Autumn Midterm; Med assessment Flashcards
what are the 4 questions to consider whether its safe to proceed with dental treatment
- can they endure physiologic and psychologic stress of the procedure
- will the patient have adequate hemostasis-
- is there increased infection susceptibility
- will drug actions of interactions cause any complications
whats H&P
history and physical exam
what are 6 question MUST ask for HEALTH history
-cardiovascular issues?
-infectious diseases?
-allergies to meds or latex?
-bleeding problems?
-take meds?
-other medical problems not asked about?
must ask this verbally! to make sure they understood the form
what vital signs are checked in dental office
- blood pressure
- heart rate
- respiratory rate
- temp
- oxygen saturation
- pain?
- blood glucose level
- biometric-height, weight bmi
(just bp and hr for asessing risk?)
how do you convert lbs to kg
lbs to kg, devide by 2 and subtract 10%
kg to lbs- multiply by 2 nd add 10%
whats: below, normal, overweight, obesitry1 2 and 3 levels BMI
below 18.5 -under 18.5-24.9 - normal 25-29.9 - overweight 30-34.9 obesity clas I 35-39.9 obesity class II above 40 class III
whats 3% lidocaine
30 mg/ml
how do you get the maximum dose
divide by 2, subtract 10% (get kilos) 170 pounds is about 76.5 kg
based on LEAN rather than actual body weight - for obese patients
whats body habitus
body type/build/composition
whats pedal edema
swelling in ankles, check if theres pitting when you put your finger- could be a sign of heart failure
whats cyanosis
skin is blue color
whats pallor
paleness in tissue-poor cardiac output
whats exapthalamos
eyes are sticking out bulb excess sclerea (sign of hyperthyroidism)
whats conjunctiva
red eyes, allergy/drug use?
whats jugular vein distention a sign of
heart failure in left side of heart
what is goiter
swelling in neck– thyroid disorder
whats 1-4, 5-6 and >10 met
metabolic equivalent threshold (excersise tolerance)
1-4; standard light home activities, walk around the house, take care of yourself eating, bathing and using toilet
5-9; climb a flight of stairs, walk up a hill, walk one or two blocks on level ground, run a short distance. moderate activities (golf,dancing), sex
> 10 strenous sports (swimming, tennis bycicle), heavy professional work
who gets a cardiac and pulmonary auscultation
anyone that gets sedation !!!!!
what are the ASA 1-6 classifications
ASA 1: normal, healthy
ASA 2: mild systemic disease (or significant health risk factor)– like smoker, social drinker, pregnancy, obesity, well controlled diabetes or hypertension, mild lung disease
ASA3: a patient with severe systemic disease that limits activity but is not incapacitating.- like poorly controlled diabetes/htn, copd, morbid obesity, active hepatitis, alcohol dependence or abuse, implanted pacemaker , moderate reducton of ejection fraction
ASA4: patient with severe systemic disease that is a constant threat to life- within the last 3 months; MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia, valve dysfunction severe, sepsis, DIC, ARD, ESRD, not undergoing regular scheduled dialysis
ASA5: pateint not expected to surfive 24 hours with or without medical intervention; aneurysm, massive trauma etc.
ASA6: a declared brain dead patient whose organs are being removed for donation
(pay attention to 3 and 4 mostly!?)
is physician consultation medical clearance
NO its OUR obligation to know appropriate dental care delivery considerations/guidelines based on the medical status
list contraindications for elective dental treatmentinc
- myocardial infarction within 6 months
- stroke within 6 months
- blood pressure above 180/110
- HIV/AIDS with CD4 <50 and or platelet count less than 60,000
- INR >3.5 with need for invasive treatment (blood clotting test)
- undiagnosed or untreated chest pain
- undiagnosed or untreated or non compliant diabetes or other endocrine diseases.
what is part of the revised cardiac risk assessment
incorporates 6 independent variables that predict the risk of cardiac complications!!
history of :
- ischemic heart disease
- heart failure
- cerebrovascular disease
- diabetes
- chronic kidney disease
- major operations (suprainguinal vascular, intrathoracic and intraperitoneal)
(in hospital mortality rates increase with the more of these you have!)
why does anxiousness matter for dentistry
increased risk of medical emergencies especially if there are baseline cardiovascular or pulmonary issues
what is the stress reduction protocol
especially for med compromised AND anxious patients:
- psych consultation
- iatrosedation
- premedication
- appointment scheduling
- minimize wait time
- preoperative and postoperative vital signs
- sedation/GA during treatment
- pain control
- watch treatment duration
- follow up communication
what does 1:100,000 epinephrine mean (how many grams in a 1.7 ml cartridge)
1 gram/100,000 ml
which is also .01 mg/ml– a 1.7 ml cartridge has 17 micrograms
1:1000 is 1000 micrograms per ml
what is levonordefrin vs epinephrine
epinephrine; impacts alpha1, beta1 and beta2 adrenergic receptors
levonordefrin or alpha methyl norepinephrine, more alpha than beta effects. usually in 1:20,000 concentration. 1 gm/20,000 mL = 50 micrograms per ml
what are alpha 1, beta 1 and beta 2 agonisms
alpha1: vascular smooth muscle constriction at arterioles- increase bp
beta1; +ionotropy and chronotropy, increased heart rate and force of contraction. increases CO
beta2: agonism vascular smooth muscle relaxation. vasodilation in skeletal muscle and decreased bp
what should you consider when it comes to vasoconstrictors
caution with cv disease, possible drug interations
- consider non vasoconstrictor local anesthetics
- take vital signs prior to injection, use a good technique, take vital signs intermittently as neeed. keep within 20% of baseline!
what are local anesthetic best practices
- know body weight kg
- convert to lean body weight as NEEDED
- know max dose for YOUR practice. local anesthetics w/epi- mainstay of dentistry. 2% lidocaine with 1/100k epinephrine- 7mg/kg!
- if you use more than one drug they are additive
- know your patient and adjust
