ASA, Vitals, Premed, Consult
What are the ASA classification?
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?
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?
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
What are the treatments for hypertension?
lifestyle (stress reduction/exercise)
What could happen if hypertension is uncontrolled?
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?
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?
What is considered prehypertension?
What is considered Stage 1 hypertension?
What is considered stage 2 hypertension?
What is considered a normal pulse for an adult?
slightly higher for women
What is considered a normal pulse for an well-trained athlete?
What is a normal pulse for a baby at birth?
What is a normal pulse for a 2 year old?
What is a normal pulse for a 4 year old?
What is a normal pulse for a 10 year old?
What is tachycardia?
pulse > 100 bpm
What causes tachycardia?
What is bradycardia?
pulse < 50 bpm
What causes bradycardia?
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?
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?
What are the normal temps for children at the age of 1? 4? 5? 12?
How do you convert Fahrenheit to centigrade?
Divide by 1.8
How do you convert centigrade to Fahrenheit?
Multiply by 1.8
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?
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
stent placement (in heart: may need premed)
What are the congenital heart diseases that no longer require premed?
ventricular septal defect
atrial septal defect
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)
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
HbAic: glycosylated hemoglobin
What are the normal/well-controlled levels for FPG, PP, HbAic?
FPG: <126 mg/dL
PP: <160 mg/dL
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?
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)?
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)?
When are all antibiotics supposed to be taken for premed?
1 hour before dental appointment