Medical Consults Flashcards
Dentistry and medicine today are different
(3)
➢ People live longer = more elderly patients
➢ People receive medical treatments for disorders that would be fatal a just a few
years ago
➢ Pharmaceuticals continue to advance
Dentistry and medicine today are different
➢ The greater the number and the more complex the conditions and the more medications that are used to manage these conditions are all proportional the
combinations and permutations of dental treatments for our patients
increased number of conditions
increased complexity of conditions
increased number of medications
=
increased combinations and
permutations of dental
treatments
The dentist must now be more knowledgeable about a wider range of
medical conditions as patients receive dental treatment
➢ Many chronic disorders or their
treatments necessitate modification
of dental treatment
(3)
➢ Hepatitis – 1982 -gloves
➢ AIDS – 1990 - PPE
➢ COVID-19 – 2019 –PPE and vaccines
Clincians must practice so that the benefit of dental treatment will — of a medical complication occurring either
during treatment or as a result of treatment.
(Pre-operative, Intra-operative, and Post-operative Considerations)
outweigh the risk(s)
P- patient evaluation
* Identify ALL —, taken or supposed to be taken
* Review —, discuss relevant issues with patient
* Examine patient for —
* Review or gather recent — or images
* Obtain a —
medications & drugs
medical history
signs and symptoms of disease
laboratory tests
medical consult
- Obtain a medical consult
if.. (2)
- If patient has a poorly controlled or undiagnosed problem
- If you’re uncertain about the patient’s health
Organized Risk Assessment
A
(5)
B
(3)
C
(1)
D
(2)
E
(2)
F
(1)
➢ Antibiotics
➢ Analgesics
➢ Anesthesia
➢ Allergies
➢ Anxiety
➢ Bleeding
➢ Breathing
➢ Blood Pressure
➢ Chair
➢ Drugs
➢ Devices
➢ Equipment
➢ Emergencies
➢ Follow up
Medical History
- Must be taken for every patient who is to receive dental
treatment
Two basic techniques used to obtain a medical history
(2)
➢ Interview the patient
- Ask patient questions, record the patient’s verbal responses (axiUM at UMKC)
➢ A printed questionnaire the patient fills out
skipped
* Questions are designed to identify or hint to medical issues that may
affect dental teatment:
(9)
- Anxiety
- Cardiovascular diseases
- Neurologic disorders
- Gastrointestinal diseases
- Respiratory tract diseases
- Musculoskeletal diseases
- Endocrine diseases
- STD’s
- Cancer & radiation treatment
Classification Range
Normal:
Elevated:
Stage 1:
Stage 2:
Hypertensive Crisis:
< 120/80 mm Hg
120 - 129/< 80 mm Hg
130-139 or 80-89 mm Hg
≥ 140 or 90 mm Hg
≥ 180 and/or >120
— Readings on — Separate Visits
≥ 2
≥ 2
Blood Pressure
Arm position matters
➢ Horizontal at heart level
(mid-sternum)
cuff too small → falsely — values*
arm too low → falsely — values*
elevated
cuff too large → falsely — values
arm too high → falsely — values
low
Current Physician(s)
(2)
Identify the patient’s physician
Why is the patient receiving medical care, diagnoses, and treatment
received
Why is the patient receiving medical care, diagnoses, and treatment
received
(2)
➢ Even for routine physical examinations, the patient should be asked
whether any problems were discovered and the last date of the exam
➢ The name, address, and phone number of the physician should be
recorded
Current Physician(s)
Patient without a physician, no recent routine check-up history?
CAUTION
The response may provide insight into the priorities that a patient assigns
to health care
The response may provide insight into the priorities that a patient assigns
to health care
(3)
➢ The patient may be unaware of an underlying condition
➢ ROS is very important in these patients
➢ Refer patient to have a check-up and general labs drawn prior to any
invasive dental treatment
Medical Consultation/Referral
On the basis of (3), contact with the patient’s physician for consultation or referral
purposes may be warranted
Consultation for a medical evaluation to rule out or identify a suspected
medical disease and to advise on any necessary precautions
Consent needed from patient to…
medical history, physical examination, and laboratory
screening
forward their health information to
another provider
Medical Consultation/Referral
Requests for information should be made in — if
possible; however, a phone call may be more expedient
֎phone call note must document
(3)
Document communications in
the patient’s —!
A — record is a legal record!
writing by letter or fax,
- responding person
(either the MD, PA, RN, NP, receptionist(?), etc.)
- date
- time
chart
written
Good practices
* Provide clinical context
* Patient-reported —
* Patient-reported —
* Positive findings on — where applicable
* — readings
* — treatment to be performed (stress, bleeding, drugs to be used pre, peri, and/or
post-operatively )
* Any other relevant — findings
medical history
medications
review of systems
Vital
Dental
intraoral or extraoral
Two basic techniques used to obtain a medical history
(2)
➢ Interview the patient
➢ Ask patient questions, record the patient’s verbal responses (axiUM at UMKC)
➢ A printed questionnaire the patient fills out
Good practices
* Avoid dental —
* — express your concerns, but be specific about the input you need
* You MUST KNOW WHY you are asking that question
* Take — (even if partial) of the risk assessment
* Remember that you are asking for a favor
jargon
Concisely
ownership
Good practices
* When there is complex medical history or if patient seems to be a poor
historian
* Ask for
last clinical note (helps provide more context on the patient’s
health status)
➢ Please provide us with a copy of the patient’s most recent clinical note
Good practices
* Check for missing medical information and updated medication list
(2)
➢ Are there any other medical problems not listed here that we should be aware of?
➢ Please provide an updated medication list. OR Is the patient taking any other
medications not listed here?
Treatment Modifications
Systematic assessment of risk and identifying potential problems
Treatment Modifications
Simple modifications in dental treatment delivery can reduce risk to the
patient
(2)
➢ Risk is always increased when treating a medically complex patient
➢ Try to anticipate possible urgencies or emergencies and be prepared to
manage
➢ Try to anticipate possible urgencies or emergencies and be prepared to
manage
(2)
➢ Liver or kidney disease – drug clearance, bleeding times, etc.
➢ HTN, coronary artery disease, atherosclerosis,
congestive heart failure (CHF)
Prudent Rules for Clinical Practice
(2)
Don’t start something you cannot finish
Don’t start a procedure if you cannot deal with the potential complications
Don’t start a procedure if you cannot deal with the potential complications
(3)
➢ Know potential complications
➢ Apply to patient’s clinical context
➢ Plan around likelihood of most severe complication
Systematic assessment of risk and identifying potential problems
Modifications in dental treatment delivery can reduce risk to the patient
(7)
CAD –and bypass surgery
Valve replacement
Organ transplant
Chemo or radiation treatment
Poorly controlled seizures, diabetes, etc.
Liver disease
Kidney disease
Hypertension Medical Consult Questions*
(4)
- What is the patient’s BP goal (range)
- What have been patient’s in-office BP readings?
- Does the patient have any end-organ damage?
- Current medications prescribed to manage Hypertension
Cardiac measures**
(4)
- Stress reduction protocol
- Nitrous oxide
- Profound anesthesia
- Cardiac epi dose = max 0.04mg
Cardiac measures**
* Cardiac epi dose = max 0.04mg
✓ Articaine for maxillary blocks and maxillary or mandibular
infiltrations
✓ 2% lidocaine 1:100,00 epi for IANB
✓ 3% mepivacaine without epi for anesthesia
*ac (ante cibum) means
“before meals“
*bid (bis in die) means
“twice a day“
*D (die)
day
*Disp
dispense
*hs (hora somni) means
“at bedtime“
*po (per os) means
“by mouth“
*pc (post cibum) means
“after meals“
*prn (pro re nata) means
“as needed“
*q3h (quaque 3 hora) means
“every
three hours“ [q4h, q6h, q8h]
*qd (quaque die) means
“every day“
*qid (quater in die) means
“four
times a day“
*RX (recipe) – means
“to take”
*Sig (signa) means
write directions
*STAT -
immediately
*tid (ter in die) means
“three times a
day“
*qid (4) , pid (5), etc.
