Day 1-Medical Assessment Flashcards
What’s the number 1 rule of OS?
Patient survival!
What is the acronym for assessing the Pt’s chief complaint?
SOCRATES
A sequential, comprehensive method of eliciting patient symptoms on an organ system basis
ROS-Review of Systems
Heart Rate: Tachycardia: >____ BPM…Bradycardia:
tachy > 100 BPM….brady
What does a fixed lymph node most likely indicate?
that it is malignant and is incorporating into the surrounding tissues
A patient with severe systemic disease that is not incapacitating
ASA III
A normal healthy patient
ASA I
A moribund patient who is not expected to survive without the operation
ASA V
A patient with mild systemic
disease or significant health risk factor
ASA II
A patient with severe systemic disease that is a constant threat to life
ASA IV
A declared brain-dead patient whose organs are being removed for donor purposes
ASA VI
Caused by ↑ myocardial O2 demand greater than available O2 delivery to the myocardium - myocardial ischemia
Angina Pectoris
Angina – stable If CP occurs only after significant exertion, responds readily to NTG administration, and no recent increase in severity **ambulatory OS procedures usually ____ with proper precautions
SAFE
Whats the magic limit for EPI use in CV at risk Pts?
0.04mg
Angina-prohylactic Abx after first __-__ weeks post stint placement.
6-8weeks
Unstable angina is a ____ risk for OS surgery!
MAJOR
One way we are going to discern Angina from MI is duration of ____ minutes or more = MI
15 minutes
What time range is the highest risk for reoccurrence of an MI?
within 6months of the first MI
Patients with transvenous pacemakers usually (do or do not?) Abx prophylaxis
DO NOT
Is Abx prophy req for pacemaker?
NO
Acute Rheumatic Heart Failure occurs as a result of a group ___ β- hemolytic streptococcal pharyngotonsillitis
Group A
What are the two standard Abx and their doses for prophylactic tx? How long before?
amoxicillin 2g and clindamycin 600mg 30min-1hr before.
\_\_\_\_\_\_\_\_\_ is NO LONGER NEEDED for • Rheumatic heart disease • Hypertrophic cardiomyopathy • Ventricular septal defect • Atrial septal defect • Calcified aortic stenosis • Bicuspid valve disease • Mitral Valve Prolapse
Antibiotic Prophylaxis
Patients with _______ should take all of their normal antihypertensive medications at their normal times with a sip of water prior to surgery
HTN
In OMS clinic upstairs, we generally will not tx anyone with SBOP>____, DBP>____. Med consult required. Often will consult for lower #’s, to encourage pt to get tx for their HTN.
> 200….>100
Avoid Rxing these antiinflammatories with asthma Pts…
NSAIDS and Aspirin
Kidney Patients; Defer treatment until day post ______ (best physiologic status, heparin duration of action is 3-4 hrs)
dialysis
RENAL TRANSPLANT: Which drug causes induced
gingival hyperplasia
cyclosporine A
Whats a normal platelet count? What can a pt with thrombocytepenia go down to?
150k-300k normal…19k thrombo pt
Hemoglobin A1c reflects an average glucose level of the previous ___-___ months.
3-6 months
When is the best time to schedule DM patients?
EARLY AM!!
Potency: Prednisone is _____ the strength of Cortisol.
4x
WHAT ARE THE THREE MAIN CATEGORIES OF PATIENTS WE WILL PROPHYLACTICALLY TREAT WITH ANTIBIOTICS?
- Prosthetic Cardiac Valve 2.Previous Bacterial Endocardidts 3.Congentital Heart Disease(cardiac transplants or valve repairs)
Dental Procedures where AbxProphy is recommended: ANY ________
EXTRACTIONS
When trying to decide whether or not to do AbXProphy for Bacterial Endocarditis, typically think: am I causing _______ or not?
bleeding (nice flashcard dude.)
What can the INR tell us about patients using plavix or aspirin?
Nothing :) INR is only used for Warfarin (coumadin)
What is the limit for INR to do a procedure?
3
If the INR is above 3 what do you do?
With physician approval, stop warfarin 3 days before surgery
What is the time window you want to have when checking Pt’s INR?
within 24 hours
What are the 4 categories of Congenital Heart Disease Pts that I will prophylactically Rx Abx to?
1.Unrepaired cyanotic congenital heart disease 2.Completely repaired CHD with prosthetic material or device for 6 months after placement 3.Repaired CHD with residual defects 4.Cardiac transplants with valvar disease
Would you recommend Abx Trophy for bleeding from trauma to lips or oral mucosa?
Nope
Would I give prophy Abx for someone with Bacterial Endocarditis if I was taking out sutures?
Nope
