Physical Diagnosis: ASA Classification

ASA classification

represents a relative value system; not inflexible

if patient has multiple diseases...

judgement used to weigh significance of each disease and establish ASA category

what "E" refers to

precedes the number if procedure is an Emergency operation

normal healthy patient

ASA I

no systemic disease; no abnormalities

ASA I

heart, lungs, liver, kidneys, CNS are all in good health

ASA I

capable to handle stress of dental treatment

ASA I

no treatment modifications

ASA I

able to walk up 1 flights of stairs or 2 city blocks without distress (dyspnea/fatigue/chest pain)

ASA I

green flag for treatment

ASA I

patient with mild systemic disease OR healthy but extreme fear and anxiety toward dentistry

ASA II

generally able to perform normal activities without distress

ASA II

minimal risk

ASA II

routine dental treatment indicated

ASA II

possible treatment modifications (premedication; sedative)

ASA II

possible medical consult

ASA II

able to walk up 1 flight of stairs or 2 level city blocks will have to stop after completion because of distress

ASA II

yellow flag for treatment=proceed with caution

ASA II

well controlled diabetes mellitus (HbA1c < or equal to 7%; FBG < or equal to 200 mg/dL)

example of ASA II

well controlled seizure disorder

example of ASA II

well controlled asthma

example of ASA II

well controlled thyroid disorder (hyper/hypo) if under care with normal thyroid function

example of ASA II

healthy pregnant woman

example of ASA II

healthy patient with severe allergies (especially to drugs)

example of ASA II

healthy patient with extreme dental fear or significant psychiatric illness

example of ASA II

patient with potential drug-induced impaired hemostasis

example of ASA II

well controlled hypertension

example of ASA II

patient presenting with BP= 140-169/90-99 mmHg

example of ASA II

severe systemic disease; limits activity but not incapacitating

ASA III

patient does not exhibit distress AT REST

ASA III

patient does exhibit distress when stressed physically or psychologically

ASA III

able to perform normal activities without distress-> may need to stop and rest during an activity

ASA III

patient at greater risk for dental treatment

ASA III

treatment modifications REQUIRED

ASA III

elective dental treatment may or may not be indicated

ASA III

able to walk up 1 flight of stairs or 2 level city blocks, but will need to stop enroute because of distress

ASA III

orange flag for treatment= proceed with caution

ASA III

stable angina pectoris

example of ASA III

post MI > or equal to 6 months with no residual signs and symptoms

example of ASA III

post CVA > or equal to 6 months with no residual signs and symptoms

example of ASA III

moderately controlled diabetes mellitus (HbA1c= 7-9%; FBG= 200-230)

example of ASA III

congestive heart failure or orthopnea and ankle edema

example of ASA III

COPD

example of ASA III

exercise-induced or stress-induced asthma

example of ASA III

poorly controlled seizure disorder (more than 1 seizure/month)

example of ASA III

symptomatic hyperthyroidism or hypothyroidism

example of ASA III

patient with BP= 170-179/100-109 mmHg

example of ASA III

patient with incapacitating systemic disease that is constant threat to life

ASA IV

severe medical problem=more important than dental treatment

ASA IV

distress AT REST

ASA IV

elective dental treatment NOT indicated (until improved health)

ASA IV

unable to walk up 1 flight of stairs or 2 level city blocks

ASA IV

managment of dental emergencies = treated non-invasively if possible

ASA IV

if dental treatment is necessary-> hospital setting required

ASA IV

red flag for treatment = NO elective dental treatment

ASA IV

unstable angina pectoris

example of ASA IV

MI or CVA within the past 6 months

example of ASA IV

patient with advanced cirrhosis

example of ASA IV

adult patient with BP= greater than 180 systolic OR 110 diastolic

example of ASA IV

sever CHF or COPD = chronic O2 supplementation or wheelchair bound due to dyspnea

example of ASA IV

uncontrolled/poorly controlled seizure disorder

example of ASA IV

poorly controlled diabetes (HbA1c >9%; FBG 230mg/dL)

example of ASA IV

patient with systemic bleeding disorder

example of ASA IV

patient with impaired hemostasis due to systemic disease

example of ASA IV

patient with chronic renal failure- requiring dialysis

example of ASA IV

not expected to live 24 hours

ASA V

hospitalized, terminally ill patients

ASA V

NO elective dental treatment

ASA V

emergency dental treatment = palliative only

ASA V

red flag for treatment = do not treat

ASA V

end stage renal disease

example of ASA V

end stage liver disease

example of ASA V

terminal cancer

example of ASA V

end stage infectious disease

example of ASA V

degree of risk ... with each category

increases

ASA I, II, III patients are candidates for ...

ELECTIVE and emergency dental treatment