into full-blown rant mode...
for this patient there is also an incidental finding of acute malignant shit-for-brains. the patient was remarkably ungracious about the whole incident. yes, youre upset because you have a big-ass bruise on your face. yes, you acknowledge it's your bloody fault that when i bent over backwards to give you a fast review you didnt show up because you thought it was getting better, and couldnt be arsed to come down and grace my chair with your presence. but for goodness sake, checking you up one more time costs money too! x-rays don't come free! and medications certainly don't come free either. if you don't want to eat medications and still want to be seen, what do you want me to do? we already bent over backwards to waive all the clinical stuff and x-ray fees, now be a good hippopotamus and eat your medication! no point coming up with stupid excuses about 'i fear medications' (this doesn't translate well from the mandarin) or 'antihistamines make me sleepy'. how do you expect things to happen if you don't eat medications? and when you casually mention the fact that a dentist in your church told you it was just a nicked vessel and not to worry, it identifies you as a person of the book and destroys testimony, not to mention the snide remarks about God blessing you with a haematoma. shit for brains! truly shit for brains...
and i have to review her again on thursday. i am so looking forward to this...
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