lecture 6 Flashcards
patient planning before surgery
perioperative mean
pre-operative
intra-operative
-post-operative
_ assessment patient evaluation
~reduces intraoperative morbidity
~allows provider to anticipate and prepare
~eliminates or minimizes surprises
pre-operative assessment
morbidity(diseased)
during the history and physical do we give full review of PMH
not expected FULL review of systems but outline overview
always start with chief complaint - why patient is there
pain after routine dental extractions:
no more than _ days of opioids can be prescribed for acute pain in adults
no more than _ days for patients under 18
dosing may not average more than _mg Morphone equivalent dose (MED) over the prescribed period
7 days - adults
5 days - under 18
30mg
Morphone equivalent dose (MED):
hydrocodone oxycodone tramadol hydromorphone codeine
hydrocodone - 30mg oxycodone-20mg tramadol-300mg hydromorphone-7.5mg codeine-200mg
Mandatory Documentation for post-op opioids
Advice on _ _
education on _
with minors, must discuss _
advice on the benefits and risks of opioids including potential for addiction
education on safe disposal
with minors, must dicuss concern for increase risk of abuse with patients suffering from mental health disorder
OSU guidelines for surgical pain control : MILD PAIN
OTC per bottle instructions OR
600mg Ibuprofen every 6 hours - 3 day supply + 650mg acetaminophen every 6 hours for 24 hours
OSU guidelines for surgical pain control : MODERATE PAIN
Perio-op : pre-medicate with _ 30min before surgery, _ injection to surgical site at end of procedure
post op : elevate head at least _ degree for 24hr, ice for _, 600mg _ every 6 hours - 3 day supply + 650mg _ every 6 hours for 24 hours, _ 5/325 every 6hr 2days, _ 50mg every 4hr 2 days
Perio-op : pre-medicate with 600mg Ibuprofen 30min before surgery, marcaine injection to surgical site at end of procedure
post op : elevate head at least 30 degree for 24hr, ice for 20 min on and 20 off (can do 36hr), 600mg Ibuprofen every 6 hours - 3 day supply + 650mg acetaminophen every 6 hours for 24 hours, NARCO 5/325 every 6hr 2days, Tramadol 50mg every 4hr 2 days
OSU guidelines for surgical pain control : SEVERE PAIN
follow the same perio-op and standard post-op options for moderate pain
consider increasing the narcotic to 10mg for only 24 hr period and back to 5mg for the next 48
this will never be your patient in dental school
contradiction to _ use
kidney disease, pregnancy, coagulation disorder, allergy, history of intolerance
NSAID
contradiction to _ use
liver disease, allergy, history of intolerance
acetaminophen
what kind of pain?
simple routine dental extractions
quadrant extractions
surgical extractions
mild pain
no narcos for this
what kind of pain?
surgical extrcations that last longer than 1 hour
significant bone removal
instructor adivce
moderate
same ibuprofen acetaminophen plus 5/325 narcos
Post-OP swelling
expect _ amount for simple extractions
expect _ for flaps, bone removal
peak swelling reaches maximum at _ hours
little or none for simple
little to substantial for flaps, bone removal
peak swelling at 36-48 hours - 2 days postop
post op
if pain does not improve or increase after _ hours, call your surgeon
72 hours - 3 days
