Carotid artery disease

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Useful Management Information

Advance health directive  (where available)
Atherosclerosis risk factor management (antihypertensive; diabetes, dyslipidemia)
Lifestyle modification (Increased activity, dietary, weight, smoking, alcohol)
It is strongly recommended that people who smoke stop before surgery as it increases the complications of surgery and is associated with delayed skin healing. Please consider directing your patient to a smoking cessation program.
Commence anti-platelet agent aspirin (clopidogrel if there is allergy or other contraindication to aspirin)
Active cholesterol and blood pressure lowering (if appropriate)
Transient Ischemic Attack definition

Minimum Referral Criteria

Category 1	Isolated Transcient Ischemic Attack (TIA)/stroke, amaurosis fugax Symptomatic internal carotid stenosis of >50% on imaging Symptomatic occluded internal carotid
Category 2	Asymptomatic internal carotid stenosis of >80% on imaging Symptomatic <50% internal carotid stenosis Symptomatic subclavian steal syndrome Asymptomatic cccluded internal carotid Carotid body tumour
Category 3	Asymptomatic internal carotid stenosis of between 50-79% on imaging
If your patient doesn't meet the minimum referral criteria If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service.

Standard Referral Information

Reason for request

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential Referral Information

Clinical history
History of TIAs (motor changes, dysarthria, ocular visual changes)
History of risk factors and management
Type/location/timing of symptoms (contralateral sensory/motor, monocular visual change)
Cardiovascular assessment
USS, duplex scan (carotid artery) results
BSL
Lipid profile
U&E
FBC & coags
Homocysteine level (HbA1C if diabetic)

If a specific test result cannot be obtained due to access, financial, religious, cultural or consent reasons a clinical override may be requested. This reason must be clearly articulated in the body of the referral.

Additional Referral Information

No additional information

Send Referrals To

Smart Referrals

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Internal Referrals

Vascular Surgery (E-Blueslip)

Fax

5687 4497

Post

Booking and Referral Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 559 083

Service Availability

Facilities

Gold Coast University Hospital

Robina Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.