Medical Consults Flashcards
(32 cards)
Why are dentistry and medicine different today than they used to be?
- 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
- 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
Patients having an increased…
number of conditions
complexity of conditions
number of medications
means that…
patiets have increased combinations and
permutations of dental treatments
Many chronic disorders or their treatments necessitate _________ of dental treatment
modification
Hepatitis – 1982 -gloves
AIDS – 1990 - PPE
COVID-19 – 2019 –PPE and vaccines
Clincians must practice so that the benefit of dental treatment will outweigh the risk(s) of a medical complication occurring either…
during treatment or as a result of treatment
Pre-operative, Intra-operative, and Post-operative Considerations
What is involved in the patient evaluation?
- Identify ALL medications & drugs, taken or supposed to be taken
- Review medical history, discuss relevant issues with patient
- Examine patient for signs and symptoms of disease
- Review or gather recent laboratory tests or images
- Obtain a medical consult
— If patient has a poorly controlled or undiagnosed problem
— If you’re uncertain about the patient’s health
What should you focus on for the organized risk assessment?
- A
➢ Antibiotics
➢ Analgesics
➢ Anesthesia
➢ Allergies
➢ Anxiety - B
➢ Bleeding
➢ Breathing
➢ Blood Pressure - C
➢ Chair - D
➢ Drugs
➢ Devices - E
➢ Equipment
➢ Emergencies - F
➢ Follow up
What must be taken for every patient treatment?
med history
What are the two basic techniques to obtain a med history?
- Interview the patient
➢ Ask patient questions, record the patient’s verbal responses (axiUM at UMKC) - A printed questionnaire the patient fills out
Questions are designed to identify or hint to medical issues that may affect dental teatment such as:
- Anxiety
- Cardiovascular diseases
- Neurologic disorders
- Gastrointestinal diseases
- Respiratory tract diseases
- Musculoskeletal diseases
- Endocrine diseases
- STD’s
- Cancer & radiation treatment
What are the ranges of blood pressure?
Where should the arm be placed during a blood pressure?
Horizontal at heart level (mid-sternum)
What happens if the cuff is too small?
→ falsely elevated values
What happens if the cuff is too large?
→ falsely low values
What happens if the arm is too low?
→ falsely elevated values
What happens if the arm is too high?
→ falsely low values
What are the questions to ask about ischemic heart disease?
- Coronary Artery Disease
- Angina (Stable or Unstable)
- Myocardial Infarction
- Congestive Heart Failure
- What is the patient’s current cardiac status?
- What is the patient’s most recent ejection fraction? (if any)
- Does the patient have any other end-organ damage? If so, please specify.
- Is the patient currently stable enough to receive the proposed dental treatment, based on their current cardiac status?
- Are there any special precautions we should consider for dental treatment?
What are the questions to ask about arrhythmias?
- Supraventricular arrhythmias (Atrial fibrillation)
- Ventricular arrhythmia
- Pacemaker
- Implanted Cardioverter-Defibrillator (ICD)
- What is the patient’s current cardiac status?
- Is the patient expected/likely to receive a cardiac
intervention in the near future?
- Is the patient expected/likely to receive a cardiac
- Is the patient stable enough to receive the proposed dental treatment, based on their current cardiac status?
What are the questions to ask about history of surgical cardiac intervention?
- Valve replacement/repair
- Coronary artery bypass graft
- Cardiac stent placement/angioplasty
If recent surgery (within the 6 months?)
- 1. What is the patient’s current cardiac status?
- 2. Is the patient stable enough to receive the proposed dental treatment, based on their current cardiac status?
Why do you need to contact a current physician of a patient?
- Why is the patient receiving medical care, diagnoses, and treatment received
➢ 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
Patient without a physician, no recent routine check-up history?
caution
➢ 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
On the basis of medical history, physical examination, and laboratory screening, contact with the patient’s _________ for consultation or referral purposes may be warranted
physician
________ needed from patient to forward their health information to another provider
Consent
Requests for information should be made in writing by…
letter or fax, if possible; however, a phone call may be more expedient
What type of clinical context is important to include 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 (stress, bleeding, drugs to be used pre, peri, and/or post-operatively )
- Any other relevant intraoral or extraoral findings
