Medical Consults Flashcards
what are questions designed to identify or hint to medical issues that may affect dental treatment
- anxiety
- cardiovascular diseases
- neurologic disorders
- GI diseases
- respiratory tract diseases
- musculoskeletal diseases
- endocrine diseases
- STDs
- cancer and radiation treatment
what is normal BP
less than 120/80 mmHgw
what is elevated BP
120-129/ less than 80 mmHg
what is stage 1 hypertension
130-139/ 80-89 mmHg
what is stage 2 hypertension
greater than 140/90 mmHg
what is hypertensive crisis
greater than 180/ greater than 120 mmHg
to dx BP you have to have
more than 2 readings on more than 2 separate visits
what falls under ischemic heart disease
-CAD
- angina
- MI
- CHF
what falls under category of arrhythmias
- supraventricular arrhythmias
- atrial fibrillation
- ventricular arrhythmia
- pacemaker
- implanted cardioverter defribrillator
what falls under the category of history of surgical cardiac intervention
- valve replacement/repair
- coronary artery bypass graft
- cardiac stent placement/angioplasty
requests for information should be made in writing by:
letter or fax, however a phone call may be faster
if you call on the phone you must document:
- responding person
- date
-time
where do you document communications with the patients physician
in the patients cahrt
a _____ record is a legal record
written
what should be provided in clinical context in a med consult
- patient reported medical history
- patient reported medications
- positive findings on review of systems where applicable
- vital readings
- dental treatment to be performed
- any other relevant intraoral or extraoral findings
what are good practices in a med consult
- provide clinical context
- avoid dental jargon
- concisely express concerns but be specific about the input you need
- take ownership of the risk assessment
- remember you are asking for a favor
- check for missing medical information and updated medication list
when there is complex medical history or if patient seems to be a poor historian:
ask for last clinical note
what are treatment modifications
systematic assessment of risk and identifying potential problems
risk is _____ when treating a medically complex patient
always increased
what are the prudent rules for clinical practic
- dont start something you cannot finish
- dont start a procedure if you cannot deal with the potential complications
- know the potential complications
- apply to the patients clinical context
- plan around the likelihood of the most severe complication
what do you do with a patient with elevated BP with diagnosed HTN
proceed with treatment
what do you do with a diagnosed HTN with greater than stage 1 HTN
- med consult -> within BP goal -> proceed with dental tx with cardiac measures
- med consult -> not within BP goal -> no tx until goal is met
what do you do with elevated undiagnosed BP
proceed with treatment but recommend med eval
what do you do with undiagnosed greater than stage 1 BP
no dental treatment until medical evaluation
any patient with SBP ___ and/or DBP _____ should be referred to the emergency room
greater than 180; greater than 120
what are the HTN medical consult questions
- what is the patients BP goal (range)
- what have been patients in office BP readings
- does the patient have any end organ damage
current medications prescribed to manage HTN
what are the cardiac measures for HTN
- stress reduction protocol
- Nitrous oxide
- profound anesthesia
- cardiac epi dose = max 0.04mg
- articaine for maxillary block and maxillary or mandibular infiltrations
- 2% lidocaine 1:100,000 epi for IANB
- 3% mepivacaine without epi for anesthesia
ac (ante cibum) means:
before meals
bid means:
twice a day
D means:
day
disp means
dispense
hs means
at bedtime
po means:
by mouth
pc means:
after meals
prn means:
as needed
qd means:
every day
qid means
four times a day
rx means
to take
sig means
write directions
STAT means
immediately
tid means
three times a day
pid means
5 times a day
