Basic Guide to Medical Emergencies in the Dental Practice

Philip Jevon

• Publisher: Wiley
• Year: 2014
• Print ISBN:
  9781118688830
• eBook ISBN:
  9781118688816
• Edition: 1
• Topic: Medicine
• Subtopic: Dentistry

The Basic Guide to Medical Emergencies in the Dental Practice is a must-have book for all dental care professionals and general dentists.

Written in a clear and accessible style, this second edition has been fully revised and updated in line with the latest guidelines. Chapters cover such key topics as the ABCDE approach to patient assessment, resuscitation equipment, respiratory and cardiac disorders, paediatric emergencies, and legal and ethical issues. Readers will also find two brand new chapters on the principles of first aid, and drugs for medical emergencies.

• Follows Resuscitation Council (UK) Guidelines
• Companion website with self-assessment exercises, serving as revision as well as non-verifiable CPD credit
• Over 50% new images
• Student friendly colourful layout with learning outcomes

Chapter 1
An overview of the management of medical emergencies and resuscitation in the dental practice

INTRODUCTION

Every dental practice has a duty of care to ensure that an effective and safe service is provided for its patients (Jevon, 2012). The satisfactory performance in a medical emergency or in a resuscitation attempt in the dental practice has wide-ranging implications in terms of resuscitation equipment, resuscitation training, standards of care, clinical governance, risk management and clinical audit (Jevon, 2009).

The Resuscitation Council (UK) (2013) has updated its standards for clinical practice and training in resuscitation for dental practitioners and dental care professionals in general dental practice. All members of the dental team need to be aware of what their role would be in the event of a medical emergency and should be trained appropriately with regular practice sessions (Greenwood, 2009).

The aim of this chapter is to provide an overview of the management of medical emergencies and resuscitation in the dental practice.

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LEARNING OUTCOMES

At the end of the chapter the reader will be able to:

• Discuss the concept of the chain of survival
• Discuss the incidence of medical emergencies in the dental practice
• Outline the General Dental Council guidelines on medical emergencies
• Summarise the Resuscitation Council (UK) standards
• Discuss the principles of safer handling during cardiopulmonary resuscitation (CPR)
• Outline the procedure for calling 999 for an ambulance
• Discuss the importance of human factors and teamwork in a medical emergency

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CONCEPT OF THE CHAIN OF SURVIVAL

Survival from cardiac arrest relies on a sequence of time-sensitive interventions (Nolan et al., 2010). The concept of the original chain of survival emphasised that each time-sensitive intervention must be optimised in order to maximise the chance of survival: a chain is only as strong as its weakest link (Cummins et al., 1991).

The chain of survival (Figure 1.1) stresses the importance of recognising critical illness and/or angina and preventing cardiac arrest (both in and out of hospital) and post-resuscitation care (Nolan et al., 2006):

• Early recognition and call for help to prevent cardiac arrest: this link stresses the importance of recognising patients at risk of cardiac arrest, dialling 999 for the emergency services and providing effective treatment to hopefully prevent cardiac arrest (Nolan et al., 2010); patients sustaining an out-of-hospital cardiac arrest usually display warning symptoms for a significant duration before the event (Müller et al., 2006).
• Early CPR to buy time and early defibrillation to restart the heart: the two central links in the chain stress the importance of linking CPR and defibrillation as essential components of early resuscitation in an attempt to restore life. Early CPR can double or even triple the chances of a patient surviving an out-of-hospital ventricular fibrillation (shockable rhythm) induced cardiac arrest (Holmberg et al., 1998, 2001; Waalewijn et al., 2001).
• Post-resuscitation care to restore quality of life: the priority is to preserve cerebral and myocardial function and to restore quality of life (Nolan et al., 2010).

Figure 1.1 Chain of survival. Source: Laerdal Medical Ltd, Orpington, Kent, UK. Reproduced with permission.

INCIDENCE OF MEDICAL EMERGENCIES IN DENTAL PRACTICE

The incidence of medical emergencies in dental practice is very low. Medical emergencies occur in hospital dental practice more frequently, but in similar proportions to that found in general dental practice (Atherton et al., 2000). With the elderly population in dental practices increasing, medical emergencies in the dental practice will undoubtedly occur (Dym, 2008).

A literature search for published surveys on the incidence of medical emergencies and resuscitation in the dental practice found the following.

Survey of dental practitioners in Australia

A postal questionnaire survey of 1250 general dental practitioners undertaken in Australia (Chapman, 1997) found that:

• one in seven (14%) had had to resuscitate a patient;
• the most common medical emergencies encountered were adverse reactions to local anaesthetics, grand mal seizures, angina and hypoglycaemia.

Survey of dentists in England

A survey of dentists (Girdler and Smith, 1999) (300 responded) in England found that over a 12-month period they had encountered:

• vasovagal syncope (63%) – 596 patients affected;
• angina (12%) – 53 patients affected;
• hypoglycaemia (10%) – 54 patients affected;
• epileptic fit (10%) – 42 patients affected;
• choking (5%) – 27 patients affected;
• asthma (5%) – 20 patients affected;
• cardiac arrest (0.3%) – 1 patient affected.

Survey of dental practitioners in a UK university dental hospital

Atherton et al. (2000) assessed the frequency of medical emergencies by undertaking a survey of clinical staff (dentists, hygienists, nurses and radiographers) at a university dental hospital. The researchers found that:

• fainting was the commonest event;
• other medical emergency events were experienced with an average frequency of 1.8 events p...

Table of contents

• Cover
• Title Page
• Copyright
• Foreword
• Acknowledgements
• About the companion website
• Chapter 1: An overview of the management of medical emergencies and resuscitation in the dental practice
• Chapter 2: Resuscitation equipment in the dental practice
• Chapter 3: ABCDE: Recognition and treatment of the acutely ill patient
• Chapter 4: Respiratory disorders
• Chapter 5: Cardiovascular disorders
• Chapter 6: Endocrine disorders
• Chapter 7: Neurological disorders
• Chapter 8: Anaphylaxis
• Chapter 9: Cardiopulmonary resuscitation in the dental practice
• Chapter 10: Airway management and ventilation
• Chapter 11: Automated external defibrillation
• Chapter 12: Paediatric emergencies
• Chapter 13: An overview of emergency drugs in the dental practice
• Chapter 14: Principles of first aid in the dental practice
• Chapter 15: Professional, ethical and legal issues
• Index