Medical emergencies do not discriminate. They may occur at any time to anyone. They happen every day and may vary widely in their severity. As their name suggests, emergencies occur unexpectedly and bring about stress to the entire dental health care team. Preparation and practice are the keys to better manage medical emergencies. Understanding why medical emergencies happen, how best to prepare for them, and how to manage them efficiently as a team will help alleviate stress placed on the team during a real crisis. This chapter provides important information for the dental practitioner to aid in the diagnosis and treatment of common medical emergencies encountered in dental practices utilizing the commonly employed principles of prevention, organization, recognition, and stabilization. There is a critical window of time from when the medical emergency first begins until the emergency medical personnel arrive at the office to provide support. It is this important period of time that the dental health care team must be prepared for. They must understand how to manage the patient. The information is provided in a concise and clear manner that facilitates retention of key concepts which may be useful in a medical emergency
Introduction
This chapter provides important information for the dental practitioner to aid in the diagnosis and treatment of common medical emergencies encountered in dental practices utilizing commonly employed principles of prevention, organization, recognition, and stabilization.
There are four medical emergencies that occur most commonly in a dental practice setting. These are as follows:
These four emergencies constitute nearly 75% of all office-based medical emergencies.
Why Medical Emergencies Occur and How to Avoid Them
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Fear: Recognize that most patients do not enjoy visiting the dentist.
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Stress: Investigate strategies that will reduce patient stress (behavioral, pharmacologic).
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Allergies: Investigate adverse drug reactions and avoid using or prescribing these meds.
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Drug interactions: Develop a deeper understanding of commonly used medications in the dental office.
How can the Dental Provider Prevent Medical Emergencies?
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By evaluating the current status of each medical condition, the practitioner not only becomes more confident in managing the patient’s dental problems but also takes steps for preventing medical emergencies in the dental office.
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A complete medical history is the foundation of investigating a patient’s current health status.
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A review of the patient’s health history ought to be performed at each clinic visit to inquire about any changes in medical conditions, new diagnoses, medication changes, or new allergies.
Blood Pressure—Clinical Limitations
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It is important that each dental office have a clearly written and consistently enforced policy for dealing with elevated patient BPs.
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Patients with significantly elevated BP are at increased risk of a stroke or cardiac event.
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Patient should be referred to his/her physician as soon as possible for evaluation and management.
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If the patient is symptomatic (headache, dizziness, confusion), 911 should be called, emergency medical response should be activated, and the patient should be transported via ambulance to the nearest emergency room or stroke center.
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Blood pressure ≥ 160/100 but < 180/110
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May proceed cautiously with emergency/non-elective dental treatment if patient’s elevated blood pressure is asymptomatic.
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Consider monitoring BP during the procedure with automated noninvasive BP monitor set at regular (5- or 10-minute intervals).
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Refer patient to his/her physician for appointment within 1 month.
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Many patients have complex medical conditions and may be undergoing management with several medical doctors.
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Dental providers should be prepared to cancel treatment or postpone treatment based on uncontrolled systemic diseases (BP too high, blood sugar too high or low) even if the patient insists that he/she is okay.
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The dental provider is ultimately responsible for managing the patient during dental treatment.
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If the dental provider is not comfortable, treatment should be canceled or postponed.
Stress Reduction to Prevent Medical Emergencies
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Alleviating patient fears is instrumental in preventing common medical emergencies in the dental office.
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Taking time to establish good rapport with patients is a worthwhile investment of time. This decreases patient anxiety as the patient feels more comfortable.
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Good communication with the patient before, during, and after the appointment/procedure.
Pain Control
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Administering profound local anesthesia in appropriate doses is critical for treatment success and helps minimize anxiety and discomfort during procedures.
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The proper use of effective sedation techniques can help patients tolerate dental procedures, but not every patient is a good candidate for sedation.
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Certain medical and emotional conditions can interfere with the ability of sedation techniques to be provided in a safe and effective manner.
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A clinician needs to be trained, licensed, and/or permitted to employ certain sedation techniques.
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Consider nitrous oxide or other sedation techniques, if appropriate.