Risk Assessment Week 1

Functional Capacity METS

• A method of determination of cardiac risk

• Based on ability to preform basic daily activities

• MET = unit of oxygen consumption

• Adequate functional capacity: 4 METS

• 4 METS: able to walk up 1 flight of stairs or walk 2 blocks w/o SOB or chest pain

ASA I

• Healthy, no systemic disease

• 4 METS

• BP normal, elevated stage 1

• No mods, stress reduction protocol

ASA II

• Mild systemic disease but no interference with daily activity

• BP: Lower Stage 2 (140/90 - 160/100)

• Mods: stress reduction protocol, disease specific mods

ASA III

• Mod - severe systemic disease that limits daily activity but not incapacitating (ex: recent heart attack pt. who regained functional capacity but still needs mods)

• BP: High stage 2 (>160/100 - 179/109) w/ no add. risk factors

• Med. consult advised after apt.

ASA IV

• Incapacitating systemic disease (constant threat to life)

• NO 4 METS

• Respiratory distress at rest

• BP: >180/110

• Med. consult required

• Emergency dent. only

Risk Assessment Review

• Vital signs

• Evaluate completed HHx

• Evaluate functional capacity (4 METS), and stress level

• Designate ASA classification

• IO/EO exam

#1 modifiable risk for strokes and heart attacks?

Hypertension

Normal BP

<120 AND <80

Elevated BP

120-129 AND <80

Hypertension stage 1

130-139 or 80-89

Hypertension Stage 2

>140 or >90

Dental treatment BP cutoff

180/110

>160/100 w/ risk factors

Hypertensive Crisis

>180/120

Elevated B.P. follow up questions

• Have you ever been told you have high BP?

• When was the last time your physician evaluated you BP?

• What changes were made in your therapy?

Stress reduction protocol

• Develop rapport

• Gentle technique

• Profound LA

• Short apt. time

• Sedation: anti-anxiety meds or Nitrous Oxide

Cardiac dose

2 cartridges of lidocaine w/ 1:100,000 epi.

0.04mg

Prolonged hypertension target organs

• Heart

• Brain (stoke)

• Kidneys (failure)

• Retina/ Eye (blindness)

Systolic BP

The pressure in arteries during ventricular contration

Diastolic BP

The pressure in arteries when the heart rests, or between beats

Tachycardia

Fast, irregular HR usually >150bpm

Bradycardia

HR <60 bpm, with normal EKG

Mr. Brown: 79 yrs old, obesity, type 2 diabetes- taking oral meds, pulse 86bpm, 20 resp, BP 170/105, SOB walking from car, dental anxiety

BP level: Hypertension Stage 2

ASA III/IV: Med. consult required

Mrs. Jones: 48yrs old, 72bpm, 16resp, BP 128/86

BP: Hypertension Stage 1

ASA: I