Considerations Flashcards
Advantages to chiropractic office minor surgery
1) cost - decease for patient. Less time loss from work (no post observation time). Less physician scheduling time. Fewer personnel (need or don’t need one trained CA)
2) Practicality - decrease in apprehension due to familiarity with physician, non hostile, comfortable environment. Return home immediately. Faster recovery/fewer complications.
1 complication of minor surgery
apprehension
Where are Staph infections often a problem?
Hospitals
Disadvantages to chiropractic office minor surgery
1) complications - poor management can be lethal. Patient anxiety can bring crisis. Potential toxic reactions to local anesthetic leading to anaphylactic shock. Unexpected post op bleeding.
2) extreme accuracy in diagnosis - knowing what the lesion is can decrease time consuming factors (bleeding, subcutaneous restructuring or multiple lesions)
3) Physician availability - always on call. Malpractice/abandonment if you are unavailable after a surgery.
4) post-operative scarring - patients need full disclosure ( procedures on the face best left for plastic surgeons)
Minor surgery cost to the physician
- Malpractice insurance is available but is potentially very expensive.
- needs room for sterilized space.
- initial set up cost is high.
- cost effectiveness
Evaluation of the cost effectiveness for performing minor surgery in practice.
-amount of cases vs potential income
What are emergency, urgent and routine cases for minor surgery?
Emergency-now (rare)
Urgent-today as soon as possible (few)
Routine-tomorrow or when convenient (majority)
Typical routine presentations minor surgery cases.
Physical exam Skin lesion/biopsy Hemorrhoids (non painful or bleeding) Backache Nausea w/o vomiting Constipation
Patient selection
Age -15 to 65 Body type - ecto,meso or endomorph Health history- frequency of flue/cold, childhood disease, hereditary disease, past surgeries Nutrition Medications Presence of diseases
Ectomorph
Tall, thin, fine boned
Hyperactive
Rule heal faster
Mesomorph
Medium frame, average weight
Very with pain sensitivity
Heal well and quickly
Endomorph
Short, heavy, large bones
Lethargic with higher blood pressures
Slower to heal
Higher risk factor
What are good medications to be familiar with?
- Recreational drugs: Cocaine, Valium, Prozac, amphetamines, barbiturates
- allergic/toxic reactions to local anesthetics like Novocain
- Aspirin
- diuretics: Dyazide orLasix (lower blood pressure)
- blood thinner: Coumadin or Heparin (stroke victims,arterial prosthesis, histoy of thrombophlebitis)
- arrhythmia: digoxin, lanozin, digitalis
Risks of certain disease when screening minor surgery cases.
- pulmonary hypertension, cognitive heart failure: avoided
- hemophilia: avoided
- diabetics: high risk/poor healers, prone to secondary infections
- know blood dyscrasia: high risk
- leukemia or simple anemia: high risk
- respiratory complaints: high risk
- nervous disorders: medium risk
- heart problems current/historically: additional risk
Routine patient exam procedure
Height Weight Blood pressure Pulses Respiration rate Reflexes Cranial nerves Funduscopic evaluation -mouth: tooth/gum disease, baccal mucosa -conjunctiva/sclera -skin
