Medical Consults Flashcards
(51 cards)
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
