Management of medically compromised patient Flashcards
What methods can we use to identify a medically compromised patient?
- Medical history questionnaire
- Direct patient questioning
- Referral from other medical practitioners
- Medication
- Investigation results
- GP
- Patient appearance
What are the 4 ASA classifications?
1 = normal health patient 2 = mild disease controlled by medication 3 = severe systemic disease, one or more moderate to severe diseases 4 = severe systemic disease that is a constant threat to life
What alerts do we need to be aware of?
- Medical conditions
- List of medications
- Any previous hospital admissions
- If they regularly attend the hospital
What do we need to include in our medical history?
- Is the patient generally well?
- Systems review
- Surgical considerations
- Anesthesia considerations
- Dental history
What do we need to be aware of when reviewing the cario-vascular system?
Angina = risk of further attacks, patient need to bring GTN spray with them.
Recent myocardial infarction = up to 3 months they are at higher risk of a further MI.
Cardiovascular disease = considering their medication
Cardiac defects/valve replacements = puts them at risk of infection
Hypertension = risk of thrombotic events including stroke and MI. Check BP before any extractions. Delay treatment if BP is over 160/100.
What are we assessing for if someone has respiratory disease?
- Any hospital admissions
- Type of inhaler used and frequency
- What is their oxygen saturation?
- Are they short of breath at rest
- Do they need supplemental oxygen
What can we do when treating someone with respiratory disease?
- Good pain management
- Sit them up
- Have inhaler on them
- Avoid aspirin and ibuprofen if patients is on corticosteroids
What are the 3 problems associated with diabetes?
1) Hypoglycaemic emergency
2) Delayed healing
3) Increased risk of infection
What do we need to establish if a patient had diabetes?
- Time last eaten
- Patient normally well controlled?
- Consider glucose drink if glucose is <4
- Signs of hypoglycemia
- Check blood pressure
If blood glucose is >15 what do we do?
Delay the treatment
Do we do extractions on patients with bleeding disorders?
NO!
They can only be treated in a hospital.
We can only treat in practice if…
- If on single anti-coagulants or dual anti-platelet therapy = you can carry out the procedure in the dental setting.
- Avoid NSAIDS and antibiotics as it can stop the affect of the anti-coagulant medication
What do we do for warfarin patients?
Check IRN levels.
If <4 then we can do the extraction.
Avoid NSAIDS and antibiotics.
What do we need to be aware of if a patient has liver disease?
Aware of prolonged bleeding and cross-infection risk if they have hepatitis.
Patient is likely to be immunocompromised or have an impaired drug metabolism.
What do we need to be aware of if a patient has kidney disease?
Bleeding tendency due to reduce platelet count. Treat patient in the morning to allow them to come back if still bleeding.
If on dialysis, do extraction on days between dialysis.
Check blood screen.
What do we need to be aware of if a patient has epilepsy?
- Seizures can be triggered in the dental setting due to stress
- Ask patient when their last seizure was, if they are on any medication and what their triggers are
- Consider IV sedation if their epilepsy is uncontrolled
- Benziodiasapine given to this patient to reduce chances of an epileptic seizure or to get them out a seizure
- Buccal midazolam gets patients out of fits also
