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Da Book
Standard Operating Procedures and Notes for the Shoulder Team
Med Consult Triage List
Med Consult should see all patients with Major Clinical Predictors:
Unstable coronary syndromes
Decompensated CHF
Significant arrythmias (e.g. ventricular tachycardia)
Severe valvular disease
Med Consult should see all patients with Intermediate Clinical Predictors:
Mild angina pectoris
Prior MI
Compensated or prior CHF
Diabetes Mellitus
Renal insufficiency
Med Consult also sees people on warfarin (Coumadin) therapy
Patients with Minor Clinical Predictors may be seen as space is available:
Advanced age
Abnormal ECG (does not include trivial computer read abnormalities)
Rhythm other than sinus
Low functional capacity
History of stroke
Uncontrolled systemic hypertension (if truly uncontrolled and on multiple meds)
Med Consult does not need to see patients with none of the above conditions unless there are special circumstances that should be discussed with the consulting physician beforehand.
Med Consult wants to serve us and our patients in the best possible way. The above evidence based criteria will help to sort out which patients are most in need of medical consultation.
If you would like to look further into the actual need for a medicine consult per the ACC and AHA guideline, then please review the following article:
Major
Unstable coronary syndromes
- Acute or recent (within 1 month) myocardial infarction with evidence of important ischemic
risk by clinical symptoms or noninvasive study- Unstable or severe angina (Canadian class III or IV)
Decompensated heart failure
Significant arrhythmias
- High-grade atrioventricular block
- Symptomatic ventricular arrhythmias in the presence of underlying heart
disease- Supraventricular arrhythmias with uncontrolled ventricular rate
Severe valvular disease
Intermediate
Mild angina pectoris (Canadian class I or II)
Previous myocardial infarction by history or pathological Q waves
Compensated or prior heart failure
Diabetes mellitus (particularly insulin-dependent)
Renal insufficiency
Minor
Advanced age
Abnormal ECG (left ventricular hypertrophy, left bundle-branch block, ST-T
abnormalities)
Rhythm other than sinus (e.g., atrial fibrillation)
Low functional capacity (e.g., inability to climb one flight of stairs with a
bag of groceries)
History of stroke
Uncontrolled systemic hypertension
Most orthopedic surgeries are intermediate risk and arthroscopic may be considered low surgical risk.
Estimated Energy Requirements for Various Activities
1 MET Can you take care of yourself?
Eat, dress, or use the toilet?
Walk indoors around the house?
Walk a block or two on level ground at 2 to 3 mph or 3.2 to 4.8 km per h?4 METs Do light work around the house like dusting or washing dishes? Climb a flight of stairs or walk up a hill?
Walk on level ground at 4 mph or 6.4km per h?
Run a short distance?
Do heavy work around the house like scrubbing floors or lifting or moving heavy furniture?
Participate in moderate recreational activities like golf, bowling, dancing, doubles tennis, or throwing a baseball or football?
Greater than 10 METs Participate in strenuous sports like swimming,
singles tennis, football, basketball, or skiing?MET indicates metabolic equivalent.
Adapted from the Duke Activity Status Index and AHA Exercise Standards.
