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Physical examination
Physical examination
Vital signs, including blood pressure, pulse, and respiration rate, are sometimes performed prior to procedures, though doing so is not a standard of care for outpatient dermatologic surgery procedures. Elevated blood pressure is common preprocedurally, and oftentimes is secondary to anxiety or exertion. Repeat measurements are imperative to better delineate โwhite coat hypertensionโ or exertional hypertension from more ominous conditions such as hypertensive urgency or emergency. Often, patients may abstain from their antihypertensive medications prior to surgery under the misconception that these are anticoagulants. If the patient has their medication with them, the physician may consider having them take their scheduled dose and reevaluating after 15 to 20 minutes. Hypertensive urgency is defined as blood pressure >180 mm Hg systolic and >120 mm Hg diastolic in the absence of an acute stressor. A careful review of systems for end-organ damage is necessary, and consideration of procedure abortion and referral to the emergency department is paramount.
Pulse must be evaluated for rate and regularity. Arrhythmias, like atrial fibrillation, are not uncommon in those on anticoagulants, and a determination of whether such an arrhythmia is well controlled must be made prior to surgery. New or symptomatic arrhythmia is a cause for abortion of the procedure and referral to the emergency department.
Any patient showing outward signs of other concerning and acute medical processes, such as shortness of breath, chest pain, or acute neurologic deficit, should be referred to the ED immediately.