• Pediatric mandibular fractures: Greenstick, esp. condyle
• TMJ ankylosis signs in child:
  • Limited mouth opening
  • Prominent antegonial notch
  • Elongated coronoid
  • Short ramus
  • Bony bridging
  • Fullness on affected side

• Q – switching: Shortens pulse time to limit lateral tissue damage (e.g., ruby laser for tattoo removal).
• CO₂ laser:
  • Zone of coagulation necrosis: ~500 microns; reduced to <100 microns with superpulse/ultrapulse.
  • Common for cosmetic skin resurfacing.
• Tissue interactions with lasers: Reflection, scatter, transmission, absorption.
• Tissue reactions to laser energy: Photothermal, photoablative, photochemical, photoacoustic.
• Delivery systems: Fiberoptic guide, articulated arm, hollow wave guide (most recent).

Endotracheal Route (L.E.A.N.)

Mnemonic for drugs that can be administered via endotracheal tube:

L - Lidocaine

• Dose: 1-1.5 mg/kg
• Indication: Ventricular arrhythmias, laryngospasm
• Mechanism: Sodium channel blockade
• Dilution: 5-10ml normal saline

E - Epinephrine

• Dose: 0.01-0.1 mg/kg (0.1-1 ml/kg of 1:10,000)
• Indication: Cardiac arrest, severe anaphylaxis
• Mechanism: α and β adrenergic stimulation
• Dilution: 5-10ml normal saline

A - Atropine

• Dose: 0.02-0.04 mg/kg (minimum 0.1mg)
• Indication: Bradycardia, organophosphate poisoning
• Mechanism: Muscarinic receptor antagonism
• Dilution: 5-10ml normal saline

N - Narcan (Naloxone)

• Dose: 0.01-0.1 mg/kg
• Indication: Opioid overdose reversal
• Mechanism: Opioid receptor antagonism
• Dilution: 5-10ml normal saline

Administration Technique

• Volume: Dilute in 5-10ml normal saline
• Method: Inject via suction catheter or directly into tube
• Follow-up: Bag ventilation to distribute drug
• Absorption: Lower bioavailability than IV route
• Monitoring: May need higher doses or repeat administration

Alternative Routes

• Intravenous: Preferred when available
• Intraosseous: Good alternative to IV
• Intramuscular: Limited utility in emergencies
• Sublingual: Some medications (nitroglycerin)

LASER THERAPY – VERY HIGH YIELD

Laser Physics & Mechanisms

Q – Switching

• Creates exceptionally short pulse time
• Limits lateral tissue damage
• Used with short thermal relaxation time tissues
• Example: Ruby laser for tattoo removal

CO₂ Laser Parameters

• Continuous wave: Coagulation necrosis zone ~500 microns
• Superpulse/Ultrapulse: Reduces zone to <100 microns

Tissue Interactions (4 Basic Types)

1. Reflection
2. Scatter
3. Transmission
4. Absorption

Tissue Reactions Post – Absorption (4 Types)

1. Photothermal
2. Photoablative
3. Photochemical
4. Photoacoustic

Clinical Applications

Cosmetic Skin Resurfacing

• Primary lasers: CO₂ laser, Er:YAG laser

Laser Delivery Systems

1. Fiberoptic guide
2. Articulated arm laser
3. Hollow wave guide technology (most recent)

Alcohols as Antiseptics

Ethanol and isopropyl alcohol are commonly used as antiseptics in various healthcare settings. They possess antibacterial properties and are effective against a range of microorganisms, although they have limitations in their effectiveness against certain pathogens.

Mechanism of Action

• Antibacterial Activity: Alcohols exhibit antibacterial activity against both gram-positive and gram-negative bacteria, including Mycobacterium tuberculosis.
• Protein Denaturation: The primary mechanism by which alcohols exert their antimicrobial effects is through the denaturation of proteins. This disrupts cellular structures and functions, leading to cell death.

Effectiveness and Recommendations

1. Contact Time:

   • According to Spaulding (1939), for alcohol to achieve maximum effectiveness, it must remain in contact with the microorganisms for at least 10 minutes. This extended contact time is crucial for ensuring adequate antimicrobial action.

2. Concentration:

   • Solutions of 70% alcohol are more effective than higher concentrations (e.g., 90% or 100%). The presence of water in the 70% solution enhances the denaturation process of proteins, as reported by Lawrence and Block (1968). Water acts as a co-solvent, allowing for better penetration and interaction with microbial cells.

Silk

• Composition: Natural protein fiber
• Structure: Braided
• Advantages: Excellent handling, superior knot security, cost-effective
• Disadvantages: Inflammatory response, bacterial adherence, gradual weakening
• Clinical uses: Oral surgery, temporary sutures requiring easy removal

Nylon (Polyamide)

• Structure: Monofilament or braided
• Advantages: High tensile strength, minimal tissue reaction
• Disadvantages: Difficult handling, poor knot security
• Clinical uses: Skin closure, situations requiring high strength

Polypropylene (Prolene)

• Structure: Monofilament
• Advantages: Chemically inert, minimal tissue reaction, maintains strength
• Disadvantages: Difficult handling, tendency to cut through tissues
• Clinical uses: Vascular surgery, situations requiring permanent support