ASA, Vitals, Premed, Consult

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What are the ASA classification?

ASA 1
ASA 2
ASA 3
ASA 4

What does ASA stand for and what are the classifications used for?

American Society of Anesthesiologiests
Physical Status Classification System

ASA 1 classification

normal healthy patient
w/ little-no anxiety about dental treatment

What are the modifications for safe patient care for ASA 1 patients?

green flag for dental treatment
no treatment modifications

ASA 2 classification

patient w/ mild systemic disease
ASA 1 patients with anxiety/fear of treatment

What diseases/conditions are examples of ASA 2 patients?

well-controlled diabetes
epilepsy
asthma

What are the modifications for safe patient care for ASA 2 patients?

yellow flag for dental treatment
employ stress-reduction strategies

ASA 3 classification

patient w/ severe systemic disease (limits activity)

What diseases/conditions are examples of ASA 3 patients?

angina
stroke
heart attack
congestive heart failure

What are the modifications for safe patient care for ASA 3 patients?

yellow flag for dental treatment
employ stress-reduction strategies
treatment modifications needed (ex premed)

ASA 4 Classification

patient w/ severe systemic disease that is a constant threat to life

What diseases/conditions are examples of ASA 4 patients?

heart attack/stroke w/i last 6 months

What are the modifications for safe patient care for ASA 4 patients?

red flag for dental treatment
elective dental care postponed until class is ASA 3 or better
Emergency dental care in hospital dentistry setting

What is blood pressure?

pressure exerted against the blood vessel walls as blood flows through them

What is systolic pressure?

pressure created by blood on vessels walls when the heart contracts

What is diastolic pressure?

lower pressure on vessel walls when heart relaxes

What physically happens to the blood vessels to cause hypertension, not including atherosclerosis?

vessels loose elasticity
smaller vessels constrict
heart has to pump same vol thru vessels w/smaller internal diameter

What is hypertension and what is considered a hypertensive BP?

abnormally high BP
above 140/90

What are the treatments for hypertension?

lose weight
lifestyle (stress reduction/exercise)
prescribed meds

What could happen if hypertension is uncontrolled?

stroke
heart attack/failure
kidney failure

What could happen if hypertension is uncontrolled in a pregnant woman?

seizures and death
premature birth and stillbirth

What artery is used to take BP?

brachial artery

What ensures that the auscultatory gap is not mistaken for the phase I sounds?

palpation of brachial or radial pulse during cuff inflation

What happens if the BP cuff is too short? Too long?

short: falsely high readings
long: falsely low readings

What is considered normal BP?

< 120/80

What is considered prehypertension?

120-139/80-89

What is considered Stage 1 hypertension?

140-159/90-99

What is considered stage 2 hypertension?

>/= 160/100

What is considered a normal pulse for an adult?

60-100 bpm
slightly higher for women

What is considered a normal pulse for an well-trained athlete?

45-60

What is a normal pulse for a baby at birth?

130 bpm

What is a normal pulse for a 2 year old?

105 bpm

What is a normal pulse for a 4 year old?

90 bpm

What is a normal pulse for a 10 year old?

70 bpm

What is tachycardia?

pulse > 100 bpm

What causes tachycardia?

exercise
anxiety
hyperthyroidism
anemia
elevated temp

What is bradycardia?

pulse < 50 bpm

What causes bradycardia?

hypothyroidism
patients on beta blockers

What is the pulse on a patient with syncope?

rapid at first
followed by slow pulse

What is the pulse on a patient in cardiac arrest?

no pulse

What is the pulse on a patient experiencing an insulin reaction (hypoglycemic vs hyperglycemic)?

hypoglycemia: pounding pulse
hyperglyceia: weak, rapid pulse

What is the pulse on a patient in anaphylactic shock?

rapid, weak pulse

What is the normal temperature of an adult? Elderly?

96-99.5ºF
96.8

What are the normal temps for children at the age of 1? 4? 5? 12?

1: 99.1
4: 99.4
5: 98.6
12: 98.0

How do you convert Fahrenheit to centigrade?

Subtract 32
Divide by 1.8

How do you convert centigrade to Fahrenheit?

Multiply by 1.8
Add 32

What are the two main groups of patients that need antibiotic prophylaxis?

patients w/ certain heart conditions
patients w/ total joint replacements

What are the heart conditions that require premed?

artificial heart valves
history of Infective Endocarditis
congenital heart diseases
cardiac transplant w/ valvulopathy

What are the congenital heart diseases that require premed?

unrepaired cyanotic CHD
completely repaired congenital heart defect w/ prothetic material/device (only 1st 6 mos.)
repaired CHD w/ residual defects at site

What are the medications given for premed in heart condition patients?

amoxicillin
ampicillin
azithromycin
cefazolin
cephalexin
clindamycin

What are the most common antibiotics prescribed for premed and what is the dosage and time before the exam?

Amoxicillin, Cephalexin, Cephradine
2 grams 1 hour prior to treatment

What is a patient prescribed for premed if they are allergic to penicillin?

Clindamycin, Azithromycin, Clarithromycin
600mg 1 hour prior

Antibiotic coverage is no longer needed for what conditions?

mitral valve prolapse
rheumatic heart disease
bicuspid valve disease
calcified aortic stenosis
congenital heart conditions
heart murmurs
stent placement (in heart: may need premed)

What are the congenital heart diseases that no longer require premed?

ventricular septal defect
atrial septal defect
hypertropic cardiomyopathy

When does the supervising dentist sign the medical history form?

when patiens pays: recare (>6mos) or new patient

When does the DH clinical faculty sign the medical history?

returns for continuing care (1, 2, 3 weeks)

What patients may need an SPC Medical Consultation/Authorization?

Amemia (incl Sickle Cell)
Most Autoimmune (Lupus, MS, RA)
Cancer
AIDS/HIV
TB
Congenital Heart Disease
CVA (if w/i 6mos)
Hypertension (if >160/100)

What are the usual blood glucose test value categories?

FPG: fast plasma glucose
PP: postprandial
HbAic: glycosylated hemoglobin

What are the normal/well-controlled levels for FPG, PP, HbAic?

FPG: <126 mg/dL
PP: <160 mg/dL
HbAic: <6%

What is the average adult reading level?

8th-9th grade level

What reading level is most healthcare material written?

10th grade level

What is the recommended premed for a patient at risk for IE with multiple dental appointments with no penicillin allergy for the first appointment?

Amoxicillin 2g

What is the recommended premed for a patient at risk for IE with multiple dental appointments with no penicillin allergy for the second appointment (2-4 days later)?

Macrolide (clarithromycin or azithromycin) 500mg

What is the recommended premed for a patient at risk for IE with multiple dental appointments with no penicillin allergy for the third appointment (2-4 days later)?

Clindamycin 600mg

What is the recommended premed for a patient at risk for IE with multiple dental appointments with no penicillin allergy for the fourth appointment (2-4 days later)?

Amoxicillin or cephalexin or cefadroxil 2g

What is the recommended premed for a patient at risk for IE with multiple dental appointments with no penicillin allergy for the fifth appointment (2-4 days later)?

Macrolide 500mg

When are all antibiotics supposed to be taken for premed?

1 hour before dental appointment

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