Introduction to Physical Evaluation Part 2
Medical History Patient must check off each box. No lines to be drawn down a column. Obtain additional info from patient on any yes answer. Make sure that you and the patient have signed the back of the medical history form.
the English translation following the Spanish
RED For all yes answers in the health history
Always answer YES Adjacent to the correct medical alert type Medical Alert type is present in the UR ALERTS BOX
Review Medical History Form Review the form with the patient --- any YES answer needs follow up info. You can write comments on the paper form and then transfer them into to the comment section in AxiUm. The Herman Ostrow School of Dentistry of USC has a system by system medical history form
At times, you may need to Update the Medical Alert box
Medical Alerts: to add or delete info, right click in the box most yes answers are automatically placed in the alert box for you some conditions will require you to manually place info in the box
Right click on computer mouse when in the medical alerts box, click on Update Medical Alerts
Click on the folder with ++ to add a medical alert.
Find the medical alert you want to add, highlight it and click OK.
The medical history is a system by system review starts off with Cardiovascular
American Heart Association Guidelines for Prophylactic Premedication In 2007, the AHA updated their guidelines for patients who require antibiotic premedication prior to invasive dental procedures Amoxicillin 2.0 grams one hour prior to the invasive procedure is the recommended drug of choice for adults
AHA Guidelines What if the person has an allergy to Penicillin? Clindamycin 600 mg one hour prior to the dental procedure
CV High B/P: limit of 2 carps of Lidocaine with epinephrine Heart attack: NO elective dental treatment for 6 months Stroke: NO elective dental treatment for 6 months, discover what side was affected Angina: exercise or stressed induced Cholesterol: current lab level
CVA/Stroke If the right side of the brain is damaged, there will be paralysis on the left side of the body --- thought, memory and spatial relations may be impaired. If the left side of the brain is damaged, the right side of the body will be affected problems with speech, language and memory. This will affect how you communicate with and educate your patient.
If patient is on anticoagulant meds:1 minute test if bleeding is excessive stop, manage and advise patient that a medical consult may be needed meds like Plavix, Aspirin, Coumadin. Lab results for INR, plts, PT/PTT, etc..
Bleeding/Clotting Labs PTT Ref range = 24.0 36.0 seconds PT Ref. range = 9.7-12.9 seconds INR Ref range 1-2 mg/dl is normal 1-3.5 is acceptable for dental treatment Over 3.5 delay treatment
Implant cases If bleeding is a concern during an implant case lab values to know are: INR Platelet count PT/PTT **picture is not an Ostrow implant case!
Anticoag meds and dentistry Evidence suggests that stopping oral anticoag meds is not necessary in patients requiring low-risk dental procedures and may actually increase thrombosis risk. Local measures can be effective at controlling bleeding.
Pacemakers There may be a risk to patients with pacemakers from ultrasonic devices and battery operated curing lights.* Find out the brand of the pacemaker, date placed and research to see if there are any contraindications to the above. *JADA, Miller 2012.
Endocrine Freq hunger/thirst: ask about diabetes Diabetic: type? Remind them to eat prior to all apts. Current HgbA1C? Cancer: type? HIV: when dx? Current CD4 count and viral load, on meds? Organ transplant: what kind? When? Blood transfusion: when?
Chemo? If a patient is on chemotherapy, a physical evaluation update is needed with phys eval faculty. A medical consult needs to be sent to the physician/oncologist. Treatment may need to be completed in the Special Patient Clinic.
HIV/Immunocompromised Patients Recent lab tests must be within 3-6 months depending on viral load. Viral Load must be less than 50. Absolute Neutrophil Count greater than 500. Platelet count greater than 60,000 CD4 greater than 200 If the lab test is not current or the values fall outside the recommendations, call phys eval faculty.
Diabetic Patients Well Controlled? Medicines and doses? Monitor glucose levels at home? Often see MD? Hemoglobin A1C test result?
The Hemoglobin A1C blood test shows the blood glucose level over a 2 3 month period. Diabetics ideally should try to be a 7% or below. A result of 7 means the person s glucose level averages around a reading of 154 daily for the past 2-3 months. HGB A1 C RESULTS
Hemoglobin A1C The Hgb A1C test is based on the lifefspan of red blood cells approximately 120 days. Note: The A1C may not be accurate in several settings, including pediatric and geriatric populations, anemia or other blood disorders resulting in rapid turnover of red blood cells, chronic liver and renal disease, recent transfusions, or in certain hospital settings. Info provided from: JOSLIN CLINIC CLINICAL GUIDELINE FOR ADULTS WITH DIABETES 05/16/2012
Implants and Diabetics If the diabetes is well controlled, ok for implant placement but final say lies with Oral Surgery and/or Perio
The End of Part 2