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35 Cards in this Set
- Front
- Back
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What's the goal of physical and psych eval?
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Determine pts ability to:
-tolerate phys. stress, psych stress treatment mod sedation technique contraindications |
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Describe all the important components involved in medical history
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-bio data
-compliants -current and past medical history -systems review -social and family history |
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How important are the physical and lab exams for a presurgical patient?
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Plays some minor role, but its still important to know.
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Chief complaint?
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why are they here?
-listen to their concenrs and clarify why they need treatment -should be in patients words -establish priorities |
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History of illness
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-When/how did the problem arise
-previous treatment pain: location, onset, intensity, duration - what makes it worsen? -Constitutional: fever, chills, lethergary, anorexia, malaise, and weakness assoc. with chief complaint |
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Past med history
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-general state of health
-med psych illness -allergies -current meds -previous surgery/anesthesia |
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Review of systems
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-sequential and comprehensive
-organ system basis -may reveal undiagnosed conditions -questions are guided by med hx -if IV or GA planned, CV, respiratory, and NS should be reviewed -Head and neck: dentists are expected to perform quick review of head, ears, eyes, nose, mouth and throat on every pt. |
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Important components of social history
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-tobacco
-alcohol - esp for liver, makes factors of clotting -drugs |
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Family history components
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DM, heart disease, cancer, anesthetic issues
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Physical exam
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-Main focus is on oral cavity first - should do it in the same way all the time so that you don't miss anything.
-2nd - entire maxillofacial region -Describe it acccurately -Start with vitals -Inspection, palpation, percussion, auscultation - joints themselves, neck, |
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How do you take a BP?
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-radial pulse : rate, rhythm, form of the pulse way, volume full vs. weak, condition of vessel wall
press on the raidal artery for 15 sec to 30 sec and multiple this by 4 to get bpm. if cuff is too tight, BP will be too high. if cuff is too loose, BP will be too low. when you don't feel the pulse any more after you inflate, go 20 above that number. then you can put your stethoscope on a listen. steth goes on brachial artery. When you hear the first sound, that is systolic. When it disppears, its diastolic. |
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Ausculatory gap
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You may not be able to hear anything during this time interval. If you stop inflating at this point, your systolic will be too low.
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Korotkov sounds
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Sounds you hear when the inflation is lowered. When you hear the first sound, it is turbulent flow.
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Head and neck exam
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Extraoral:
asymmtery, lymph nodes, trachea/thyroid, eyes, tmj intraoral tongue, palate, pharynx, floor or mouth, gingiva, teeth |
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Purpose of a consultation??
Lab tests for what? |
-discuss management
-evaluate a new symptom -control an uncontrolled problem. lab test: when indicated. based on medical history, procedure planned. |
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ASA classes
1, 2, 3, 4 |
1. normal healthy patient
2. mild systemic diseease that doens't interfere w/ daily activity. may or may not need dental management 3. mod to severe disease that affects daily activity and isn't incapacitating. require dental management operation. 4. severe systemic disease that's a constant thread to life. need dental managements Ex. severe cardiac disease, end stage renal disease, advanced AIDS, unstable angina. |
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What types of stress make dental procedures worse.
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Cardiac disease
1. CAD - narrowing, spasm of cornoary cessels. Myocardial O demand is greater than supply. MI - cell death due to ischemia. Angina - chest pain or pressure (symptom of myocardial ischemia) |
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Stress reduction protocol?
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-Recognize the stress and what causes it.
-Ma want to premedicate the night before and day of -Morning appt. -Min waiting time = sedation during treatment - good =adequate control of pain -Post op pain |
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Managemetn of pt with CAD
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-consult doc
- stress reduction protocol -have nito avail maybe n2o sedation -profound local anesthesia, vital signs - defer treatment until 6 months after MI -check if pt is using anticoagulants |
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Management of asthma
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-hyperactivity of tracheobronchial tree
-can give epinephrine -increased bronchial smooth muscle spasm. increased mucous secretions increased bronchial wall edema Triggers: stress, allergy, bronchial infect, histamine releasing drugs -Defer tx until asthma is well controlled -listen to chest wtih steth for wheezing and follow stress reduction protocol keep bronchodilator ready -pt regarding ASA or NSAID sensitivity |
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Management of those with dialysis
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-ask physician
-avoid/ mod drugs that depend on metabolism/excretion -avoid NSAIDs. TX ccurs day after dialysis Prophylactic antibiotics for arteriovenous (A-V) shunt Monitor BP and HR Look for signs of secondary hyperparathyroidism Hepatitis screening/precautions |
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Liver functs
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Hepatitis screening/precautions
Avoid/modify drugs which require hepatic metabolism/excretion (Tylenol) Screen for bleeding disorders -consult pts physician |
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Epilepsy
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Question patient about the frequency, type, duration of seizures
Consider checking drug levels Stress-reduction protocol |
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Pregnant
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Defer tx until after delivery if possible
Consult patient’s obstetrician Avoid x-rays if possible; especially in 1st trimester; proper shielding Monitor vital signs Avoid teratogenic medications Can use al of these: Lidocaine (with epinephrine) Bupivicaine (Marcaine) Mepivicaine (Carbocaine) Acetaminophen (Tylenol) Codeine Penicillin Avoid supine position for long periods of time (vena cava compression) Allow frequent “bathroom breaks” |
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What are increased with epinephrine
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heart rate & cardiac output
arrhythmias blood pressure stroke volume bronchodilation |
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Absolute contraindications with epinephrine
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Uncontrolled hyperthyroidism
sulfite sensitivity; steroid-dependent asthma pheochromocytoma recent cocaine abuse Cardiovascular disease unstable angina recent M.I. recent coronary artery bypass graft refractory arrhythmias* uncontrolled hypertension uncontrolled congestive heart failure |
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Epinephrine relative contraindications
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tricyclic antidepressants
phenothiazine compounds MAO inhibitors nonselective B-blockers |
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Local anesthetics relative contraindications
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malignant hyperthermia
atypical plasma cholinesterase methemoglobinemia patients undergoing renal dialysis |
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Corticosteroids - signs of crisis
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: hypotension, nausea, vomiting, weakness, headache
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How do you manage type 1 and type 2 dm in dental clinic?
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Type 1: Insulin dependent (IDDM)
juvenile onset early AM, short appointments take usual insulin/ eat regular meal IV anesthesia - take 1/2 insulin, give dextrose IV Keep “on the sweet side” (100-200) Type 2: Non-insulin dependent (NIDDM) Adult onset Early AM, short appointments Much less prone to hypo- or hyperglycemia Take usual insulin med, regular meal IV anesthesia - skip medication |
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What is coumadin (warfarin)?
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Anticoagulant
Decrease formation of factors II,VII,IX,X Affects the extrinsic pathway Measure prothrombin time (PT) and INR Blood levels reached in 48-72 hrs Reverse with vitamin K |
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How do you manage dental patients who are on coumadin?
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Why is patient on coumadin?
If PT < 1.5 x normal, INR < 4 - normal tx If PT > 1.5 x normal, INR > 4 - discuss tx Coumadin must be DC’d for 48-72 hours If patient MUST be anticoagulated, heparinize in hospital |
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1. What does cimetidine + ASAIII and CHF represent?
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Relative contraindication to use of amide local anesthetics
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What is an absolute contraindication to ester local anesthetics?
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sulfonamides
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What should be avoided in patients taking TCAs?
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Administration of norepinephrine and levonordefrin
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