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Flashcards in Patient Evaluation Deck (10):
1

Risk Assessment 4 components

  • The nature, severity, and stability of the patients medical condition
  • The functional capacity of the patient
  • The emotional status of the patient
  • The type of magnitude of the planned procedure (invasive or noninvasive)

2

The cornerstones of patient evaluation and risk assessment are

  • Med hx
  • Physical examination
  • Lab tests as needed
  • Medical consultation as needed

3

Functional Capacity METS

  •  Metabolic Equivalent Levels
  • MET is a unit of oxygen consumption
    • 1 MET equals 3.5 mL/kg/min at rest 
    • Risk of perioperative event is increased in patients who are unable to meet a 4 MET demand during normal daily activity 
  • 4 METS include level walking at 4 miles/hr or climbing a flight of stairs 

4

Physical Examination

  • Assessment of general apperance
  • Measurement of vital signs
  • examination of head and neck

5

Vital Signs 6

  • Blood pressure
  • Pulse
  • Respiratory rate
  • Temp
  • Height 
  • Weight

6

HbA1c

  • Glycolated hemoglobin levels in diabetes
  • 4-6% with diabetes
  • 5.7-6.4% increased risk for diabetes
  • 6.5% and greater diabetes

7

Lab tests

  • Daily glucose level check
  • ACTH stimulation test for primary adrenal failure
  • INR- coagulation therapy
  • Platelet count- 150,00-450,000/ uL
    • Less than 40,000 is an urgent situation

8

INR Targets 5

  • INR 1 - normal, healthy patient
  • INR 2 - Atrial fibrillation target (2-3)
  • INR 3 - Mechanical heart valve target
  • INR 4 - Risk of uncontrolled bleeding
  • INR 5 - Uncontrolled bleeding

9

Medical Consultations 7

Dont ask 3

  • Anticoagulation
  • Cancer
  • Cardiac disease
  • Diabetes
  • Dialysis
  • Hypertension
  • Multisystem disease
  • Dont ask for
    • A medical clearance
    • Any contraindications to dental care
    • guidance in dental care

10

Complete Blood Normal Count

WBC

RBC (MF)

Platelets

Hematocrit (MF)

Hb (MF)

  • WBC 4400-11,000/mL
  • RBC
    • Male 4.5-5.9 10^6/uL
    • Females 4.5-5.1 10^6/uL
  • Platelets 150,000-450,000/uL
  • Hematocrit
    • Male 41.5-50.4%
    • Females 35.9-44.6%
  • Hb
    • Male 13.5-17.5 g/dL
    • Female 12.3-15.3 g/dL