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Oral Surgery > Module 2_General Assessment > Flashcards

Module 2_General Assessment Flashcards

1
Q

What is the purpose of a general assessment?

A

Determine medical fitness of patient to undergo procedure (the more demanding the procedure the more vigorous the assessment)

If patient collapse assessment of vital signs allow diagnosis

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2
Q

What are the key vital signs you need to be able to assess?

A
  • Blood pressure
  • Pulse
  • Temperature
  • Consciousness
  • Respiration
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3
Q

What instrument is used to measure blood pressure? How do you use it? How does it work?

A

-Sphygmomanometer

(sphigmo-manometer)

  1. Place cuff above the elbow
  2. Ensure tubing in line with antecubital fossa (pit on the elbow)
  3. Ensure patient relaxed and arm level with the heart
  4. Place stethoscope on the blood vessels in the antecubital fossa
  5. Puff up cuff until pulse sounds disappear (cuff pressure occludes artery preventing blood flow)
  6. Slowly let down cufff until the first heartbeat is heard (which is systolic blood pressure)–>once cuff pressure falls just below (roughly equal) systolic pressure blood is let through intermittently (let through when heart contracts on systolic and blocked once again when heart relaxes to diastolic) resulting in intermittent turbulent sounds as blood is forced through the narrowed artery.
  7. Continue to let down until the beating stops (this is the diastolic blood pressure)–>as cuff pressure lowered sound duration increases as blood is being forced through narrow artery for longer periods. Once cuff pressure falls below diastolic pressure, artery is no longer being constricted and blood flow becomes laminar, thus no sound is heard.

(or just use automatic BP machine)

  1. Apply cuff as above
  2. Start machine, it will automatically inflate and measure blood pressure and pulse as the cuff starts automatically deflating
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4
Q

What are the normal values for systolic and diastolic pressure?

A

Sys: 120-140 mmHg
Dias: 60-90 mmHg

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5
Q

T or F?

Wider cuff is used for higher BMI and narrow cuff is used for low BMI/child patients?

A

T

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6
Q

How is pulse measured?

A
  • Use radial pulse (pulse of radial artery)
  • Count number of pulses in 15 seconds
  • Multiply by 4 for pulses per minute
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7
Q

How is respiration measured?

A
  • After 15 seconds of counting pulse, use next 15 seconds to count rise and fall of patient’s chest
  • Multiply by 4 for breaths per minute
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8
Q

What is the normal pulse range?

A

60-80 beats per minute

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9
Q

What is hte normal respiration range?

A

12-16 breaths per minute

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10
Q

Hyperventilation

A

More than 20 shallow breaths per minute

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11
Q

How do you measure temperature with a traditional mercury thermometer?

A
  • Place under tongue for 2 minutes
  • Remove
  • Get the reading
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12
Q

When should a mercury thermometer not be used?

A
  • Children
  • Adults with behavioiural problems
  • Risk of biting/breaking thermometer
  • If patient has oral infection
  • Placing it against an abscess can result in abnormally high reading that does not reflect patient condition
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13
Q

T or F?

Oral temperatures are reliable

A

F

Instead use body’s core temperatures (EAM, Axilla, Groin, Rectum)

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14
Q

What are some alternatives to oral thermometers?

A

-Ear or skin thermometers

cleaner, quicker, more accurate

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15
Q

What is the normal range for body temperature?

A

-35.5 to 37.5 degrees celsius

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16
Q

How should patient’s consciousness be assessed?

A
  • Test whether responsive to surroundings (eg. speech)

- Test their knowledge and whether they are oriented in time and space

17
Q

How should you respond if your patient becomes sleepy?

A
  • Firm commands accompanied with a light touch or shake

- If non-responsive can stimulate by twisting earlobe

18
Q

What is the medical measure of consciousness?

A

Glasgow Scale

Eye opening (E):

  • Spontaneous 4
  • To speech 3
  • To pain 2
  • No response 1
Best Verbal Response (V):
Oriented and converses: 5
Disoriented and converses: 4
Inappropriate words: 3
Incomprehensible sounds: 2
No response: 1

Best motor response (M):
Obeys verbal command: 6
Localises pain (to painful stimulus): 5
Flexion/withrawal (to painful stimulus): 4
Flexion abnormal (to painful stimulus): 3
Extension: 2
No response: 1

E + V + M normal range 14-15
13=mild brain damage
9-12 = moderate brain damage
8 or less= severe brain damage

19
Q

What additional medical assessments are available in addition to the vital signs?

A
  • BMI

- BGL

20
Q

What is the significance of BMI?

A

Measures obesity
-Risk factor for diabetes, coronary disease, premature death

-Needs to be assessed if patient going to have sedation or GA

21
Q

How is BMI measured?

A
  • Obtain patient’s height and weight
  • Apply to formular BMI= weight/(height)^2
  • Weight in kg, height in m
22
Q

What can confound BMI measurements?

A

-WEight could be fat or muscle

23
Q

What is the normal BMI range/categories?

A 
Underweight < 18.5
Health 18.5 - 24.9 
Overweight: 25- 29.9
Obese: >30
Morbidly obese: >40
24
Q

What is used to measure BGL?

A

Glucometer

kit consists of measuring device, test strips, skin wipe and needle

25
Q

How is BGL measured?

A
  1. Wipe tip of finger
  2. Puncture the tip of the finger to obtain a drop of blood
  3. Drop of blood placed on test strip and inserted into glucometer
  4. Automatic reading obtained
26
Q

What factors affect BGL?

A

When and what patient last ate

If diabetic level of control

27
Q

What is the normal range for BGL?

A 
In mmol/L:
Hypoglycaemic: <3
Normal: 3-8
Prediabetic: 9-10
Hyperglycaemic: 11<
If over 60 years 5-12 is normal
*Patients are treatable in normal dental context if between 3.5-12mmol/L
  • If abnromal advise see medical practitioner
  • If markedly low give sugar or glucagon
  • If high then may need emergency aid
  • If very high or low do not allow to leave office unescorted
28
Q

What occurs to the vital signs in vasovagal syncope?

A

BP: decrease
Pulse: Decrease then increase
Respiration: decrease
Consciousness: decrease

29
Q

How should you manage a patient experiencing vasovagal syncope?

A
  • Lay them flat
  • Talk to them
  • Take their pulse, initially thready but will become stronger
  • Get assistant to place cold towel on forehead
  • If vasovagal syncope then will rapidly recover
30
Q

What occurs to the vital signs in hyperventilation?

A

BP: no change
Pulse: decrease
respiration: increase
consciousness: decrease

31
Q

When is hyperventilation most likely ot occur?

A

Prior to extractions, especially if you are not talking to or observing them

32
Q

How should you manage hyperventilation?

A

Get patient to take a few deep breaths (usually all that is needed)
Can also cup hand over patient’s mouth or get them to breathe into plastic bag to rebreathe expired air and increase partial pressure of carbon dioxide

As hyperventilation progresses may faint–> can be mistaken for vasovagal syncope if you are not observing them

33
Q

What happens at the advanced stage of hyperventilation?

A
  • Body goes rigid
  • Feet go numb
  • Back arches
  • Hands undergo carpopedial spasm
  • Keep them rebreathing and eventually they will recover
  • Can also give intravenous muscle relaxant such as diazepam if trained to do so
34
Q

What happens to the viutal signs in cardiac arrest?

A
  • All decrease
  • Initial stage may mimic faint or vasovagal attack
  • Key difference is more profound and they don’t respond
35
Q

How do you manage a cardiac arrest?

A
  • Lay them flat
  • Talk to them
  • Ask if pain in chest
  • Check radial or carotid pulse (they have none)
  • Call for emergency assistance and start CPR
36
Q

What are normal haemoglobin levels for:
Children
Adult males
Adult females?

A

C: 11-13gm/dL
AM: 14-18gm/dL
AF: 12-16gm/dL

(dL=decilitre=1/10th of a litre= 100mL)
(just remember the first number, children have a range of 1, adults a range of 4)

Oral Surgery (17 decks)

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