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Green flag for treatment 2 Mild to moderate systemic disease, medically well controlled, with no functional limitation Can walk up one flight of stairs or two level city blocks but will have to stop after completion of the exercise because of distress ASA I with extreme anxiety and fear, a respiratory condition, pregnancy or active allergies Well controlled disease states including diabetes, hypertension, obesity, epilepsy, asthma or thyroid conditions Minimal risk

Yellow flag for treatment 3 Severe systemic disease that results in functional limitation Can walk up one flight of stairs or two level city blocks but will have to stop enroute because of distress History of angina pectoris, MI, CVA; HF >six months ago, COPD, diabetes with vascular complications, poorly controlled HTN, morbid obesity

Yellow flag for treatment 4 Severe incapacitating disease process that is a constant threat to life Unable to walk up one flight of stairs or two level city blocks. Distress is present even at rest. History of unstable angina, MI or CVA within last six months; severe HF, severe COPD; uncontrolled diabetes, HTN, epilepsy or thyroid condition Advanced pulmonary, renal or hepatic dysfunction The risk may be too great for elective surgical procedure Medical consultation needed for emergency treatment

Red flag for treatment 5 Moribund patient not expected to survive 24 hours without an operation Ruptured abdominal aneurysm, pulmonary embolus, head injury with increased intracranial pressure Elective treatment is contraindicated; however, emergency surgery may be necessary

Red flag for treatment 6 A declared brain-dead patient being maintained for harvesting of organs E Suffix to indicate emergency surgery for any class Any patient in whom an emergency operation is required Otherwise healthy young woman requiring D&C for persistent vaginal bleeding MI: myocardial infarction; CVA: cerebrovascular accident; HF: heart failure; HTN: hypertension; D&C: dilation and curettage. Adapted from: Cohen MM, Duncan PG, Tate RB. Does anesthesia contribute to operative mortality? JAMA 1988; 260:2859 and Malamed SF. Medical Emergencies in the Dental Office, Sixth Edition, Mosby Elsevier, St Louis 2007.